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Hilary Swank reveals how she kept her pregnancy at 52 a secret
Hilary Swank says it wasn’t that difficult to keep her third pregnancy a secret thanks to people in her life being so ‘respectful of my privacy.’
Hilary Duff defends her mother Susan after Frankie Muniz called her a 'super intense’ stage mom during the 'Lizzie McGuire' days
Hilary Duff defends mother Susan after Frankie Muniz labeled her ‘super intense’ stage mom: ‘I was never pushed into acting.'
There’s new ‘toxic mom group’ drama starring Ashley Tisdale and Hilary Duff’s husband
Beef looks a little different these days for some teens stars from the early 2000s.
Hilary Swank addresses ‘backlash’ over pregnancy at 52: ‘You’re too old’
Meanwhile, she said men don’t receive the same criticism.
Hilary Duff to perform in Hershey next year; here are the details
Beloved early 2000s actor and pop singer Hilary Duff recently announced that she would extend her "The Lucky Me Tour," adding a Hershey stop among 31 other dates.
Hilary Duff on feuding with Lindsay Lohan, the 'toxic' mom group drama and more: 4 things we learned from her 'Call Her Daddy' interview
Duff makes one thing abundantly clear, though: Life has certainly been life-ing, and she's grateful to her fans for sticking by her more than 20 years later.
‘Everybody Watches’: TIME100 Sports Honorees on Red Carpet Celebrate Rise of Women’s Sports
Eileen Gu, Hilary Knight, and Trinity Rodman spoke to TIME on the red carpet of the inaugural TIME100 Sports Gala.
Didn’t get Hilary Duff ‘Lucky Me Tour’ tickets? Here’s where you can still buy them
Entertainment shows, tickets and streaming
US women's hockey team beats Canada 4-1 in Edmonton to sweep Rivalry Series
Hilary Knight scored twice in the third period and the U.S. women's hockey team beat Canada 4-1 on Saturday night to sweep the four-game Rivalry Series.
Photos: Seattle welcomes home gold medal Torrent Olympians with record-breaking attendance
KOMO 4 TV provides news, sports, weather and local event coverage in the Seattle, Washington area including Bellevue, Redmond, Renton, Kent, Tacoma, Bremerton, SeaTac, Auburn, Mercer Island, Bothell, Shoreline, Lynnwood, Mill Creek and Everett.
AMAs 2026 red carpet: Best and worst looks celebrities wore
Hilary Duff, Karol G, and Teyana Taylor were among the stars who attended the 2026 American Music Awards and walked the red carpet in bold fashion.
Must've been 'luck... or something': Hilary Duff debuts in the top 10
Comeback complete: Hilary Duff's back in the top 10.
Hilary Holley dominates HD 51 Special Election, will replace Josie Tomkow
Holley had both a fundraising advantage and more institutional support.
Hilary Swank, 52, pregnant with third baby
“A lot of people have been asking what project I’m doing next,” the actress captioned her Instagram announcement.
NI health: Burrows defends Nesbitt decision to halt puberty blockers trial
Northern Ireland's participation in the trial was reported last week in a review of Northern Ireland's gender identity services carried out by Dr Hilary Cass.
SGMC Health Announces Hilary Gibbs as Senior Vice President and Chief Administrative Officer
SGMC Health is pleased to announce Hilary Gibbs will assume the role of Senior Vice President and Chief Administrative Officer.
UCare paid CEO $1.28M during collapse, including a bonus
Hilary Marden-Resnik and a dozen top executives received incentive compensation last year as the nonprofit health insurer staggered toward its demise.
