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Carpita B, Nardi B, