Measurement of social-evaluative anxiety

Self-Consciousness, Self-Objectification, and Social Anxiety as Predictors of Photo Editing Behavior among Emerging Adults

This study aims to assess the impact of self-consciousness, self-objectification, and social anxiety on photo editing behavior among emerging adults. Correlational research strategy was used for the present quantitative research, and convenient sampling strategy was used to collect data of 444 university students (135 males and 309 females) with the age range of 18-25 years. The self-consciousness scale, objectified body consciousness scale, photo manipulation scale, and social anxiety scale were used as assessment tools for this study. For data analysis, $t$ -test for independent samples, correlation, and regression analysis were implied. The results revealed that women had higher self-consciousness and social anxiety in contrast to men. Moreover, self-objectification and evaluation anxiety were positively correlated with photo editing behavior. Lastly, overall self-objectification and body shame, one of the three aspects of self-objectification resulted as significant predictors of photo manipulation behavior among emerging adults. This study contributes to the indigenous literature of clinical and social psychology.

Relationship Between Hardiness and Social Anxiety in Chinese Impoverished College Students During the COVID-19 Pandemic: Moderation by Perceived Social Support and Gender

During the COVID-19 epidemic, quarantine and financial disadvantages might exacerbate social anxiety among impoverished college students. Based on the hardiness model and the social support buffering model, the present study proposed and verified a dual moderation model to investigate the effects of hardiness on social anxiety and the moderating roles of gender and perceived social support. The hardiness scale, the perceived social support scale, and the social anxiety subscale of the self-consciousness scale were administered to 673 Chinese college students aged 18 to 23 years who were recognized as impoverished by the Chinese authorities and provided with funding. The results revealed that (1) hardiness had a significant negative effect on social anxiety, (2) perceived social support moderated the effect of hardiness on social anxiety, and (3) gender moderated the effect of hardiness on social anxiety. The dual moderated model proposed in the study provides practical implications for helping impoverished college students cope with social anxiety during the COVID-19 pandemic.

Cognitive behavioural therapy (group) for schizophrenia

BACKGROUND

Schizophrenia is a disabling psychotic disorder characterised by positive symptoms of delusions, hallucinations, disorganised speech and behaviour; and negative symptoms such as affective flattening and lack of motivation. Cognitive behavioural therapy (CBT) is a psychological intervention that aims to change the way in which a person interprets and evaluates their experiences, helping them to identify and link feelings and patterns of thinking that underpin distress. CBT models targeting symptoms of psychosis (CBTp) have been developed for many mental health conditions including schizophrenia. CBTp has been suggested as a useful add-on therapy to medication for people with schizophrenia. While CBT for people with schizophrenia was mainly developed as an individual treatment, it is expensive and a group approach may be more cost-effective. Group CBTp can be defined as a group intervention targeting psychotic symptoms, based on the cognitive behavioural model. In group CBTp, people work collaboratively on coping with distressing hallucinations, analysing evidence for their delusions, and developing problem-solving and social skills. However, the evidence for effectiveness is far from conclusive.

OBJECTIVES

To investigate efficacy and acceptability of group CBT applied to psychosis compared with standard care or other psychosocial interventions, for people with schizophrenia or schizoaffective disorder.

SEARCH METHODS

On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, four other databases and two trials registries. We handsearched the reference lists of relevant papers and previous systematic reviews and contacted experts in the field for supplemental data.

SELECTION CRITERIA

We selected randomised controlled trials allocating adults with schizophrenia to receive either group CBT for schizophrenia, compared with standard care, or any other psychosocial intervention (group or individual).

DATA COLLECTION AND ANALYSIS

We complied with Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated risk ratio (RR) and 95% confidence interval (CI) for binary data and mean difference (MD) and 95% CI for continuous data. We used a random-effects model for analyses. We assessed risk of bias for included studies and created a summary of findings table using GRADE.

MAIN RESULTS

The review includes 24 studies (1900 participants). All studies compared group CBTp with treatments that a person with schizophrenia would normally receive in a standard mental health service (standard care) or any other psychosocial intervention (group or individual). None of the studies compared group CBTp with individual CBTp. Overall risk of bias within the trials was moderate to low. We found no studies reporting data for our primary outcome of clinically important change. With regard to numbers of participants leaving the study early, group CBTp has little or no effect compared to standard care or other psychosocial interventions (RR 1.22, 95% CI 0.94 to 1.59; studies = 13, participants = 1267; I2 = 9%; low-certainty evidence). Group CBTp may have some advantage over standard care or other psychosocial interventions for overall mental state at the end of treatment for endpoint scores on the Positive and Negative Syndrome Scale (PANSS) total (MD -3.73, 95% CI -4.63 to -2.83; studies = 12, participants = 1036; I2 = 5%; low-certainty evidence). Group CBTp seems to have little or no effect on PANSS positive symptoms (MD -0.45, 95% CI -1.30 to 0.40; studies =8, participants = 539; I2 = 0%) and on PANSS negative symptoms scores at the end of treatment (MD -0.73, 95% CI -1.68 to 0.21; studies = 9, participants = 768; I2 = 65%). Group CBTp seems to have an advantage over standard care or other psychosocial interventions on global functioning measured by Global Assessment of Functioning (GAF; MD -3.61, 95% CI -6.37 to -0.84; studies = 5, participants = 254; I2 = 0%; moderate-certainty evidence), Personal and Social Performance Scale (PSP; MD 3.30, 95% CI 2.00 to 4.60; studies = 1, participants = 100), and Social Disability Screening Schedule (SDSS; MD -1.27, 95% CI -2.46 to -0.08; studies = 1, participants = 116). Service use data were equivocal with no real differences between treatment groups for number of participants hospitalised (RR 0.78, 95% CI 0.38 to 1.60; studies = 3, participants = 235; I2 = 34%). There was no clear difference between group CBTp and standard care or other psychosocial interventions endpoint scores on depression and quality of life outcomes, except for quality of life measured by World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF) Psychological domain subscale (MD -4.64, 95% CI -9.04 to -0.24; studies = 2, participants = 132; I2 = 77%). The studies did not report relapse or adverse effects.

AUTHORS' CONCLUSIONS

Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high-quality research, reporting useable and relevant data is needed.

Bias and sensitivity in numerosity perception of negative emotions among individuals with high social anxiety

The cognitive model of social anxiety suggests an association between social anxiety and cognitive bias toward negative social information. This study investigated the numerosity perception of emotional faces among individuals with high social anxiety. Seventy-five college students completed self-reported questionnaires—assessing social anxiety symptoms—and a numerosity comparison experiment. In each trial of the experiment, participants were presented with a group of 16 emotional faces, varying in the number of faces expressing positive and negative emotions. They were asked to judge which emotion—positive or negative—was more numerous in the crowd. Bias and sensitivity in numerosity perception of emotions were estimated by fitting a psychometric function to participants’ responses. Individuals with low social anxiety showed a bias toward positive faces (t(17) = 2.44, p = 0.026), while those with high social anxiety did not (t(17) = 1.87, p = 0.079). Correlation analyses indicated that social anxiety was negatively associated with the parameters of the function (mean for bias and standard deviation for sensitivity; r =  − 0.34, p = 0.003 for mean; r =  − 0.23, p = 0.047 for standard deviation). Thus, our results suggest that socially anxious individuals lack the bias toward positive emotion and are more sensitive to negative emotion than nonanxious individuals in perceiving the numerosity of facial expressions.

Individual differences in self-esteem and social anxiety predict problem smartphone use in adolescents

Smartphones have many characteristics that make them attractive to adolescents. Recent work, however, has established a link between smartphone-related problems and self-esteem (self-worth) and social anxiety (fear of social relations). To date, little is known about the characteristics underpinning these relationships in combination. Driven by theory, the present study examined the association between self-esteem, social anxiety, and nomophobia (fear of being without access to a smartphone) and problem smartphone use (PSU) in a sample of early adolescents ( N = 254). Self-esteem (Rosenberg Self Esteem Scale), social anxiety (Social Avoidance and Distress Scale) and their combined contribution (self-esteem × social anxiety) served as predictor variables of nomophobia (Nomophobia Questionnaire) and PSU (Mobile Phone Problem Usage Scale – Adolescent version) in separate moderated regression analyses. We found that lower self-esteem was associated with higher nomophobia and PSU, and that higher self-esteem may be a protective factor in those lower in social anxiety, such that they are not prone to excessive smartphone use. Our findings offer preliminary markers for psychologists addressing the challenges related to excessive smartphone use in this age group.

The effects of mood disorders and childhood trauma on fear of positive and negative evaluation

Fear of positive and negative evaluation is maladaptive and may result in psychosocial dysfunction. Although being diagnosed with mood disorders or experiencing childhood trauma may potentially affect fear of evaluation, previous studies examined this phenomenon mostly in social anxiety disorders. To fill this gap, we investigated the relationship between childhood trauma and fear of positive and negative evaluation in individuals with bipolar disorder (BD), depressive disorders (DD), and healthy controls (HC). 43 individuals with BD, 89 with DD, and 65 HC completed clinical interviews and self-report assessments. The relationship between participants’ diagnoses and presence of trauma on fear of positive and negative evaluation was examined using ANCOVA. Independently of experiencing childhood trauma, fear of positive evaluation was significantly higher in individuals with mood disorders vs. HC. Fear of negative evaluation was significantly associated with diagnosis-by-trauma interaction. Significantly lower scores were observed in individuals with BD without childhood trauma compared to those with childhood trauma and individuals with DD. Compared to HC, more individuals with mood disorders experienced childhood trauma. While experiencing childhood trauma may increase vulnerability to mood disorders in general, it is especially detrimental for individuals with BD by increasing the risk for developing a fear of negative evaluation.

Design and Methods of a Prospective Smartphone App-Based Study for Digital Phenotyping of Mood and Anxiety Symptoms Mixed With Centralized and Decentralized Research Form: The Search Your Mind (S.Y.M., ) Project

In this study, the Search Your Mind (S.Y.M., ) project aimed to collect prospective digital phenotypic data centered on mood and anxiety symptoms across psychiatric disorders through a smartphone application (app) platform while using both centralized and decentralized research designs: the centralized research design is a hybrid of a general prospective observational study and a digital platform-based study, and it includes face-to-face research such as informed written consent, clinical evaluation, and blood sampling. It also includes digital phenotypic assessment through an application-based platform using wearable devices. Meanwhile, the decentralized research design is a non-face-to-face study in which anonymous participants agree to electronic informed consent forms on the app. It also exclusively uses an application-based platform to acquire individualized digital phenotypic data. We expect to collect clinical, biological, and digital phenotypic data centered on mood and anxiety symptoms, and we propose a possible model of centralized and decentralized research design.

