Lindsey Younkins
Empirical Report
10/13/2013
Report on the Relationship between Fear and Anxiety
It has been established through past research studies that fearful temperament is a risk
factor for developing anxiety disorders, however the factors that mediate the relationship
between fearful temperament and anxiety disorders have not yet been established. In the
examined article, the author attempts to explain the role of context in the development of a
dysregulated fear response (Buss, 2011). Using a prospective longitudinal design, the author
examines how toddlers respond to multiple low-threat situations and predicts that toddlers whom
exhibit high fear response across situations will be more likely to show higher levels of anxiety
when measured upon kindergarten entry.
The sample was composed of 111 male and female, predominantly white, middle class
children from intact families, between the ages of 18 and 30 months at first measurement. The
experimenter compiled a ‘low-risk’ sample to control for other risk factors of anxiety disorders
such as poverty and parental divorce. To test the hypothesis that fearful behavior in low-threat
situations is a risk factor for developing anxiety disorders, the experimenter designed several
scenarios that are mildly fear provoking, to gauge how the toddler would respond to strangers,
unfamiliar objects, novel activities, and new social situations. Each toddler was subjected to
twelve situations in a randomized order; five of which were designed to elicit positive emotions
(such as free play with toys), and seven of which were designed to be mildly threatening and
provoke fear behaviors (such as being approached by a stranger). Behavior was analyzed
second by second in order to accurately measure fear and sadness in both behavior and emotional
expression. Fearful behaviors were defined as freezing, diminished play, and withdrawal
behaviors. Sad behaviors were defined as shoulder slumping, head bowing, and crying. Fearful
expression was defined as brows raised and drawn together, eyelids raised or tense, and mouth
open with corners pulled back. Sad expression was defined as brows raised at inner corners and
lowered at outer corners, eyes narrowed, cheeks raised, and corners of the mouth pulled down or
out. Behavior was analyzed for both duration (how long the behavior lasted) and latency (how
long it took for the behavior to occur). In addition to the lab visit, mothers completed the Infant
Toddler Social and Emotional Assessment at ages two and three. The author examined the items
designed to assess general anxiety, separation anxiety, depression, withdrawal, and inhibition to
novelty. At age four, mothers were asked to complete a Child Behavior Check List in order to
assess behavioral and emotional problems present in the past six months, and given the
hypothesis the author focused on the internalizing aspect of the measure. Upon kindergarten
entry, both mothers and teachers were asked to complete the internalizing dimension of the
MacArthur Health and Behavior Questionnaire, with items designed to assess depression, overanxiousness, separation anxiety, social withdrawal, and social inhibition. Consequent to
conducting statistical analysis, the author determined if the toddlers that exhibited a dysregulated
fear response also exhibited anxiety symptoms in kindergarten.
In order to determine which toddlers displayed high fear in low-threat situations, the
researcher first ordered the fear-provoking situations into three categories; high threat (where
children were exposed to a motorized robot and spider), moderate threat (where one stranger
approached the child and another stranger worked passively in the same room), and low threat
(where children were exposed to a puppet show and a clown). The author defined high fear as
scoring one standard deviation above the mean for fearful behavior and emotional expression
and found that there was a small proportion of toddlers that exhibited high fear throughout all
situations, noting that these toddlers exhibited high fear in the low threat situations. The author
used a combination of three approaches to isolate the toddlers who demonstrated high fear across
situations including the process described above, Latent Profile Analysis to identify the high-fear
group, and identification of the toddlers that showed little or no increase in fear as threat
increased. There were eight toddlers identified that fell into all three categories. To determine
the association between fearful temperament at age two and anxiety at age five, the researcher
ran an analysis of variance between each extreme group classification. The researcher found that
toddlers that exhibited high-fear in low-threat situations later exhibited high anxiety scores at age
five, which supports the hypothesis. Interestingly, toddlers who exhibited high-fear in highthreat situations had insignificant anxiety scores when measured at age five, again supporting the
authors hypothesis that it is not important how much fear is expressed, but the situations in
which fear is expressed that later predicts anxiety.
The results implicate that the inability to regulate fear across contexts is a risk factor for
developing an anxiety disorder. This research can be used to identify children with a greater risk
of developing an anxiety disorder by determining which toddlers exhibit high fear in low-threat
situations. The examined study could be extended by continuing research on the sample as they
progress through school, to determine whether or not their anxious behaviors are persistent. By
continuing to measure this sample of children throughout their education, there may be
presenting evidence that anxiety symptoms diminish as the child progresses through school. It
could be that the anxiety reported in the beginning of kindergarten was due to difficulties with
school adjustment, and that these children merely need more time to adjust than their peers, thus
appearing more anxious.
By measuring the children again, further into their education, we can
determine if their anxiety is related to fearful temperament or if it is merely due to difficulties
with school adjustment. In the discussion, the author brought up another point that warrants
further research; the fear and anxiety expressed for some of the children may only be elicited by
social situations. Many of the situations that the toddlers were exposed to involve a social theme
designed to prompt the child towards interaction, and social withdrawal was a feature component
on the MacArthur Health and Behavior Questionnaire used by parents and teachers after
kindergarten entry. It is a possibility that social competency moderates the relationship between
fearful temperament and anxiety, meaning that if social competencies are present despite a
fearful temperament, the child will show lower anxiety symptoms later in life. Alternatively, the
lack of social competencies may put a child with fearful temperament at greater risk for the
development of an anxiety disorder. This research study, like all others, is not without its
limitations. The ‘low-risk’ sample comes with the cost of low generalizability. The author
chose to conduct this study on a sample seemingly free of risk factors for anxiety disorders
(poverty, parental divorce) but by doing so made the results less applicable to the general
population. Additionally, anxiety symptoms displayed after entering kindergarten were based on
parent and teacher reports, and therefore may be more subjective and less accurate than a
clinician’s perspective. Despite these limitations, the researcher found evidence to support that a
dysregulated fear response, shown by high fear in low-threat situations, is a risk factor for the
developing an anxiety disorder.
Based upon the discussed results, it can be hypothesized that anxiety disorders develop
due to a maladaptive fear response across contexts. Robert Weis stated in his text that fear is a
component of anxiety, so it is plausible that the inability to regulate fear could lead to the
development of an anxiety disorder (2008, p. 448). It was also stated that anxiety disorders are
the most frequently given diagnosis in children and adolescents, and currently about five percent
of all youth are afflicted with an anxiety disorder. This high prevalence should serve as a call to
action; more research is needed to better understand the causes of anxiety disorders and validate
the effectiveness of interventions. The results from this study cannot only be used for early
identification of at risk toddlers, but also form a foundation for further research. This study
could inspire researchers to conduct a quasi-experimental study to gather more information on
the etiology of anxiety disorders. This study could also facilitate the development and evaluation
of efficacious treatments. The results can be applied to interventions by focusing on correcting
maladaptive emotional regulation by teaching children to restructure their cognitions and
appropriately re-label their emotions. By outlining a developmental trajectory of anxiety
disorders, this study provides information applicable to interventions and further research.
References
Buss, K.A. (2011). Which fearful toddlers should we worry about? Context, fear, regulation, and
anxiety risk. Developmental Psychology, 47(3), 804-819.
doi:http://dx.doi.org/10.1037/a0023227
Weiss, R. (2008). Abnormal child and adolescent psychology. Thousand Oaks, California:
Sage Publications.