Good science requires much more than evidence
Empiricists believe that scientific theories are true only if they make correct empirical predictions: if we can't verify these predictions, then there is no reason to expect that they tell us anything about reality. However, Professor of Philosophy at King's College David Kyle Johnson argues that this is mistaken. In response to Bas van Fraassen, who has written on this subject for the IAI, he argues that we have many reasons for believing a theory to be true, such as it being parsimonious and having large scope — qualities which have been used throughout the history of science as criteria for judging theories. In 2024, Princeton philosopher Bas van Fraassen wrote a short article for IAI News entitled “Science Does not Describe Reality: The Limits and Benefits of Explanation.” At the time, I was working on two projects (a science book and a Great Course) that, when completed, would (among other things) defend science’s ability to describe reality. I wanted to write a response to van Fraassen, but the projects demanded too much of my attention. But now that those projects are complete, I am in a position to explain the objections to van Fraassen’s thesis. Summarizing van Fraassen’s argumentIn a nutshell, his argument is this: What scientists do is make predictions based on theories and then invite others to test to see whether those predictions are borne out. “If theory T is right, result R should happen in experimental condition C.” Many think that running an experiment that shows that R happens in condition C is proof that theory T is true (and should be believed). But, van Fraassen argues, that R happened in condition C is only a reason to think that R happens in condition C. That’s the only observable, or empirical, result we can actually see, so that is all that we are really justified in believing. (The underlying theory that made that prediction still may or may not be true.) That is why he calls those who accept his position “empiricists.”Before I explain what is wrong with this position, let me explain what it gets right. What van Fraassen Gets RightFirst, a theory correctly predicting the results of an experiment is not, strictly speaking, “proof” that the theory is correct. The basic line of reasoning is this:If the theory T is true, result R should happen. Result R did happen. Thus, theory T is true.In other words:“If T then R. R. Thus, T.”This is a deductively invalid, fallacious mode of reasoning, called “affirming the consequent.” Those premises do not guarantee that the conclusion follows. “If I am in Pennsylvania, then I am in the USA. I am in the USA. Thus, I am in Pennsylvania.” Clearly that argument doesn’t guarantee its conclusion; neither does the above argument.However, science is not a deductive method of reasoning; it is an inductive one. And inductive arguments merely try to raise the probability of their conclusion, not “prove” them for certain. Thus, the fact that an experimental result doesn’t prove a theory is true is irrelevant; it’s not supposed to. That is not what scientific reasoning is about.___If the hypothesis that something exists clearly provides the best explanation for what we can observe, then the belief that it exists is what is rational.___Second, it’s also true that a single experimental result doesn’t provide enough justification to believe that a theory is true. Scientists do not come to a consensus about whether a theory is true by looking at a single experiment; they look at all the evidence to determine where the preponderance of evidence points. The mere fact that I am in the USA raises the probability that I am in Pennsylvania, but not nearly enough to conclude that I am in Pennsylvania. However, if I am also regularly encountering people wearing Eagles and Phillies hats and seeing advertisements for Founding Father tours, I probably am. In the same way, a theory successfully predicting the outcome of one experiment is not enough to conclude that it is true; but if a theory makes a wide variety of predictions that are all vindicated by multiple experiments, performed by many different groups and people, all actively trying to prove the theory false (which is what good scientific experiments are designed to do)—that is a good reason to conclude that the theory is true. In other words, if you repeatedly try to prove something false but can’t, that is a very good indication that it isn’t. The problem of underdeterminationIn reply, those whom van Fraassen calls “empiricists” often point to the “problem of underdetermination.” For any given theory that makes successful predictions about what happens in experimental conditions, there are countless other possible theories that make exactly the same predictions—and since they do, the experimental evidence in question is just as much reason to accept any of those theories as it is to accept our original one. Thus, the argument goes, we have no way of knowing whether our original theory is true, or one of the other “predictively equivalent” theories is true. SUGGESTED VIEWING How Occam's Razor changed the world With Johnjoe McFadden As an example of underdetermination, philosophers often offer this example. The evidence of fossils seems to provide reason to conclude that the universe is quite old; ancient fossils are what the “ancient