Independent Psychometric Evaluation and Predictive Utility of The Social Anxiety Questionnaire

The Social Anxiety Questionnaire (SAQ) is a 10-item measure of social anxiety developed to comprehensively and concisely target the mechanisms described in Clark and Wells' model of social anxiety and address the breadth of social anxiety symptoms which may not all be encompassed in existing questionnaires. The aim of the current studies is to independently investigate the factor structure of the SAQ (i.e., Study 1 and 2) and determine its predictive validity and utility (i.e., Study 3 and 4). Data were collected across 4 studies to evaluate the factor structure and utility. Overall, the results suggest that a total summed score of the SAQ appeared to capture unique aspects of social anxiety that may not be captured using a single measure and appears to provide utility in experimental manipulations of theoretical maintenance factors. The current study was limited by a convenience sample and future research should continue to document the psychometric properties and clinical utility of this novel measure of social anxiety. The SAQ may show promise in both correlational and experimental research but future research should consider further evaluation of its utility.

Abusive Supervision and Employee's Creative Performance: A Serial Mediation Model of Relational Conflict and Employee Silence

Many previous studies on creativity have focused on discovering positive factors to improve creativity and innovation performance from leader, individual, and organizational perspectives. However, research on factors that hinder creative performance was relatively insufficient. This study examines leaders' behavior that hinders employees' creative performance by focusing on abusive supervision. Based on the Korean employee context, our research model draws upon constructs of abusive supervision, relational conflict, employee silence, and creative performance to hypothesize serial mediation mechanisms connecting abusive supervision to creative performance. Using survey data of 555 Korean employees, we find that abusive supervision is negatively related to creative performance. We also find that both relational conflict and employee silence mediate the relationship between abusive supervision and employee creative performance. More importantly, our empirical analysis indicates that a serial mediation effect testing a dual coordination effect was identified in the process of the leader's abusive supervision leading to employee's creative performance. Although many previous studies were focused on a single medium effect in the relationship between leadership types and employee creativity, this study applied the serial mediation effects in the relationship to test a dual medium effect. We further addressed a more complex process to explain the path of reducing creative performance by supervisor abusive supervision. We conclude by discussing both theoretical and practical implications.

Effects of the COVID-19 Pandemic on Chinese Graduate Students' Learning Activities: A Latent Class Analysis

To investigate the impact of the pandemic on graduate students' learning activities, a series of questionnaires were distributed to graduate students in universities across China, and 2,818 responses were collected. A latent class analysis was performed to classify the effects of the pandemic on graduate students' learning activities. Then, a multinomial logistic regression analysis and an analysis of variance analysis were carried out to explore the impact of demographic variables on the classification and their mental health status. The analysis identified four latent classes: "the overall less affected" (34.83%), "the overall more affected" (31.97%), "course activities were more affected" (19.40%), and "social activities were more affected" (13.79%). The multinomial logistic regression analysis indicated that during the pandemic, the learning activities of graduate students in all grades were affected to varying degrees, and the impacts on second-year and third-year graduate students were greater than those of first-year graduate students. The analysis of variance revealed that the scores for anxiety, depression, and social anxiety of "the overall more affected" were significantly greater than those of the other three groups, and nearly one-third of students belonged to this class, suggesting that more attention and care should be given to these students. As a result of the COVID-19 pandemic, a number of graduate students have suffered mental problems (anxiety and depression). Under the current backdrop of a new normal, schools and teachers should pay attention to graduate students' mental health, providing targeted assistance to different types of students.

Cultural Differences in Fear of Negative Evaluation After Social Norm Transgressions and the Impact on Mental Health

Social norm transgressions are assumed to be at the root of numerous substantial negative outcomes for transgressors. There is a prevailing notion among lay people and scholars that transgressing social norms can negatively impact one's mental health. The present research aimed to examine this assumption, focusing on clinically relevant outcomes such as anxiety and depression. The present research further aimed to examine a social cognitive process for these outcomes in the form of fear of negative evaluations as a result of one's norm transgressing behavior. Specifically, it examined whether it is negative evaluations about ourselves or about those close to us that mediates the effect of social norm transgressions, and whether those may vary as a function of culture. Results of the present research, including a study with a community sample (N = 410), suggest a positive association between social norm transgressions and psychological distress. Results also suggest that increased fear of negative evaluation mediates that association but does so differently for people from more collectivistic cultures and people from less collectivistic cultures. For people from more collectivistic cultures increased fear of negative evaluation of close others may mediate the association between social norm transgressions and psychological distress. However, for people from less collectivistic cultures that association may be mediated by increased fear of negative evaluation of oneself. Implications for research on consequences of social norm transgressions and cross-cultural differences in perceptions of such consequences are discussed as are practical implications for motivating social norm adherence and the maintenance of constructive social norms.

Construction and Validation of a Scale to Measure Loneliness and Isolation During Social Distancing and Its Effect on Mental Health

A variety of factors contribute to the degree to which a person feels lonely and socially isolated. These factors may be particularly relevant in contexts requiring social distancing, e.g., during the COVID-19 pandemic or in states of immunodeficiency. We present the Loneliness and Isolation during Social Distancing (LISD) Scale. Extending existing measures, the LISD scale measures both state and trait aspects of loneliness and isolation, including indicators of social connectedness and support. In addition, it reliably predicts individual differences in anxiety and depression. Data were collected online from two independent samples in a social distancing context (the COVID-19 pandemic). Factorial validation was based on exploratory factor analysis (EFA; Sample 1, N = 244) and confirmatory factor analysis (CFA; Sample 2, N = 304). Multiple regression analyses were used to assess how the LISD scale predicts state anxiety and depression. The LISD scale showed satisfactory fit in both samples. Its two state factors indicate being lonely and isolated as well as connected and supported, while its three trait factors reflect general loneliness and isolation, sociability and sense of belonging, and social closeness and support. Our results imply strong predictive power of the LISD scale for state anxiety and depression, explaining 33 and 51% of variance, respectively. Anxiety and depression scores were particularly predicted by low dispositional sociability and sense of belonging and by currently being more lonely and isolated. In turn, being lonely and isolated was related to being less connected and supported (state) as well as having lower social closeness and support in general (trait). We provide a novel scale which distinguishes between acute and general dimensions of loneliness and social isolation while also predicting mental health. The LISD scale could be a valuable and economic addition to the assessment of mental health factors impacted by social distancing.

