Perturbations in observational threat learning predict anxiety symptoms in war-exposed adolescents: A longitudinal study

Exposure to war and terrorism presents a significant, global mental health challenge. Such adverse events give rise to extreme stress, resulting in widely varying psychological outcomes, from minimal impact to severe anxiety and related symptoms. Adolescence, a developmental period marked by an increased prevalence of anxiety disorders, may render individuals particularly vulnerable to the psychological consequences of war. Identifying biomarkers predicting risk is critically important for early detection and intervention efforts. Considerable research examines the role of variation in firsthand (direct) threat learning processes in the emergence of enduring anxiety symptoms, highlighting potential learning-related biomarkers. However, observational (vicarious) threat learning, whereby individuals learn about potential dangers by observing others’ responses, has received limited attention. This longitudinal study examined whether observational threat acquisition and its generalization predicted subsequent anxiety symptom severity in 65 adolescents approximately one year later during exposure to acute war-related stress. At baseline, we assessed observational learning of safety and threat associations and their subsequent generalization, using psychophysiology and cognitive indices, alongside generalized anxiety disorder (GAD) symptoms. Approximately one year later, six weeks into the Israel-Hamas war (2023), GAD symptoms were reassessed. Results showed difficulty in adapting threat responses across contexts with varying threat levels, and cue overgeneralization, as measured in the laboratory, predicted elevated GAD symptoms during the war. These findings suggest difficulties in the adaptation and generalization of observational threat learning may increase vulnerability to anxiety during times of acute stress, highlighting its potential as an early risk marker.