universe” hypothesis predicts. But it’s also possible that God created an ancient-looking universe 200 years ago, complete with a “fake” fossil record for us to find, to make it look old. The existence of fossils is what that theory predicts too. So, the argument goes, the fossil record can’t be used as evidence that the universe is ancient; the fossil record supports the “200-year-old ancient-looking universe” theory just as much. The problem of underdetermination points out that, for any theory with supporting evidence, we could invent another completely different theory that predicts exactly the same evidence, and thus undermine that evidence’s ability to support the original theory.But this “argument from underdetermination” betrays a fundamental misunderstanding of what scientific reasoning is and how it works. To explain, let me use another rather strange (but very real and commonly discussed) philosophical thought experiment called “The Grue Problem.” The “Grue” ProblemSuppose I want to know what color emeralds are, so I observe a few, see that they all appear green, and form the theory that “all emeralds are green.” I thus predict that the next 100 emeralds I find will also appear to be green. And let’s say that happens, and so I thus conclude that my theory that all emeralds are green is true. Now, one might rightly point out that I don’t know for sure that all emeralds are green—I have not seen them all. Maybe some I haven’t found yet are blue. Fair enough. After all, we used to think that all swans were white, until we found some black ones. But let’s say that I go on a quest and collect every emerald in the universe—and, for the sake of the argument, let’s say I can do this, and can even know that I have every one of them. So, I collect them all, look at them all, and verify that they all appear green. Can’t I now rightly conclude that all emeralds are green?Inspired by the problem of underdetermination, a friend might argue that I cannot.Sure, they all appear green now—but there could be another kind of color called “grue.” Something is grue if it is green up to a certain point in time, but then spontaneously turns blue. And there could be an infinite number of “shades” of grue. Something that is one shade of grue will turn blue at noon today, but something that is another shade of grue will turn blue at noon tomorrow, etc. So yes, the emeralds appear green now; and since they haven’t turned blue yet, they are not some “past” shade of grue. But they might be some “future” shade of grue (e.g., they may turn blue at noon tomorrow). And since all future shades of grue are consistent with “being green up to this point in time,” the evidence you have is completely consistent with the notion that all emeralds are some future shade of grue, rather than green. Indeed, that they would appear green until now is what the “some future shade of grue” hypothesis predicts. So, we have just as much reason to conclude that all emeralds are some shade of grue as we do to conclude that they are green.You’re probably thinking “It’s not equally possible that the emeralds are grue; they are obviously green.” You are right! But explaining why your instinctive reaction to my friend’s argument is correct will help inform why van Fraassen’s “empiricist” is wrong and science actually does describe reality.The main mistake my friend makes is in thinking that the “empirical evidence” (of all the emeralds appearing green) is (or even should be) all I am using to draw the conclusion that all emeralds are green. It is not. I am also considering known facts about how colors typically work; things don’t usually change color, and when they do, they don’t do so suddenly, without cause, and all at once. So, even though the simple evidence of the emeralds all appearing green up to this point is consistent with them being some future shade of grue—that is even what the grue hypothesis “predicts”—it is still exceedingly unlikely that they are. The hypothesis that they are green is much more likely. Understanding science refutes the problem of underdetermination The misunderstanding about science that the “empiricist” pointing to “the problem of underdetermination” makes is similar to the one that my friend made. Science is not just about considering experimental evidence; in fact, it’s not even just about considering empirical evidence. As Ernan McMullin and many other philosophers of science have pointed out, the inference that makes science is “inference to the best explanation” (sometimes called “abduction” or “retroduction” by McMullin). While, depending on the circumstances, scientists use many different kinds of reasoning, science as a whole is, simply put, the process of considering multiple competing explanations and comparing them to certain criteria—explanatory criteria (the kinds of things explanations must be and do, by definition, to be a good explanation)—to see which explanation is the best.And these criteria do not deal only with empirical results. Yes, successful predictions raise the probability of a hypothesis, but it’s also the case that the more new assumptions a theory makes, the less likely it is to be true; every new assumption presents an opportunity for the theory to be false. (The fewer assumptions a theory makes, the simpler or “more parsimonious” it is said to be.) Likewise, the more existing evidence a theory contradicts, the less likely it is, because in order for a theory to be true, every piece of evidence it contradicts has to be somehow faulty. (The fewer established theories a new theory contradicts, the more “conservative” it is said to be.) And, obviously, the more something explains, the better explanation it is. (This is called having “scope.”) If a theory raises unanswerable questions, it’s not expanding our understanding, and thus is not wide-scoping. Scientists consider all these things when deciding which theory to accept, because the theory that adheres best to these explanatory criteria is most likely to be true.___the mere fact that a theory’s predictive success is why it “sticks around” or “becomes accepted” in the scientific community is not a reason to be skeptical about its truth.___The reason the grue hypothesis is no good is because it invents an entirely new kind of color—not just a new shade, but an entirely different category of color (a different way colors work)—and thus is not parsimonious. It raises unanswerable questions about how and why emeralds would just spontaneously change from green to blue (and thus does not have wide scope). And it contradicts what is already well established about how color works (and thus is unconservative).The theories that the problem of underdetermination points to do the same thing. Yes, the theory that God created an “ancient-looking universe” (complete with an ancient-looking fossil record) two hundred years ago is also consistent with the empirical evidence (of a fossil record) that presently exists; but that theory is monumentally unparsimonious (it requires many extra assumptions about infinite entities) and not wide-scoping (it raises unanswerable questions about why God would do such a thing). So, I can rationally conclude that it is false.Indeed, the history of science includes many examples of theories that were rejected because they lacked parsimony and/or scope, even before their falsity (and the truth of their competing theory) was confirmed by observation. As I point out in my book, geocentrism was rejected by the scientific community because it lacked parsimony, almost 200 years before the observation of parallax confirmed that the Earth moves around the sun. And the continuum theory of matter was completely rejected by 1860, because it couldn’t explain chemical reactions or organize matter into a periodic table, even though the experiments that eventually confirmed atomic theory weren’t even proposed until the 1870s. Solving the best of a bad lot problemIn response, the “empiricists” are likely to object, this time pointing to the “best of a bad lot” problem. “We have no reason to conclude that an explanation that has been shown to be better than others is true because we have no guarantee that the true theory was among those that we were considering.” If you have a “lot” (a collection) of poor explanations, even the best one is not true.The responses to this problem, however, are numerous. Peter Lipton argues that the set of hypotheses that scientists consider are not just randomly selected and thus unlikely to contain a theory that is true; they use existing knowledge to home in on what is most likely to be true. A doctor trying to explain abdominal pain is not going to bother wondering whether demons are causing it; they are going to stick with things like appendicitis and kidney stones, because they are most likely. Further, despite its name, inference to the best explanation is not just the process of comparing hypotheses and accepting the best one; we also want one that is a good explanation in its own right. If it’s not, we are going to keep looking until we find an explanation that is. And while that process does not guarantee that we will come across the exact truth, it’s very likely that the theory that emerges as the best will be at least approximately true, and thus we will be justified in believing it. And lastly, as I point out in my book, although many theories not based in scientific evidence (like geocentrism and continuum theory) have been completely overturned, science almost always progresses by the refinement of scientifically established theories—not their replacement. (Although our sun is not the center of the universe, heliocentrism was our first step in understanding the Earth’s true place in the universe.) So even if a theory we accept today may not be completely right, accepting it is a step on the journey toward the complete truth. The example of atomic theoryNow, it’s worth pointing out that most empiricists are not skeptical of all scientific theories; they are only skeptical of the ones that hypothesize the existence of “unobservables.” It’s not like they think that round Earth, heliocentrism, and germ theory are just useful (but untrue) “instruments” for making predictions about how to most efficiently navigate the seas, predict planetary motion, and treat diseases. They admit that the Earth actually is round, that the planets revolve around the sun, and that germs exist and cause disease. These facts and entities can be observed; the theories that suggest they exist are true. It’s only when theories start hypothesizing the existence of unobservables—like electrons, or quantum fields—that can’t be observed directly, that