Longitudinal associations between social media use, mental well-being and structural brain development across adolescence

Youth of today grow up in a digital social world but the effects on well-being and brain development remain debated. This study tracked longitudinal associations between structural brain development, social media use and mental well-being. The study demonstrated two pathways of heterogeneity in brain development. First, adolescents who used social media more than their peers showed higher baseline cortical thickness in lateral prefrontal cortex (PFC) and medial PFC; and stronger decreases in the lateral PFC and temporal parietal junction. In contrast, adolescents with lower mental well-being showed lower baseline levels of surface area in the medial PFC and posterior superior temporal sulcus relative to their peers. Whereas the associations between structural brain development and well-being remained significant after correction for multiple testing, the results for social media use did not survive FDR correction. These findings demonstrate that although social media use and mental well-being were both associated with differential trajectories of brain development, the associations we report are distinct. These results show a nuanced perspective on the presumed relations between social media use and well-being and provide a starting point to further examine neural mechanisms that could explain which adolescents thrive by social media and which might be harmed.

Internet-delivered cognitive therapy for social anxiety disorder in Hong Kong: A randomized controlled trial

Background

Research is needed to determine the extent to which internet-delivered psychological therapies are effective when delivered in countries and cultures outside of where they were developed.

Objective

This waitlist-controlled study evaluated the efficacy of a UK-developed, therapist-guided internet Cognitive Therapy programme for Social Anxiety Disorder (iCT-SAD) when delivered in Hong Kong by local therapists.

Methods

Patients were randomized to iCT-SAD (n = 22) or a waitlist control group (n = 22). Assessments took place at weeks 0, 8, and 15 (posttreatment/postwait), with a further 3-month follow-up assessment for the iCT-SAD group. The primary outcome measure was the Liebowitz Social Anxiety Scale (self-report), and posttreatment/postwait diagnostic assessments were completed by independent assessors blind to condition. Trial Registration: ISRCTN11357117.

Results

Compared with the waitlist group, iCT-SAD significantly reduced social anxiety symptoms (adjusted difference at posttreatment 55.36, 95%CI 44.32 to 66.39, p < 0.001; d Cohen 2.41). The treatment was also superior to waitlist on all secondary outcome measures. 86% of the iCT-SAD group demonstrated remission from SAD based on the LSAS, compared to 5% of the waitlist group. 73% no longer met diagnostic criteria at posttreatment, compared to 9% of the waitlist group. The gains made by the iCT-SAD group were maintained at three-month follow-up.

Conclusions

iCT-SAD showed strong efficacy for the treatment of SAD in Hong Kong. As the clinical outcomes were similar to UK studies, this suggests the dissemination of the treatment into a different cultural setting did not result in a substantial loss of efficacy.

Nomophobia and relationships with latent classes of solitude

Recently, nomophobia (separation anxiety from mobile phone) has become a common phenomenon. The authors' main purpose was to explore latent classes of solitude behaviors and how they are related to nomophobia. Chinese versions of the Nomophobia Scale and the Solitude Behaviour Scale were used in a sample of college students (351 female and 327 male). Latent class analysis, analysis of variance, and regression analysis were employed to classify solitude behaviors and explore the relationship between solitude and nomophobia. A six-class model best fit the data (BIC = 60086.49). Significant differences among the classes were found on nomophobia. Loneliness, social avoidance, and eccentricity significantly predicted nomophobia. Solitude behaviors of college students can be divided into six latent classes. The classes with a high response preference for solitude scored higher on nomophobia, especially the fear of losing an Internet connection. Not self-determined solitude and negative-solitude had a positive effect on nomophobia.

The relationship between depression and social avoidance of college students: A moderated mediation model

BACKGROUND

The fact that depression and anxiety are highly prevalent and often co-occur has been well documented. The present study hypothesized that loneliness and interpersonal trust mediate the relationship between depression and social anxiety, with self-esteem playing a moderating role.

METHODS

1021 college students completed the interpersonal trust scale (ITS), self-rating depression scale (SDS), UCLA loneliness scale, self-esteem scale (SES), and social avoidance and distress (SAD) scale. And descriptive statistical analysis and correlation analysis, structural equation model analysis were conducted.

RESULTS

1) The correlations between depression, loneliness, interpersonal trust, self-esteem and social avoidance were all statistically significant. 2) Loneliness and interpersonal trust mediated the relationship between depression and social avoidance. 3) Self-esteem moderated the relationship between interpersonal trust and social avoidance. Specifically, compared with individuals who had high self-esteem, social avoidance in those with low self-esteem individuals was more susceptible to the effects of interpersonal trust.

LIMITATIONS

First, the questionnaire data may be influenced by social approval. Second, most of the participants were college students. Finally, the causal relationship between the variables could not be inferred.

CONCLUSIONS

The results indicated that loneliness and interpersonal trust played mediating roles between depression and social avoidance, and the relationship between interpersonal trust and social avoidance was moderated by self-esteem. It provides a new way to explain the mechanism of depression, and a new perspective for the clinical intervention of depression, that is, from the perspective of their self-experience and self-esteem.

Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering

Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.

Social phobic beliefs mediate the relationship between post-event processing regarding the worst socially aversive experience and fear of negative evaluation

The experience of socially aversive events is proposed to be a critical etiological factor in the development of social anxiety symptoms even though the experience itself is also common among healthy individuals. Rather than the event itself, accompanying factors such as maladaptive processing might be associated with higher levels of social anxiety symptoms. One-hundred-seventy-four individuals participated in this online-survey comprising questionnaires regarding social anxiety symptoms and retrospective reports concerning maladaptive processing of the worst socially aversive event. Structural equation modelling was used to analyze the hypothesized mediation of maladaptive processing and fear of negative evaluation by intrusive re-experiencing and social phobic beliefs. The positive association between retrospectively evaluated maladaptive processing after the worst socially aversive event and fear of negative evaluation was mediated by social phobic beliefs but not by intrusive re-experiencing. These results point towards the relevance of further investigating processing strategies after socially aversive events as a potential influencing factor for SAD development. Trial registration. The trial was registered at the German Clinical Trial Register (DRKS00021502) on June 3rd, 2020.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02805-9.

Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis

Background

Stigma, social avoidance and distress may seriously affect the quality of life of infertility patients. Psychological resilience has been proved to effectively combat psychological stress. This study aimed to explore the mediating role of psychological resilience between stigma and social avoidance and distress (SAD) in females with an unfulfilled wish for a child.

Methods

Stigma Scale, Social Avoidance and Distress Scale (SADS), and Psychological Resilience Scale were used to evaluate 266 females with infertility. Structural equation model was used to test the mediating effect of psychological resilience on the relationship between stigma and SAD.

Results

The SADS, stigma scores, and psychological resilience scores of 266 females with infertility were 13.36 ± 5.77, 77.84 ± 16.91, and 58.84 ± 12.24 points, respectively. The stigma scores were positively correlated with SADS, and negatively correlated with psychological resilience scores. The psychological resilience scores were negatively correlated with SADS. Psychological resilience played a partially mediating role between the stigma and SAD of infertility patients, and the mediating effect accounted for 25.5% of the total effect.

Conclusion

Psychological resilience had a partial mediating effect on the relationship between stigma and SAD, and could reduce the negative effect of stigma on the development of SADS. Therefore, positive psychological interventions improving psychological resilience might help to reduce stigma and improve SAD in infertility patients.

Creative Self and Fear of Rejection

Abstract. Realization of creative potential in everyday life, sharing an original product or idea with others involves the risk of being rejected. In the current study, we explored the factors affecting the process of realization of creative potential in creative activities and creative achievements. We examined whether creative self-efficacy and creative personal identity, on the one hand, and fear of negative evaluation and rejection sensitivity, on the other hand, moderate the relationship between creative potential and real-life creativity (i.e., creative activities and achievements). According to the results, the relationship between creative potential and real-life creativity is stronger when people with creative potential have high creative personal identity and fear of negative evaluation scores. However, the relationship between creative potential and real-life creativity is not significant when people with creative potential have high scores on the creative self-efficacy and rejection expectancy scales (a cognitive aspect of rejection sensitivity). Possible explanations of the different results related to the different indicators of creativity and implications for future research are discussed.

Different drives of herding: An exploratory study of motivations underlying social conformity

We often align our behaviors, attitudes, and opinions in line with a majority of others, a phenomenon known as "social conformity." A seminal framework has proposed that conformity behaviors are mainly driven by three fundamental motives: a desire to gain more information to be accurate, to obtain social approval from others, and to maintain a favorable self-concept. However, previous studies usually have interpreted conformity behaviors as driven by one motive or another, largely ignoring the fact that human behaviors could be concurrently induced by multiple and even conflicting motivations. Adopting a typical conformity paradigm widely used in previous studies, we explored distinct and concurrent motives underlying the same conformity behavior, combining personality and individual differences with more nuanced analyses of observed conformity behaviors. Our findings provide novel evidence to show that three motivations exist within a single conformity behavior, suggesting that multiple motivations drive the conformity concurrently. These findings provide a potential solution for the extensive debate about what drives human social conformity and help to better understand the conformity behavior in daily life.

Sexual Self-Concept and Psychological Functioning of Women With a History of Childhood Sexual Abuse in Hong Kong

Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.

Evidence on Problematic Online Gaming and Social Anxiety over the Past Ten Years: a Systematic Literature Review

Purpose of Review

The present study aimed to review the literature concerning the relationship between problematic online gaming (POG) and social anxiety, taking into account the variables implicated in this relationship. This review included studies published between 2010 and 2020 that were indexed in major databases with the following keywords: Internet gaming, disorder, addiction, problematic, social phobia, and social anxiety.

Recent Findings

In recent years, scientific interest in POG has grown dramatically. Within this prolific research field, difficulties associated with social anxiety have been increasingly explored in relation to POG. Indeed, evidence showed that individuals who experience social anxiety are more exposed to the risk of developing an excessive or addictive gaming behavior.

Summary

A total of 30 studies satisfied the initial inclusion criteria and were included in the present literature review. Several reviewed studies found a strong association between social anxiety and online gaming disorder. Furthermore, the relationships among social anxiety, POG, age, and psychosocial and comorbid factors were largely explored. Overall, the present review showed that socially anxious individuals might perceive online video games as safer social environments than face-to-face interactions, predisposing individuals to the POG. However, in a mutually reinforcing relationship, individuals with higher POG seem to show higher social anxiety. Therefore, despite online gaming might represent an activity able to alleviate psychopathological symptoms and/or negative emotional states, people might use online gaming to counterbalance distress or negative situations in everyday life, carrying out a maladaptive coping strategy.

