Cultural differences in perceived social norms and social anxiety

The polysemy of psychotropic drugs: continuity and overlap between neuroenhancement, treatment, prevention, pain relief, and pleasure-seeking in a clinical setting

BACKGROUND

Enhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one's cognitive or emotional capacities.

MAIN BODY

This article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding prevention, patients' mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient's temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one's performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.

CONCLUSIONS

The notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision.

Comorbid Anxiety Increases Suicidal Risk in Bipolar Depression: Analysis of 9720 Adolescent Inpatients

Objective: To evaluate the risk of association between suicidal behaviors and comorbid anxiety disorders in adolescents with bipolar depression. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS) from the United States. This study included 9720 adolescent inpatients with bipolar depression and further grouped by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety after controlling demographic confounders and psychiatric comorbidities. Results: Out of total inpatients, 34.8% (n = 3385) had comorbid anxiety disorders with a predominance in females (70.3%) and White patients (67.7%). About 54.1% of inpatients with comorbid anxiety had suicidal behaviors versus 44.6% in the non-anxiety cohort (p < 0.001). Comorbid anxiety disorders were associated with 1.35 times higher odds (95% CI 1.23–1.47, p < 0.001) for suicidal behaviors. Conclusion: Suicidal behaviors are significantly prevalent in bipolar depression adolescents with comorbid anxiety disorders. Anxiety disorders are an independent risk factor in bipolar depression that increase the risk of suicidal behaviors by 35%. This necessitates careful assessment and management of comorbid anxiety disorders in bipolar youth to mitigate suicidality.

Treatment Options for Fear of Blushing

PURPOSE OF REVIEW

To review mechanisms of blushing and fear of blushing from physiological, neuropharmacological and psychological viewpoints, and to evaluate current forms of treatment for blushing-related fear.

RECENT FINDINGS

Blushing appears to be driven primarily by sympathetic adrenomedullary and neural vasodilator discharge, possibly in association with secondary neurovascular inflammation. Psychological risk factors for fear of blushing include social anxiety, coupled with heightened self-focused attention and inflated beliefs about the likelihood and social costs of blushing. In addition, schemas of emotional inhibition, social isolation and alienation may underlie blushing-related fears. Established psychological treatments for fear of blushing include task concentration training, exposure, cognitive therapy, social skills training, psychoeducation and applied relaxation. More novel approaches include mindfulness and mindful self-compassion, video feedback and imagery rescripting. There are no established pharmacological treatments specifically for fear of blushing. However, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are effective treatments for social anxiety disorder and may thus help some patients manage their fear of blushing. A reactive sympathetic nervous system may interact with psychological predispositions to intensify fear of blushing. These physiological and psychological risk factors could be promising targets for treatment.

Personal and Media Factors Related to Citizens' Pro-environmental Behavioral Intention against Haze in China: A Moderating Analysis of TPB

This study extends the theory of planned behavior by taking communication factors into account to examine the determinants of pro-environmental behavioral intention in haze mitigation. Unlike other theory of planned behavior (TPB) extension studies, we shift the focus of inquiry from examining the mediating role of TPB variables to investigating the moderating role in promoting pro-environmental behavior. Using an online survey in China, the results indicated that attitude, subjective norms, perceived behavioral control, and attention to haze-related efficacy messages were positively associated with pro-environmental behavioral intention. Notably, attention to haze-related threat messages had no significant relationship with behavioral intention. Moreover, moderation analyses revealed that the interaction effects between attention to efficacy messages and attention to threat messages on behavioral intention vary among people with different attitude, subjective norms, and perceived behavioral control. Theoretically, this study contributes to the literature of the TPB by analyzing its moderating role in promoting behavior change. Findings from this study suggest the importance of disseminating distinctive media messages to audiences with different personality traits, which is beneficial for practitioners to tailor specific messages in environmental campaigns.

Fear of positive evaluation and social anxiety: A systematic review of trait-based findings

BACKGROUND

Although fear of negative evaluation (FNE) has long been recognized as a core cognitive bias in social anxiety, fear of positive evaluation (FPE) has received considerable attention over the past several years. The literature would benefit from a synthesis of the current state of the research in order to contribute to our understanding of FPE.

METHODS

A systematic review of the literature was conducted in order to address several questions: (a) Is self-reported FPE distinct from self-reported FNE? (b) Is self-reported FPE related to social anxiety symptomatology? and (c) Is self-reported FPE uniquely related to social anxiety symptomatology when accounting for self-reported FNE? Inclusion criteria included studies published in English, testing FPE and FNE with trait-based measures, and testing social anxiety with either self-report or diagnostic interviews.

RESULTS

There were 33 studies identified in this review that provided convincing empirical support for each of these questions across community and clinical samples of adolescents, undergraduates, and adults.

LIMITATIONS

The systematic review did not have access to null results, present meta-analytic results, or include studies that evaluated FPE or social anxiety with experimental designs.

CONCLUSIONS

The findings from the systematic review support updated theoritical models of social anxiety and highlight the importance of assessing and treating FPE in clinical interventions.

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale–21 (DASS-21) Across Eight Countries

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale–21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States ( N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Depression and Anxiety Symptoms in a Representative Sample of Undergraduate Students in Spain, Portugal, and Brazil

Abstract University students have shown a significant occurrence of depression and anxiety symptoms. This epidemiological work investigated the prevalence of such symptoms in university students in Spain, Portugal, and Brazil, as well as the possible differences according to nationality and gender from a representative sample of three universities (University of Extremadura/Spain, n = 1216; University of Coimbra/Portugal, n = 426, and PUC-Rio, n = 315) in 2015. The results suggest that Brazilian students have a greater manifestation of depression symptoms, especially women, and they also presented greater symptoms of anxiety. No difference was found in the anxiety results between countries. The correlation between depression and anxiety was positive and strong. This study can be of value in social, clinical and political settings.

The Relationship of Gender Roles and Beliefs to Crying in an International Sample

This study aimed to (1) investigate the variation in self ascription to gender roles and attitudes toward gender roles across countries and its associations with crying behaviors, emotion change, and beliefs about crying and (2) understand how the presence of others affects our evaluations of emotion following crying. This was a large international survey design study (N = 893) conducted in Australia, Croatia, the Netherlands, Thailand, and the United Kingdom. Analyses revealed that, across countries, gender, self-ascribed gender roles, and gender role attitudes (GRA) were related to behavioral crying responses, but not related to emotion change following crying. How a person evaluates crying, instead, appeared to be highly related to one’s beliefs about the helpfulness of crying, irrespective of gender. Results regarding crying when others were present showed that people are more likely both to cry and to feel that they received help around a person that they know, compared to a stranger. Furthermore, closeness to persons present during crying did not affect whether help was provided. When a crier reported that they were helped, they also tended to report feeling better following crying than those who cried around others but did not receive help. Few cross-country differences emerged, suggesting that a person’s responses to crying are quite consistent among the countries investigated here, with regard to its relationship with a person’s gender role, crying beliefs, and reactions to the presence of others.

Exploring cultural meanings of adaptive and maladaptive behaviors in children and adolescents: A contextual-developmental perspective

In this article, I discuss major theoretical and methodological issues in the study of cultural meanings of children’s behaviors. Research in this area is conducted mainly through assessing individual beliefs using hypothetical vignettes or other self-report methods. I argue that it is important to investigate functional meanings of children’s behaviors from a contextual-developmental perspective, which emphasizes the role of social and developmental processes in mediating links between culture and behaviors. Information about the relevance of behaviors to social interactions and relationships and to the development of adjustment outcomes in different cultures helps us understand the nature of the behaviors beyond individual views. Such understanding is crucial for interpreting cross-cultural differences and similarities in the display of adaptive and maladaptive behaviors.

Social anxiety and dynamic social reinforcement learning in a volatile environment

Adaptive social behavior requires learning probabilities of social reward and punishment, and updating these probabilities when they change. Given prior research on aberrant reinforcement learning in affective disorders, this study examines how social anxiety affects probabilistic social reinforcement learning and dynamic updating of learned probabilities in a volatile environment. N=222 online participants completed questionnaires and a computerized ball-catching game with changing probabilities of reward and punishment. Dynamic learning rates were estimated to assess the relative importance ascribed to new information in response to volatility. Mixed-effects regression was used to analyze throw patterns as a function of social anxiety symptoms. Higher social anxiety predicted fewer throws to the previously punishing avatar and different learning rates after certain role changes, suggesting that social anxiety may be characterized by difficulty updating learned social probabilities. Socially anxious individuals may miss the chance to learn that a once-punishing situation no longer poses a threat.

Children with dyslexia in different cultures: Investigation of anxiety and coping strategies of children with dyslexia in Indonesia and Germany

Hitherto the majority of research on anxiety and coping was undertaken on individuals with specific profiles (i.e., individuals with specific difficulties or in cross-cultural settings). However, to our knowledge, no studies have combined cross-cultural and specific difficulty settings to grant a complex analysis of this paradigm nor conducted an investigation of children to reveal the developmental trend in this phenomenon. This study investigates the anxiety profile and coping strategies of children with and without dyslexia from different cultures. A total of 124 children ranging from the age of eight to eleven from Indonesia (n = 64) and Germany (n = 60) were administered a coping and an anxiety scale. Around 50% of the sample were diagnosed with dyslexia and therefore were specifically asked what strategies they implemented in dealing with their difficulties in reading. Findings indicate that dyslexia and cultural factors have distinct contributions in explaining the variance of anxiety and coping strategies. Specifically, dyslexia has a significant effect on separation and generalized anxiety, while an incredible cultural effect is valid for the support-seeking coping strategy. Recommendations for future studies are also discussed.

Measurement equivalence of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) across individuals with social anxiety disorder from Japanese and Australian sociocultural contexts

BACKGROUND

Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan.

METHODS

Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework.

RESULTS

The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants.

LIMITATIONS

We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture.

CONCLUSIONS

When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD.

Anticipation of Uncertain Threat Modulates Subsequent Affective Responses and Covariation Bias

Uncertainty contributes to stress and anxiety-like behaviors by impairing the ability of participants to objectively estimate threat. Our study used the cue-picture paradigm in conjunction with the event-related potential (ERP) technique to explore the temporal dynamics of anticipation for and response to uncertain threat in healthy individuals. This task used two types of cue. While ‘certain’ cues precisely forecasted the valence of the subsequent pictures (negative or neutral), the valence of pictures following ‘uncertain’ cues was not predictable. ERP data showed that, during anticipation, uncertain cues elicited similar Stimulus-Preceding Negativity (SPN) to certain-negative cues, while both of them elicited larger SPN than certain-neutral cues. During affective processing, uncertainty enlarged the mean amplitude of late positive potential (LPP) for both negative and neutral pictures. Behavioral data showed that participants reported more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures and overestimated the probability of negative pictures following uncertain cues. Importantly, the enlarged anticipatory activity evoked by uncertain cues relative to that evoked by certain-neutral cues positively modulated the more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures. Further, this more negative mood ratings and the general arousal anticipation during anticipatory stage contributed to the covariation bias. These results can provide a novel insight into understanding the neural mechanism and pathological basis of anxiety.

[Separation anxiety disorder in adults - a new diagnostic category]

Anxiety separation disorder (SAD) became the subject of increased attention of researchers in recent decades. DSM-5 and project of ICD-11 allow us to treat this disorder as an independent nosological unit without attachment to age. The review provides information on the prevalence, clinical manifestations and diagnosis of SAD in adults, summarizes information on the etiopathogenesis, relations to other psychiatric disorders, and highlights the lack of modern therapeutic approaches to SAD. The purpose of this review is to raise the level of knowledge about SAD and its new positioning in classification systems.

Young Adult Unemployment and Later Depression and Anxiety: Does Childhood Neighborhood Matter?

Young adulthood represents a developmental period with disproportionately heightened risk of losing a job. Young adult unemployment has been linked to increased mental health problems, at least in the short term. However, their possible long-term impacts, often referred as "scarring effects," have been understudied, possibly underestimating the magnitude of mental health burden that young adult unemployment generates. This longitudinal study examined whether duration of unemployment during young adulthood is associated with later mental health disorders, after accounting for mental and behavioral health problems in childhood. Furthermore, the current study investigated whether childhood neighborhood characteristics affect this association and if so, in what specific functional ways. Data were drawn from a longitudinal study of developmental outcomes in a community sample in Seattle. Data collection began in 1985 when study participants were elementary students and involved yearly assessments in childhood and adolescence (ages 10-16) and then biennial or triennial assessments (ages 18-39; N = 677 at age 39; 47% European American, 26% African American, 22% Asian American, and 5% Native American; 49% female). The current study findings suggest that duration of unemployment across young adulthood increased mental health problems at age 39, regardless of gender. Childhood neighborhood characteristics, particularly their positive aspect, exerted independent impacts on adult mental health problems beyond unemployment experiences across young adulthood. The current findings indicate a needed shift in service profiles for unemployed young adults-a comprehensive approach that not only facilitates reemployment but also addresses mental health needs to help them to cope with job loss. Further, the present study findings suggest that childhood neighborhoods, particularly positive features such as positive neighborhood involvement, may represent concrete and malleable prevention targets that can curb mental health problems early in life.