we should start doubting the theories’ truth. And to be fair to van Fraassen, in this published work, he doesn’t really say that we should doubt the truth of such theories. Only that scientific reasoning does not rationally force us to accept them as true. Skepticism, or agnosticism, he argues, is warranted. SUGGESTED READING Science is based in metaphor By Andrew Reynolds But the history of atomic theory throws a monkey wrench into that argument. Atoms used to be unobservable; again, scientists first accepted the theory that they exist because it had such grandiose explanatory power. But then atoms were seen with electron microscopes. They thus moved into the category of the observable. But this didn’t substantially change anything about what scientists were justified in believing; it certainly didn’t change any “atomic skeptics’” minds. It just confirmed what everyone already knew! If the hypothesis that something exists clearly provides the best explanation for what we can observe, then the belief that it exists is what is rational. The fact that the thing itself is not technically observable does not make doubting its existence rational.What’s more, the atoms were seen with an electron microscope. But electrons are themselves unobservable. How can an electron microscope reveal an atom if electrons are not real? This leads us to what is famously known as Hilary Putnam’s “miracle argument.” It’s (not) a miraclePhilosopher Hilary Putnam’s miracle argument is somewhat famous. Basically, he argued that a scientific theory being able to repeatedly make successful predictions—even about unobservables—without being at least approximately true would require a “miracle.” In other words, it would be such an improbable occurrence that it could not rationally be believed—the better explanation for why scientific theories about unobservables make the right predictions is because the unobservable entities and structures they hypothesize exist.Van Fraassen has addressed this argument. Indeed, in his original article, where he references Alison Gopnik’s point about orgasms not being “necessary for procreation” even though the desire for orgasm “drives the creation of progeny,” he is pointing to his own argument about how organisms are not naturally selected by evolution to get true beliefs; to the extent that belief-forming processes are selected for, the ones that are selected are the ones that are useful for survival—not the ones that produce true beliefs. In the same way, van Fraassen argues, scientific theories are accepted, not because they are true, but because they aren’t falsified; they make successful predictions; that’s what makes them “stick around.” So, the fact that they make successful predictions (and thus became accepted) is not a reason to think they are true.This argument is similar to C. S. Lewis’s “argument from reason,” which he used to argue against evolution: “The truth of evolution undercuts our ability to know that it is true.” Lewis’ argument famously failed; Elizabeth Anscombe, by Lewis’s own admission, demolished Lewis in a debate on the topic, and I have explained elsewhere why modified versions of the argument fail as well. In short, it’s because it fails to recognize that a belief-forming process can make an organism more likely to survive because it reliably produces true beliefs. It is therefore not the case that beliefs generated by naturally selected belief-forming processes are automatically false or unjustified.In the same way, the reason a theory “sticks around” could be because it’s not falsified, because it “makes correct predictions.” But the reason it makes correct predictions is most likely because it is true. (In pointing this out, I am echoing the arguments of Musgrave, Lipton, Psillos, and Kitcher, who refuted van Fraassen’s argument and analogy long before his 2024 article.) It would be a huge coincidence that it could do so without being true. And that is the point of Putnam’s miracle argument. Thus, contrary to van Fraassen’s suggestion, the mere fact that a theory’s predictive success is why it “sticks around” or “becomes accepted” in the scientific community is not a reason to be skeptical about its truth. ConclusionLet me close by saying something about the fact that empiricists don’t doubt the truth of all scientific theories, just the ones that hypothesize unobservables. In today’s society, this theory is dangerous to espouse publicly. The nuance between being skeptical about all of science, and just the highly technical theories about unobservables, is guaranteed to be lost to the average reader. And there is so much unjustified skepticism and doubt about the findings of science and experts that a headline like “Science Does Not Describe Reality” could easily fuel the anti-science movement, worsen climate change denial and cause the next pandemic.This is why I believe it was important to still respond to van Fraassen’s article, a full two years after he wrote it. Not only, as I have argued, does it represent a philosophically inaccurate view of how scientific reasoning works and what scientific reasoning can do, but it is a dangerous view to boot. It should thus be rejected.
Is this what dreams are made of? Hilary Duff coming to Nashville
Hilary Duff's 2026 tour marks a return to music with her new album "Luck...or something."