Social anxiety and rumination in the context of the revised reinforcement sensitivity theory and the mediation model of social anxiety

The aim of this study was to examine the relationship between temperament, ruminative thought style and social anxiety using latent variable modeling. Before examining the integrated model that specifies the relations between the constructs, relevant measurement issues were examined. The study was conducted on a heterogeneous sample from the general population that included 1,029 participants (62.1% female) aged 19 to 79. The findings show that the Behavioural Inhibition System is the most important vulnerability factor for the development of social anxiety, and it has both a direct effect and an indirect one through the ruminative thought style. Also, Freeze has an additional contribution to the increased experience of social anxiety. The Behavioural Approach System has complex effects on social anxiety ? with a direct protective effect, and indirectly ? with a facilitation of the ruminative thought style. Thus, BAS can also act as a risk factor. The findings support the revised Reinforcement Sensitivity Theory and provide a basis for the extension of the Kimbrel?s Mediation Model of Social Anxiety.

Differences in mGluR5 Availability Depending on the Level of Social Avoidance in Drug-Naïve Young Patients with Major Depressive Disorder

BACKGROUND

Previous research has shown that metabotropic glutamate receptor-5 (mGluR5) signaling is significantly involved in social avoidance. We investigated the relationship between levels of social avoidance and mGluR5 availability in drug-naïve young patients with major depressive disorder (MDD).

METHODS

Twenty non-smoking patients and eighteen matched non-smoking healthy controls underwent [¹¹C]ABP688 positron emission tomography (PET) and magnetic resonance imaging scans. The binding potential (BP_ND) of [¹¹C]ABP688 was obtained using the simplified reference tissue model. Patients' level of social avoidance was assessed using the Social Avoidance and Distress Scale (SADS). For [¹¹C]ABP688 BP_ND, the region-of-interest (ROI)-based between-group comparisons and correlations with SADS scores were investigated. The frontal cortices were chosen as a priori ROIs based on previous PET investigations in MDD, and on literature underscoring the importance of the frontal cortex in social avoidance.

RESULTS

Independent samples t-tests revealed no significant differences in [¹¹C]ABP688 BP_ND in the frontal cortices between the MDD patient group as a whole and healthy controls. One-way analysis of variance with post-hoc tests revealed significantly lower BP_ND in the bilateral superior frontal cortex (SFC) and left middle frontal cortex (MFC) in MDD patients with low levels of social avoidance (L-SADS) than in healthy controls. The L-SADS patients also had significantly lower BP_ND in the medial part of the right SFC than both MDD patients with high levels of social avoidance (H-SADS) and healthy controls. The L-SADS patients also showed significantly lower BP_ND in the orbital parts of the SFC, MFC, and inferior frontal cortex than H-SADS patients. No significant group differences were found between H-SADS patients and healthy controls. The ROI-based correlation analysis revealed significant positive correlations between social avoidance levels and frontal [¹¹C]ABP688 BP_ND in the entire patients.

CONCLUSION

Our exploratory study shows significant differences in frontal mGluR5 availability depending on the level of social avoidance in drug-naïve non-smoking MDD patients, suggesting that social avoidance should be considered as one of the clinical factors involved in mGluR5 signaling changes in depression.

Comparing evaluations of social situations for adults who do and do not stutter

PURPOSE

Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or-if like individuals with SAD-adults who stutter exhibit negative interpretation biases.

METHOD

Forty-eight adults who stutter and 42 age-and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios.

RESULTS

Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme "stuttering" was mentioned infrequently by the adults who stutter.

CONCLUSIONS

Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.

Attentional Biases in Adults Who Stutter before and following Social Threat Induction

<b><i>Purpose:</i></b> We know that adults who stutter report higher levels of social anxiety [Craig and Tran: J Fluency Disord 2014;40:35–43; Iverach et al.: J Anxiety Disord 2009;23(7):928–34]. What is not clear is whether adults who stutter develop maladaptive attentional shifts, similar to what is observed in socially anxious individuals, in response to social anxiety. The purpose of this study was to investigate the attentional biases in adults who stutter compared to adults who do not stutter before and after social evaluative threat induction and determine whether responses are associated with objective and subjective measures of anxiety. <b><i>Method:</i></b> Twelve adults who stutter and 14 matched adults who do not stutter performed a modified response time paradigm, the dot-probe task, where they responded to a probe appearing behind one of two faces, one emotional (positive or negative) and one neutral. Participant’s reaction times were measured before and after a social threat induction task. Skin conductance levels were used as an index of induced stress. Self-reports of trait and social anxiety were used as subjective measures of anxiety. <b><i>Results:</i></b> Adults who stutter compared to controls exhibited an attentional bias towards negative facial expressions following a social evaluative threat induction. This effect remained when covarying for levels of trait and social anxiety. Before social evaluative threat induction, visual inspection of the data showed that adults who stutter compared to adults who do not stutter avoided positive facial expressions as they attended more to the negative facial expressions; however, these differences were not significant. <b><i>Discussion:</i></b> This study provides evidence for a maladaptive attentional behavior in adults who stutter when undergoing feelings of social evaluative threat. Results provide rationale for research aimed at assessing the use of attention restructuring in highly anxious adults who stutter.