Short Form of the Social Anxiety Scale for Adolescents among community and institutionalized Portuguese youths

Background/Objective: Social anxiety is a common issue arising in adolescence that can cause significant impairment and have detrimental consequences for development in the absence of treatment. In this study we examined the factor structure and the psychometric properties of a 12-item short form of the Portuguese-Language Social Anxiety Scale for Adolescents (SAS-A-SF). Method: A community adolescent sample (N = 835) and a young offender sample (N = 244) completed the SAS-A, the Basic Empathy Scale and the Reactive-Proactive Aggression Questionnaire. Confirmatory factor analysis, internal consistency, cross gender and cross sample invariance, convergent and discriminant validity of the SAS-A-SF were analyzed. Results: The confirmatory factor analysis revealed that the 3-factor second-order model obtained the best fit.The results provided evidence that the SAS-A-SF is a psychometrically sound instrument that shows measurement invariance across genders and across samples, good reliability and positive correlations with empathy. Conclusions: The Portuguese version of SAS-A-SF is a useful, time-efficient tool for both researchers and practitioners who need to assess social anxiety, a relevant construct in adolescent psychopathology.

Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women's Eating Behavior

The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people's eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women's susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project's findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.

Investigating the Relationships Among Resilience, Social Anxiety, and Procrastination in a Sample of College Students

This study investigated the relationships among resilience, social anxiety, and procrastination in a sample of college students. Specifically, structural equation modeling analyses were applied to examine the effect of resilience on procrastination and to test the mediating effect of social anxiety. The results of this study suggested that social anxiety partially mediated the relationship between resilience and procrastination. Students with higher levels of resilience reported a lower frequency of procrastination behavior, and resilience had an indirect effect on procrastination through social anxiety. The results of this study clarify the current knowledge of the mixed results on resilience and procrastination behaviors and offer practical learning strategies and psychological interventions.

Individual Difference in Goal Motives and Goal Content: The Role of Action and State Orientation

The purpose of this study was to investigate whether hesitant or preoccupied people (state-oriented) have different goal content and motives compared to initiative or disengaged people (action-oriented). People rated the degree of autonomous versus controlled feelings for extrinsic or intrinsic types of goals. Results showed that action-oriented people had a higher autonomous motive than state-oriented people for intrinsic goals, but not for extrinsic goals. Moreover, action-oriented individuals were related to a more internalised goal content (intrinsic goal) than state-oriented individuals. Implications for goal internalisation are discussed.

Factors related to self-reported social anxiety symptoms among incoming university students

AIM

The aim of this study was to explore the lifestyle/social, personality trait and mental factors among incoming university students with higher self-reported social anxiety symptoms (SAS).

METHODS

A total of 5126 incoming university students were recruited. The test battery included a self-administered questionnaire that examined personal lifestyle, the Measurement of Support Functions, the Chinese Internet Addiction Scale-Revision, the Organizational Citizenship Behaviour Scale, the Social Phobia Inventory, the suicide ideation from the Brief Symptoms Rating Scale and the Pittsburgh Sleep Questionnaire.

RESULTS

SAS (23.7%) were prevalent. Using logistic regression analysis, we found that the significant predictors of higher levels of SAS were being an undergraduate student and a non-smoker, having lower Measurement of Support Functions score (poorer social support), having higher Chinese Internet Addiction Scale-Revision score (Internet addiction), having lower Organizational Citizenship Behaviour Scale score (less altruistic behaviour), having suicide ideation and having higher Pittsburgh Sleep Questionnaire score (poorer sleeper).

CONCLUSIONS

Given the high prevalence of SAS among university students, it is necessary to build a better strategy to detect students with potential social anxiety-related problems/disorders or other mental problems early on.

Temperament traits in suicidal and non-suicidal mood disorder patients in Taiwan

Suicide is a major social and clinical problem in Asia. Although studies have suggested that personality traits are possible risk factors for suicide, no study has been conducted among Chinese to compare the temperament traits of suicidal and non-suicidal mood disorder patients with those of healthy controls. This study compared temperament traits of two patient groups, those with a mood disorder who have attempted suicide (n=204), and those with a mood disorder who have not attempted suicide (n=160), and compared the traits of these patients to those of healthy controls (n=178), assessed by Cloninger's Tridimensional Personality Questionnaire and the Brown-Goodwin Aggression Inventory. Patients with suicidal attempts had significantly higher novelty seeking and aggression scores than healthy controls and patients without suicidal attempts. Two groups of patients with mood disorder had significantly higher harm avoidance scores than the healthy controls. However, patients with suicidal attempts did not have higher harm avoidance scores than patients without suicidal attempts. This study confirms findings that harm avoidance and mood disorder are related, and extends them by suggesting that those with a mood disorder and suicide attempts have higher novelty seeking and lifetime aggression scores than those without suicidal attempt, either patients or healthy controls.

Development and evaluation of a modified brief assertiveness training for nurses in the workplace: a single-group feasibility study

Background

Effective communication has a great impact on nurses’ job satisfaction, team relationships, as well as patient care/safety. Previous studies have highlighted the various beneficial effects of enhancing communication through assertiveness training programs for nurses. However, most programs take a long time to implement; thus, briefer programs are urgently required for universal on-the-job-training in the workplace. The purpose of this feasibility study was to develop and evaluate a modified brief assertiveness training program (with cognitive techniques) for nurses in the workplace.

Methods

This study was carried out as a single-group, open trial (pre-post comparison without a control group). Registered nurses and assistant nurses, working at two private psychiatric hospitals in Miyazaki Prefecture in Japan, were recruited. After enrolling in the study, participants received a program of two 90-min sessions with a 1-month interval between sessions. The primary outcome was the Rathus Assertiveness Schedule (RAS), with secondary measurements using the Brief Version of the Fear of Negative Evaluation Scale (BFNE) and the Brief Job Stress Questionnaire (BJSQ). Assessments were conducted at baseline and after a 1-month interval (pre- and post-intervention).

Results

A total of 22 participants enrolled in the study and completed the program. The mean total score on the primary outcome (RAS) significantly improved from −12.9 (SD = 17.2) to −8.6 (SD = 18.6) (p = 0.01). The within-group effect size at the post-intervention was Cohen’s d = 0.24; this corresponds to the small effect of the program. Regarding secondary outcomes, there were no statistically significant effects on the BFNE or any of the BJSQ subscales (job-stressors, psychological distress, physical distress, worksite support, and satisfaction).

Conclusions

This single-group feasibility study demonstrated that our modified brief assertiveness training for nurses seems feasible and may achieve a favorable outcome in improving their assertiveness. Further controlled trials with longer follow-up periods are required in order to address the limitations of this study.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-017-0224-4) contains supplementary material, which is available to authorized users.

Physical Activity Behavior After a Diagnosis of Lung Cancer Differs Between Countries: An Observational Cohort Study

INTRODUCTION

Physical activity (PA) is important in lung cancer.

OBJECTIVES

To investigate PA levels and health-related quality of life (HRQoL) of patients with lung cancer in China and compare this to a similar cohort in Australia.

METHODS

Prospective cohort study. 71 patients from China (group CH) and 90 patients from Australia (group AU) with newly diagnosed lung cancer. Questionnaires assessed self-reported PA levels and HRQoL at baseline (diagnosis) and 8 weeks.

RESULTS

At baseline, group CH were engaged in less overall PA than group AU (Physical Activity Scale for the Elderly [PASE] total score: median [IQR] group CH, 56 [32-59]; group AU, 66 [38-116]; P < .005), and less occupational and household activity ( P < .005). However, at baseline, group CH reported significantly more walking time than group AU (median [IQR]: group CH, 210 [150-315] min/wk; group AU, 55[0-210] min/wk; P < .0005). Global HRQoL scores were similar between groups (P = .038). Over 8 weeks, group CH increased their overall PA levels ( P < .005) and walking time ( P = .008), and HRQoL remained unchanged. The comparison group AU experienced a reduction in PA levels ( P = .02) and HRQoL ( P < .005).

