# Sleep and Fear Extinction Learning among Adolescents with Anxiety or OCD

> **NIH NIH P20** · EMMA PENDLETON BRADLEY HOSPITAL · 2022 · $352,534

## Abstract

Pediatric anxiety and Obsessive Compulsive Disorder (OCD) are prevalent and impairing, yet a significant 
subset of youth who receive the first-line treatment (Cognitive Behavioral Therapy; CBT) will not 
experience symptom remission. Youth with anxiety and OCD report high rates of sleep problems; 
evidence suggests that self-reported sleep-related problems predict slower improvement and poorer 
clinical outcomes in exposure-based CBT. Gaps in knowledge remain about the role of sleep for 
therapeutic learning during CBT treatment. This project aims to address these gaps by integrating 
multi-method sleep assessments with fear extinction learnings, which is one of the presumed mechanisms 
of action in CBT for anxiety and/or OCD. The research objectives are to characterize sleep problems in a 
sample of youth with anxiety and/or OCD and examine the association between sleep variables and 
psychophysiological measures of fear extinction learning. The central methodology involves multi-method 
sleep assessments including self-report measures, actigraphy, and night time electroencephalography, 
and a computer-based fear extinction learning task, which includes measuring skin conductance 
responses (SCR) in 84 adolescents (age 13-17) with primary anxiety or OCD entering a CBT-based 
intensive outpatient program. The central hypothesis is 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. This project is innovative in that 
the use of multi-method sleep assessments in a clinical sample of youths with anxiety and/or OCD is 
novel. In addition, linking sleep measures with psychophysiological indexes of fear extinction learning in a 
clinical sample of youths has not yet been done, to our knowledge. Future research will investigate these 
associations with repeated measurement across a full course of CBT treatment. If successful, we will be 
poised to develop and test augmentation strategies that target specific aspects of sleep that contribute to 
sub-optimal fear extinction learning. Ultimately, results from this work may serve as proof-of-concept for 
identifying sleep targets to guide the augmentation of behavioral treatments for anxiety and OCD.

## Key facts

- **NIH application ID:** 10553901
- **Project number:** 5P20GM139743-02
- **Recipient organization:** EMMA PENDLETON BRADLEY HOSPITAL
- **Principal Investigator:** Giulia Righi
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $352,534
- **Award type:** 5
- **Project period:** 2022-03-01 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10553901

## Citation

> US National Institutes of Health, RePORTER application 10553901, Sleep and Fear Extinction Learning among Adolescents with Anxiety or OCD (5P20GM139743-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10553901. Licensed CC0.

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