Yale School of Medicine On the Science of Childhood Anxiety, Say, Anxiety Disorders Are the Most Common Mental Health Challenges In Youth
Credit: Matt Bradbury October 5, 2026 - By Isabella Backman - Anxiety disorders are the most common mental health challenges in youth. Left untreated, they can disrupt the lives of both children and their families. The good news is that with intervention, most children will overcome these conditions. Across Yale School of Medicine, scientists are working to understand anxiety at every level, from common anxious behaviors to molecular biomarkers in the brain. They are using their findings to develop and disseminate new evidence-based treatments for childhood anxiety. Today, the go-to treatment for childhood anxiety disorders is cognitive behavioral therapy (CBT). This is a form of psychotherapy that teaches children skills for confronting anxious thoughts and helps them practice managing situations that cause anxiety. While it is the gold-standard treatment backed by considerable scientific evidence, up to 50% of children will not see sufficient benefit from CBT alone. Wendy Silverman, PhD, Alfred A. Messer Professor in the Child Study Center, co-directs the Anxiety and Mood Disorders Program alongside Eli Lebowitz, PhD, associate professor in the Child Study Center. One of their main interests is learning how to improve outcomes beyond CBT. “We’re developing cutting-edge, research-based knowledge that can reduce the suffering that anxiety causes children and their families,” says Silverman. Changing parent behavior YSM experts are investigating how to improve CBT outcomes for children by involving the parents. Silverman’s research has uncovered two main components of parent intervention that improve childhood anxiety: not enabling children to completely avoid the things that make them anxious and taking steps to enhance their autonomy. Parents may unintentionally reinforce their child’s anxiety by allowing them to avoid what makes them anxious. They also may unintentionally limit the children’s sense of autonomy by being overly intrusive. “One of the things that we take pride in is that we’ve focused on trying to understand what parents need to do, and to test our ideas and see if changing the parents’ behaviors is enhancing the effects of CBT,” Silverman says. “Our findings thus far suggest that they do." As much as CBT can be helpful, it can also be challenging to get one’s child to do the necessary steps for CBT to work. This is one important reason why Lebowitz created a novel intervention program for parents named Supportive Parenting for Anxious Childhood Emotions (SPACE). Existing intervention programs often teach parents to act as therapists for their child, such as training them on how to practice breathing exercises. “It makes sense, but this doesn’t work very well in practice,” says Lebowitz. “And part of the reason, I think, is that it’s not easy to get your kid to do things, especially if they’re not excited about doing it.” SPACE is unique because it focuses entirely on parent involvement and changing parental behavior—children are not involved in the sessions. For example, parents learn how to use supportive messages that convey confidence that their child can tolerate and manage distress. “It might sound like a parent saying to a child, ‘I get that this is really hard for you, but I know that you can handle it,’” Lebowitz says. The program also works with parents to identify the ways in which they are accommodating anxious behaviors. “We’ll pick one thing that parents are doing that is an accommodation and help them make a detailed plan for how they’re going to change that,” Lebowitz explains. Treating Anxiety in Children and Adolescents Much of the existing research on SPACE has focused on parents of children under age 14. Ongoing studies are now exploring its use with parents of older teens. “Both anxiety and accommodation can interfere with normative developmental shifts during the teen years, including increased autonomy and individuation from parents,” says Rebecca Etkin, PhD, associate research scientist in the Child Study Center. “In this sense, SPACE may be particularly well-suited for anxious teens and their parents. We want to see whether it is effective during this distinct developmental window.” Unfortunately, many families in need of CBT face barriers, including limited availability of services and geographic constraints. One way to improve access is digital interventions. Silverman and her team are developing an evidence-based digitized intervention program for parents that they can access directly from their computer or smart phone. “The work we’re doing will be one of the very few parent interventions that is digitized and importantly tested for effectiveness,” she says. Creating interventions for anxiety-related challenges Silverman and Lebowitz recently received a generous gift to develop and test other interventions that help parents reduce other child anxiety-related behavioral and emotional difficulties, such as restrictive eating and unexplained somatic symptoms. One of these projects in particular focuses on understanding the risks of social media and its potential benefits, including offering a sense of connection. “A lot of research has focused on the idea that social media is harmful and the less of it the better,” says Lebowitz. “But we actually see is that this is not quite right—there are negatives, but there are also positives. So, we’re trying to get a little bit more nuanced of a picture.” The team is working with teens with social anxiety and their parents over an extended