CONCLUSIONS

A diagnosis, patients in China were less physically active than those in Australia. Following diagnosis, patients in China increased their PA levels, whereas those in Australia reduced their PA levels. Research is required to explore potential reasons behind differences, and this may inform research/clinical services to facilitate patients with lung cancer to be more active.

Using a cultural and RDoC framework to conceptualize anxiety in Asian Americans

Asian Americans are one of the fastest growing minority groups in the United States; however, mental health within this population segment, particularly anxiety disorders, remains significantly understudied. Both the heterogeneity within the Asian American population and the multidimensional nature of anxiety contribute to difficulties in understanding anxiety in this population. The present paper reviewed two sources of heterogeneity within anxiety in Asian Americans: (1) cultural variables and (2) mechanisms or components of anxiety. Specifically, we examined four cultural variables most commonly found in research related to anxiety in Asian Americans: acculturation, loss of face, affect valuation, and individualism-collectivism. We also discussed ways to parse anxiety through a Research Domain Criteria (RDoC) framework, specifically focusing on sensitivity to acute and potential threat, constructs within the Negative Valence System. Previously unpublished preliminary data were presented to illustrate one way of examining ethnic differences in anxiety using an RDoC framework. Finally, this paper offered recommendations for future work in this area.

Eating symptomatology and general psychopathology in patients with anorexia nervosa from China, UK and Spain: A cross-cultural study examining the role of social attitudes

Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People´s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.

The Social Costs in Communication Hiccups Between Native and Nonnative Speakers

It is well-established that native speakers perceive nonnative speakers with strong foreign accents, compared with those with a more nativelike accent, as less intelligent and competent, less ambitious and dependable as coworkers, and less comfortable around native speakers. But little is known about how nonnative speakers themselves are affected when communication hiccups—often due to incorrect or accented pronunciations—occur in their conversations with native speakers. In this experiment, mispronunciations of an English word were elicited from native Chinese speakers in phone conversations via the Internet with an American English speaker, who then either asked for clarification of the word or showed no confusion about the word but asked about something else. Chinese speakers’ reactions were measured using a combination of self-reports, facial affective coding, and skin-conductance responses. When the American asked for clarification—compared with when he did not—Chinese speakers were left feeling more anxious, embarrassed, and unsure of their English abilities, as well as feeling less positive about the American, finding him less attractive socially and their conversation with him less enjoyable.

The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model

BACKGROUND

Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD.

METHODS

A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model.

RESULTS

A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model.

LIMITATIONS

There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model.

CONCLUSIONS

The IAM model provides a framework for future investigations into the development and persistence of SAD.

Does self-focused attention in social anxiety depend on self-construal? Evidence from a probe detection paradigm

Cognitive models of social anxiety disorder propose self-focused attention as a key maintenance factor of the disorder. However, whether this holds true for different cultural contexts has not been investigated. The present experiment investigated the influence of self-construal (interdependent versus independent) on self-focused attention in high and low socially anxious individuals. Eighty-seven participants, divided into high versus low socially anxious and interdependent versus independent self-construal, performed a self-focused attention probe detection paradigm. A reaction time metric relating to attention deployment on the self versus the other served as an index of self-focused attention. In individuals with an interdependent self-construal those who are highly socially anxious showed decreased self-focused attention compared to those who are low socially anxious. In individuals with an independent self-construal the effect of social anxiety was less strong and in the opposite direction (but congruent with cognitive models). These results indicate that self-focused attention in social anxiety depends on self-construal. These findings implicate different therapies for people with social anxiety disorder, depending on their self-construal.

Community-Based Validation of the Social Phobia Screener (SOPHS)

There is a need for brief, accurate screening scales for social anxiety disorder to enable better identification of the disorder in research and clinical settings. A five-item social anxiety screener, the Social Phobia Screener (SOPHS), was developed to address this need. The screener was validated in two samples: (a) 12,292 Australian young adults screened for a clinical trial, including 1,687 participants who completed a phone-based clinical interview and (b) 4,214 population-based Australian adults recruited online. The SOPHS (78% sensitivity, 72% specificity) was found to have comparable screening performance to the Social Phobia Inventory (77% sensitivity, 71% specificity) and Mini-Social Phobia Inventory (74% sensitivity, 73% specificity) relative to clinical criteria in the trial sample. In the population-based sample, the SOPHS was also accurate (95% sensitivity, 73% specificity) in identifying Diagnostic and Statistical Manual of Mental Disorders–Fifth edition social anxiety disorder. The SOPHS is a valid and reliable screener for social anxiety that is freely available for use in research and clinical settings.

