Exploring the association between sleep and fear extinction learning in adolescents with anxiety and/or OCD: a study protocol.

Pediatric anxiety disorders (including Obsessive Compulsive Disorder) are prevalent and impairing. Youth with anxiety disorders frequently experience sleep disturbances. Exposure, the primary component of gold-standard Cognitive Behavioral Therapy (CBT) for treating anxiety disorders, works by harnessing fear extinction learning. Given that sleep plays a critical role in the consolidation and retrieval of emotional memories, we hypothesize that shorter sleep quantity and greater sleep disruption are associated with psychophysiological responses indicating reduced fear extinction learning and reduced fear extinction recall in adolescents with anxiety and OCD. In this protocol paper, we describe a pilot study testing this hypothesis in a clinical sample of adolescents participating in a CBT-based partial hospital program (PHP) dedicated to the treatment of anxiety disorders. Participants complete a multi-method sleep assessment over 10 days during the first portion of their admission in the program (within the first 4 weeks) and at the end of their stay (at least over 5-7 days before discharge). Standardized clinical interviews and sleep questionnaires are coupled with multi-modal at-home sleep monitoring using sleep diaries, patch-based actigraphy, and wearable sleep electroencephalography (EEG). Participants also complete a computerized task assessing initial fear learning (day 1), fear extinction learning (day 2), and extinction recall (day 3) as measured by skin conductance responses (SCR). This use of multi-method sleep assessments in a clinical sample of youths with more clinically severe anxiety disorders is innovative and, to our knowledge, has not yet been done.