Aspects of Large-Enrollment Online College Science Courses That Exacerbate and Alleviate Student Anxiety

Anxiety is the top mental health concern for undergraduates. While researchers have identified ways that in-person science courses can affect anxiety, little is known about how online science courses affect anxiety. In this study, 2111 undergraduates at a large research-intensive institution completed survey questions about their anxiety in large-enrollment online science courses. Specifically, we assessed students' anxiety in the context of online science courses and asked what aspects of online science courses increase and decrease their anxiety. Students also identified what instructors can do to lessen anxiety in online classrooms. We used open coding and logistic regression to analyze student responses. More than 50% of students reported at least moderate anxiety in the context of online college science courses. Students commonly reported that the potential for personal technology issues (69.8%) and proctored exams (68.0%) increased their anxiety, while being able to access content at a later time (79.0%) and attending class from where they want (74.2%) decreased their anxiety. The most common ways that students suggested that instructors could decrease student anxiety is to increase test-taking flexibility (25.0%) and be understanding (23.1%). This study provides insight into how instructors can create more inclusive online learning environments for students with anxiety.

The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study

BACKGROUND

Dental anxiety is of public health importance because it leads to postponed dental treatment, which comes with health complications. The present study investigated whether there is a correlation between the degree of dental anxiety and other kinds of anxiety and whether there are prognostic factors for the different kinds of anxiety.

METHOD

In the sample (N = 156) from a dental practice in a large German city, 62% of patients received a check-examination and 38% received dental surgery. The target variables were recorded with validated questionnaires: dental anxiety (IDAF-4c+), subclinical anxiety (SubA), anxiety of negative evaluation (SANB-5), current general anxiety (STAI state), loneliness (LS-S) and self-efficacy (GSW-6). The applied statistics were: t-tests for 31 variables, correlation matrix and multivariate and bivariate regression analyses.

RESULTS

The dental surgery patients displayed more dental anxiety and more dental interventions than the check-examination group. The main result was a positive correlation of all kinds of anxiety with each other, a positive correlation of loneliness and neuroticism with all forms of anxiety and a negative correlation between all forms of anxiety and self-efficacy. Especially dental anxiety is positively associated with other kinds of anxiety. In multivariate regression models only neuroticism is associated with dental anxiety, but feelings of loneliness are positively associated with with the other kinds of anxiety assessed in this study. The higher the self-efficacy, the lower the level of general anxiety.

CONCLUSIONS

In dentistry, anxiety from negative experiences with buccal interventions should be distinguished from anxiety caused by personality traits. Self-efficacy tends to protect against anxiety, while loneliness and neuroticism are direct or indirect risk factors for anxiety in this urban dentistry sample. Dental anxiety seems to be independent from biographical strains but not from neuroticism. In practice, more attention must be paid to anxiety control, self-management and efforts to improve the confidence of patients with emotional lability, less self-confidence and propensity to shame.

Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan

Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

The Impact of the COVID-19 Pandemic on Chinese Postgraduate Students' Mental Health

To understand the mental health status of Chinese postgraduate students during the COVID-19 pandemic, we used three online questionnaires: self-rating anxiety (SAS) scale, self-rating depression (SDS) scale, and social avoidance and distress (SAD) scale. A total of 3137 postgraduate students from different regions of China participated in our study. We explored the relationship between participant characteristics and mental health using an analysis of variance (ANOVA). We found that the proportions of respondents with severe, mild, and moderate depression were 1.4%, 10.48%, and 21.99%, respectively, and the corresponding proportions of respondents with anxiety were 1.56%, 4.65%, and 14.69%, respectively. A one-way ANOVA revealed that the mental health statuses of the participants were different between the subgroups based on majors, classes, degree types, and the method of communication with advisors and students. A two-way ANOVA revealed significant effects on interaction and the method of communication with advisors and peers. These findings suggest that the mental health of postgraduate students should be monitored during the pandemic, especially when they are unable to communicate directly with their advisors or peers, and targeted psychological counselling must be focused on anxiety and depression.

Validity of the 15-item social inhibition questionnaire in outpatients receiving psychological or psychiatric treatment: The association between social inhibition and affective symptoms

OBJECTIVE

Social inhibition may promote symptoms of depression and anxiety in adults from an outpatient hospital population. The current work builds on a previously corroborated construct of social inhibition and examines the psychometric properties of this assessment tool and its predictive validity in the adult outpatient hospital population.

METHODS

A total of 350 adult outpatients receiving treatment at the department of Medical Psychology or Psychiatry completed measures of social inhibition and symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire). Factor analyses, reliability estimates, and regression analyses were used to replicate the robustness of the model of social inhibition, and the 15-item Social Inhibition Questionnaire (SIQ15).

RESULTS

In the current sample (N = 350; M_age = 45 years; 67.4% women), factor analyses confirmed the previously suggested three-factor model of social inhibition as measured by the SIQ15. The subscales of behavioral inhibition, interpersonal sensitivity and social withdrawal proved to be internally consistent (Cronbach's α between 0.87/0.95) and stable over time (test-retest reliability between r = 0.76/0.83). At baseline, interpersonal sensitivity and social withdrawal were associated with anxiety and depressive symptoms. At three months follow-up, only interpersonal sensitivity was related to depressive symptoms.

CONCLUSIONS

Social inhibition is associated with anxiety and depression at baseline and can be reliably assessed with the SIQ15 in an outpatient hospital population. The association of interpersonal sensitivity with depressive symptoms at three-month follow-up suggests an important aim for future research on the development of preventive methods for affective symptoms in socially inhibited outpatients.

The Impact of the COVID-19 Pandemic on the Anxiety of Adolescents in Québec

Background

Several studies conducted since the beginning of the COVID-19 pandemic have shown its harmful effects on young people’s mental health. In Québec and Canada, few studies have focussed on adolescents, and even fewer of these studies have examined this subject using a methodology that involved comparisons of data obtained before and during the pandemic, which is the purpose of this study.