Mother-child attachment and social anxiety: Associations with friendship skills and peer competence of Arab children

The goal of the study was to examine the joint and distinct contribution of attachment security and social anxiety to Arab children’s peer competence in middle childhood. We focused on Arab children as very little research has examined close relationships for this group. A sample of 404 third-, fourth- and fifth-grade Arabic students (203 boys and 201 girls), mostly from lower middle-class neighborhoods in northern Israel, participated in the study. In a cross-sectional design, bivariate correlations and regression analyses were performed, and findings revealed that attachment security was negatively related to distancing strategies in help-seeking and help-giving contexts, whereas social anxiety was positively related to these strategies. Secure attachment was also associated with providing reassurance to friends, and with peer competence as perceived by teachers. The possible implications of the socio-cultural context, suggestions for future studies, and implications for school intervention are discussed.

The structure of feared social situations among race-ethnic minorities and Whites with social anxiety disorder in the United States

We investigated feared social situations in individuals with social anxiety disorder from different racial and ethnic groups in the United States. The sample included 247 African Americans, 158 Latinos, and 533 non-Latino Whites diagnosed with social anxiety disorder within the past 12 months from the integrated Collaborative Psychiatric Epidemiology Studies data set. After randomly splitting the full sample, we conducted an exploratory factor analysis with half of the sample to determine the structure of feared social situations in a more diverse sample than has been used in previous studies. We found evidence for a model consisting of three feared social domains: performance/public speaking, social interaction, and observational. We then conducted a confirmatory factor analysis on the remaining half of the sample to examine whether this factor structure varied significantly between the race-ethnic groups. Analyses revealed an adequate fit of this model across all three race-ethnic groups, suggesting invariance of the factor structure between the study groups. Broader cultural contexts within which these findings are relevant are discussed, along with important implications for comprehensive, culturally sensitive assessment of social anxiety.

Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review

In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.

Social Anxiety among Chinese People

The experience of social anxiety has largely been investigated among Western populations; much less is known about social anxiety in other cultures. Unlike the Western culture, the Chinese emphasize interdependence and harmony with social others. In addition, it is unclear if Western constructed instruments adequately capture culturally conditioned conceptualizations and manifestations of social anxiety that might be specific to the Chinese. The present study employed a sequence of qualitative and quantitative approaches to examine the assessment of social anxiety among the Chinese people. Interviews and focus group discussions with Chinese participants revealed that some items containing the experience of social anxiety among the Chinese are not present in existing Western measures. Factor analysis was employed to examine the factor structure of the more comprehensive scale. This approach revealed an “other concerned anxiety” factor that appears to be specific to the Chinese. Subsequent analysis found that the new factor—other concerned anxiety—functioned the same as other social anxiety factors in their association with risk factors of social anxiety, such as attachment, parenting, behavioral inhibition/activation, and attitude toward group. The implications of these findings for a more culturally sensitive assessment tool of social anxiety among the Chinese were discussed.

Health-promoting lifestyle behaviors and psychological status among Arabs and Koreans in the United Arab Emirates

Cultural variations among ethnic groups may differentially influence health and health behavior. We explored and compared health-promoting lifestyle behaviors and psychological status, including depression, anxiety, and stress, among Korean migrants (n = 117) and Arab nationals (n = 103) in the United Arab Emirates (UAE). Pender's Health Promotion Model guided this research. The Health-Promoting Lifestyle Profile was used to measure health-promoting lifestyle behaviors and Lovibond and Lovibond's Depression, Anxiety, and Stress Scale to measure psychological status. The data were analyzed using bivariate procedures and multiple linear regression. No group differences were found in total scores for health-promoting lifestyle behaviors or psychological status. Both groups scored high on self-actualization and interpersonal support; Arabs scored low on exercise, and Koreans scored low on health responsibility. Across groups, psychological status (β = -.390, p < .001), education (β = .239, p < .001), and gender (β = .238, p < .001) were significant determinants of health-promoting lifestyle behaviors in multivariate analysis. Ethnicity and religious attendance were not significant determinants. Education level had a moderating effect; for those with a lower educational level, psychological distress had a stronger negative effect on health behavior. Findings suggest considering cultural aspects, such as different values placed on physical fitness and social/interpersonal relationships, in developing and implementing health education and/or promotion programs. Assessment of psychological status (i.e., depression, anxiety, and stress) should also be included in health promotion programs and related health policies for Korean migrants and Arab nationals in the UAE.