period to better understand their social media habits and how their anxiety levels affect engagement with different platforms. The teens will answer questions sent to an app on their phones about mood and social media usage in an effort to capture emotional responses as they unfold. “We hope to develop interventions that can help make the best of social media while protecting against the more problematic effects,” Lebowitz says. The brain’s role in anxiety Researchers are also testing therapies to address anxiety at the neurological and molecular levels. In collaboration with Dylan Gee, PhD, professor of psychology in Yale's Faculty of Arts and Sciences, and Hilary Blumberg, MD, John and Hope Furth Professor of Psychiatric Neuroscience at Yale School of Medicine, Lebowitz and Silverman are using brain imaging to identify changes in a child’s brain before and after parents enroll in SPACE. In one study, children viewed anxiety-inducing images while undergoing magnetic resonance imaging (MRI); the researchers conducted scans with and without the children’s parents nearby. Before SPACE, children’s brains were better able to activate the regulatory circuitry needed to turn off an anxious response when their parents were nearby. But after SPACE, children could activate this circuitry even without the parent around. “As parents work on gradually reducing some of their accommodations, you can see a child get better at regulating their own fear system in the brain,” Lebowitz says. “It’s remarkable.” Research into the molecular underpinnings of anxiety can also inform new childhood anxiety treatments. In a recent study, Lebowitz, Silverman, and Flora Vaccarino, MD, Harris Professor in the Child Study Center, discovered that a protein known as fibroblast growth factor 2 (FGF2) could be protective from the toxic effects of stress. FGF2 levels in children and their parents were linked to the children’s risk of developing anxiety and depression, the study showed. The findings could help explain why some children who are exposed to early life trauma such as poverty or abuse are more prone to developing mental health disorders. And FGF2 could be a target for treatment. “This is very novel because it starts to give a clue to what is the molecular chain that connects those lived experiences to the actual psychological outcomes,” Lebowitz says. New ways to study and treat childhood anxiety Michael Crowley, PhD, associate professor in the Child Study Center, collaborates with Silverman and Lebowitz to study the role that attention plays in development and maintenance of childhood anxiety. There is a large body of research that shows that anxious children, like anxious adults, are prone to focus on threatening stimuli such as angry faces compared with neutral faces. This has led to innovative interventions that involve attention retraining. The idea is that if experts train children to look away from threatening stimuli, it may reduce their anxiety—especially children with social anxiety who are most prone to attend to threats. The researchers have just completed a clinical trial for attention retraining with 10- to 14-year-olds with social anxiety disorders and are currently analyzing the findings. Besides this innovative attention retraining research, as Crowly notes, “I like to design tasks that are engaging to kids,” Crowley says. “My goal is to assess something without the kids knowing what we are assessing.” With this goal in mind, Crowley has created a virtual game, named Boom, to study threat processing in children with anxiety disorders. The game is similar to that of hot potato—the child and three digital players take turns virtually passing a ball to each other’s gloves. At some point, the ball turns into a bomb, and as the bomb lands in each player’s glove, the outline of the glove turns yellow. The goal is to avoid having the bomb go off in your glove. What isn’t obvious is that the game is designed to measure different types of threatening stimuli, both ambiguous and direct. In the game, the direct threat occurs as the bomb is traveling towards your glove. The ambiguous threat is the yellow outlined glove as it is unknown where the bomb will travel next. While children play the game, Crowley’s team measures their brain activity using electroencephalography (EEG). The researchers have discovered that in kids with anxiety, the brain reacts more strongly to ambiguous threats than it does in their peers, but less strongly to direct threats. They believe that the initial abnormally large brain response to not knowing where the bomb is going impairs the brain's ability to properly respond when the threat is actually traveling the child’s way. “The brains of children with anxiety are unable to differentiate between threats you need to do something about and those that are not your problem.” Michael Crowley, PhD, develops innovative games for studying anxiety in children and adolescents.Credit: Matt Bradbury Based on these insights, Crowley hopes to study whether interventions like attention training could restore appropriate threat processing. Crowley’s team is also working on a test called the Balloon Risk Avoidance Task, which evaluates risk-taking and avoidance behaviors. It features a digital balloon that is full of air and about to burst. Kids have six seconds to let air out of the balloon. The more air they let out, the less risk they face that the balloon will pop. But at the same time, the balloon becomes less valuable as it deflates. “The more air you keep in the balloon, the more points you get,” Crowley explains. So far, the researchers have found that when the