Objective

The objective of this study is to determine the impact of the COVID-19 pandemic on the anxiety of secondary 1 and 2 students in Québec, using data obtained before and during the pandemic.

Method

Participants were 2990 French Canadian students in secondary 1 (grade 7) and secondary 2 (grade 8) in Québec. Two independent samples completed the questionnaires, one sample before the pandemic (fall 2019) and one sample during the pandemic (fall 2020). Their answers were subjected to descriptive analysis and multivariate analysis of variance.

Results

Results show that the pandemic has had variable impacts on the student’s mental health, with some of them reporting negative effects on their lives, others reporting no effect, and some reporting positive effect. However, the students surveyed during the pandemic generally reported more symptoms of generalized anxiety, and higher levels of test anxiety, fear of judgment and perfectionism than the ones surveyed before the pandemic.

Conclusions

The discussion puts forward possible explanations for the results obtained, which contribute to a better understanding of young adolescents’ experience during the COVID-19 pandemic. It also discusses the importance of developing interventions for adolescents affected by this pandemic.

Situational Embarrassment and Its Relationship to Social Anxiety in Adults Who Stutter

Purpose Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS. Method AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated. Results Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety.

Influence of learning flow and distance e-learning satisfaction on learning outcomes and the moderated mediation effect of social-evaluative anxiety in nursing college students during the COVID-19 pandemic: A cross-sectional study

Aim

The purpose of this study was to examine the potential mechanism underlying the association between learning flow and learning outcomes in nursing students in South Korea during the pandemic. In particular, we examined the mediation effect of distance e-learning satisfaction moderated by social-evaluative anxiety related to COVID-19 on the relationship between learning flow and learning outcomes.

Background

Despite the COVID-19 pandemic, the education of nursing students has continued by shifting the manner of delivering their education. Distance e-learning is being widely used under the strong social distancing policies currently in place and many educators are struggling to enhance the efficiency of this distance e-learning.

Methods

A cross-sectional study was conducted among 310 nursing students attending two colleges in South Korea. Data were collected from December 2–15 in 2020 by using an online survey.

Results

As a result, an association was observed between learning flow and learning outcomes and distance e-learning satisfaction mediated this association. Importantly, social-evaluative anxiety caused by COVID-19 moderated the mediation effect of distance e-learning satisfaction. Students’ anxiety related to COVID-19 played a negative role in the distance e-learning mechanism for nursing students.

Conclusions

It is thus necessary for educators and staff in nursing schools to exert effort to reduce students’ COVID-19-related anxiety to enhance the outcomes of distance e-learning in nursing students.

Fear of Evaluation and Online Self-Disclosure on WeChat: Moderating Effects of Protective Face Orientation

Fear of evaluation is a key factor that affects how social media users present themselves to others, but little is known about the effects and mechanisms involved, especially on the relationship between fear of positive evaluation and online self-disclosure. This study explores how fear of evaluation affects online self-disclosure and examines how this relationship is moderated by protective face orientation in the Chinese context. A total of 750 Chinese WeChat users constituted the sample for a questionnaire-based analysis and regression analysis. The results showed that both fear of positive evaluation and fear of negative evaluation had a significant negative effect on the amount of online self-disclosure and a significant positive effect on the depth of online self-disclosure. Protective face orientation had a moderating effect on the relationship between fear of evaluation and online self-disclosure for both the amount and depth of online self-disclosure. Our findings suggest that social network site (SNS) users' fear of evaluation can be attributed to their cognitive attitude toward the external environment, and the loss of face in the Chinese context can be included in the social context.

Impact of attention-deficit/hyperactivity disorder comorbidity on longitudinal course in Internet gaming disorder: a 3-year clinical cohort study

BACKGROUND

Although attention-deficit/hyperactivity disorder (ADHD) symptoms were identified as a key risk factor for Internet gaming disorder (IGD), the effect of ADHD comorbidity on longitudinal course of IGD in the clinical population remains to be further examined. This study aimed to investigate whether ADHD comorbidity in IGD patients affects the recovery, recurrence rates, and trajectories of IGD symptoms, and examine the relationship between the changes in IGD and ADHD symptoms.

METHODS

The study included 128 IGD patients without any psychiatric comorbidities (pure-IGD group) and 127 IGD patients with comorbid ADHD (ADHD-IGD group) aged 11 to 42 years. IGD and ADHD were diagnosed according to DSM-5 criteria at enrollment. Participants were offered 8-week treatment with additional care provided as needed and followed up over a 3-year period. IGD diagnosis was reassessed annually and used as a dichotomous outcome. The severity of IGD and ADHD symptoms was measured using the Young Internet Addiction Scale and the Korean ADHD rating scale, respectively, at baseline and each annual follow-up.

RESULTS

The recovery rates of IGD by Year 3 were 60% and 93% in ADHD-IGD and in pure-IGD groups, respectively. The ADHD-IGD group showed lower rates of recovery, higher odds of recurrence within 1 year, and higher severity of IGD symptoms over time than the pure-IGD group. Family environment was also associated with the trajectories of IGD symptoms. The changes in ADHD symptoms were significantly associated with the changes in IGD symptoms.

CONCLUSIONS

This study found that ADHD comorbidity in IGD patients was associated with poor clinical course of IGD and that the changes in ADHD symptoms were associated with the changes in IGD symptoms over time. Our findings suggest that evaluation and treatment of ADHD symptoms and family environment in IGD patients may be important in improving the prognosis of IGD.