Anxiety among community-dwelling U.S. Chinese older adults

BACKGROUND

This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults.

METHODS

Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between 2011 and 2013.

RESULTS

Of 3,159 older adults surveyed, 8.5% had anxiety disorders and 65.0% reported having any anxiety symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptoms. Living with fewer people and having fewer children were only correlated with any anxiety symptoms and lower income was only correlated with anxiety disorders.

CONCLUSIONS

This study emphasizes that interventions for anxiety among Chinese older adults should give special attention to older women, those who are unmarried, with impaired health status, and poorer quality of life. Further longitudinal studies should be conducted to better understand risk factors and outcomes associated with anxiety among U.S. Chinese older adults.

Unpacking Cultural Variations in Social Anxiety and the Offensive-Type of Taijin Kyofusho Through the Indirect Effects of Intolerance of Uncertainty and Self-Construals

This article presents two studies that aim to unpack cultural variations in general social anxiety (SA) and the offensive-type of Taijin Kyofusho (OTKS)—a type of SA characterized by the extreme fear of offending others. Cultural variations in the expression and manifestation of SA are well established; however, the mechanisms underpinning this relation are unclear. The present studies use the Parallel Multiple Mediation Model to study how SA and OTKS are jointly shaped by self-construal and intolerance of uncertainty (IU). Study 1 compared Euro-Canadians and Chinese migrants in Canada. Results showed a mean group difference in OTKS, but not SA, with the difference mediated by IU. Study 2 tested this pattern of multiple mediations in Japanese, Chinese, and Euro-Canadian cultural contexts. Results showed significant differences among these three cultural groups on both SA and OTKS via multiple mediators (e.g., independent vs. interdependent self-construals and IU). Findings in both studies revealed that OTKS seems to be a psychopathology that is not specific to Japanese participants. The underlying mechanisms and processes of OTKS are also significantly different from SA. Significant cultural variations in SA and OTKS between Chinese versus Japanese cultural contexts were observed in Study 2. These studies demonstrate the conceptual and empirical advantages of using more complex models to unpack the psychological mechanisms shaping cultural variations in SA and OTKS.

A personalized and control systems engineering conceptual approach to target childhood anxiety in the contexts of cultural diversity

In the child and adolescent anxiety area, some progress has been made to develop evidence-based prevention protocols, but less is known about how to best target these problems in children and families of color. In general, data show differential program effects with some minority children benefiting significantly less. Our preliminary data, however, show promise and suggest cultural parameters to consider in the tailoring process beyond language and cultural symbols. It appears that a more focused approach to culture might help activate intervention components and its intended effects by focusing, for example, on the various facets of familismo when working with some Mexican parents. However, testing the effects and nuances of cultural adaption vis-à-vis a focused personalized approach is methodologically challenging. For this reason, we identify control systems engineering design methods and provide example scenarios relevant to our data and recent intervention work.

An Examination of the Measurement Equivalence of the Brief Fear of Negative Evaluation Scale Across Individuals Who Identify With an Asian Ethnicity and Individuals Who Identify With a European Ethnicity

A body of research has demonstrated that individuals with Asian ethnicity endorse higher levels of fear of negative evaluation compared with individuals with European ethnicity. To date, no study has examined whether this Asian-European difference may be confounded by the differential interpretation of the measures of fear of negative evaluation by the two groups. The current study thus aimed to examine the measurement equivalence of the 12-item Brief Fear of Negative Evaluation (BFNE) scale and its 8-item variant composed of straightforwardly worded items (BFNE-S) in a sample of individuals who identified with a Chinese ethnicity ( n = 204) and a sample of individuals who identified with an Anglo ethnicity ( n = 528). Measurement equivalence across the samples was obtained for a two-factor BFNE model and a one-factor BFNE-S model. However, the BFNE-S model demonstrated superior fit to the data. Using the BFNE-S, we found that the Chinese ethnicity sample scored significantly higher on the latent dimension of fear of negative evaluation compared with the Anglo ethnicity sample ( d = 0.24). These findings disambiguate previous research on Asian-European differences in fear of negative evaluation and highlight the need for the continued examination of the validity of measures across different ethnicities and cultures.