balloons pop unexpectedly, teens with social anxiety show distinct brain responses. Studying these responses can help psychologists understand the underlying pathways driving the various manifestations of anxiety. The genetics of anxiety When Thomas Fernandez, MD, associate professor in the Child Study Center and of psychiatry, was still in training, there was a lot of excitement about understanding the genetics associated with autism spectrum disorder. Since then, scientists have identified around 250 genes associated with autism. The genetic contribution to anxiety disorders, on the other hand, has historically received less attention. Anxiety is less heritable than autism, but the genetic contribution for anxiety disorders that emerge in childhood may be higher than for anxiety disorders overall. While scientists estimate the heritability of anxiety disorders in general to be around 30% to 50%, some studies suggest higher heritability for certain childhood-onset anxiety presentations. “I saw firsthand how researchers in the field went about finding vulnerability genes for autism,” Fernandez says. “So, we’re using a very similar playbook for childhood anxiety.” “I saw firsthand how researchers in the field went about finding vulnerability genes for autism. So, we’re using a very similar playbook for childhood anxiety.” Thomas Fernandez, MD Associate Professor In the Child Study Center and in Psychiatry Now, Fernandez and Emily Olfson, MD, PhD, assistant professor in the Child Study Center, are studying children and their parents to identify genetic changes that are present in the child but not the parents, known as “de novo mutations.” “All of us have some de novo mutations—maybe about 50 to 100 sprinkled throughout the genome,” Olfson says. “But when they occur within the coding regions of genes, they can be really disruptive.” Previous research shows that people with autism have higher rates of damaging de novo mutations than the general population. In 2022, Olfson, Lebowitz, Silverman, and Fernandez published a study on 68 children and their families that found that children with anxiety had similarly high levels of these mutations. Studying de novo mutations can help point the researchers to where they should be looking for genes associated with anxiety. “The end game is using the genes to steer us toward the right part of biology that we can then target to come up with better treatments,” Fernandez says. Building on those findings, the team is now studying more families to better understand how these de novo mutations, along with other genetic and environmental factors, shape pediatric anxiety disorders. They recently received a National Institutes of Health grant to enroll 750 new families over the next five years. Olfson is the principal investigator, with co-investigators Lebowitz, Fernandez, Silverman, and Shuangge Steven Ma, PhD, department chair and professor of biostatistics at Yale School of Public Health. Neurodevelopment, Risk Genes, and Mental Health Conditions - The Olfson Lab Joel Gelernter, MD, Foundations Fund Professor of Psychiatry, is interested in how different anxiety disorders differ genomically. “We are studying social phobia, panic disorder, and generalized anxiety disorder, working to understand why people differ in their risk to these specific anxiety disorders and evaluating various risk factors,” he says. Gelernter was recently involved in one of the largest studies to date of the genomics underlying anxiety disorder. The study included around 122,000 people with anxiety disorders and around 730,000 without. It found that some genetic differences associated with anxiety were linked to signaling that helps reduce overactivity in the nervous system. Many anxiety medications available today work by targeting this process. “It’s nice when the biology that you get out of a large genome-wide study ratifies things that we already know because that can help increase confidence in further findings from the study,” Gelernter says. Uncovering the neurobiology of psychiatric disorders John Krystal, MD, Robert L. McNeil, Jr. Professor of Translational Research and chair of the Department of Psychiatry, is interested in the neurobiology of psychiatric disorders, including post-traumatic stress disorder (PTSD), of which anxiety is a major symptom. In the late 1980s, Krystal’s team discovered that the drug yohimbine activated symptoms in patients with PTSD. “This was the first time we could link a specific biological mechanism to the symptoms of PTSD,” Krystal says. At the time, he adds, this finding was highly controversial. “A lot of people felt that PTSD was a purely psychological syndrome that didn’t have an underlying biology.” Since then, Krystal has dived deep into understanding the neurobiology of PTSD to learn how to better treat it. His team is evaluating the use of ketamine and psychedelics. These would be among the first treatments to be developed specifically for PTSD. They may also be applicable for other disorders including anxiety disorders, Krystal adds. An important gap in PTSD treatment is the absence of biological tests that inform how to best help patients manage their PTSD symptoms. A doctor doesn’t diagnose cancer based on how they feel. Rather, they use tests of the biology of the cancer to determine the best course of treatment. “And we can’t do that in any psychiatric disorder other than Alzheimer’s disease,” Krystal says. “But now we are building a foundation for this approach to the treatment of anxiety disorders for the first time.” Source: Yale School of Medicine
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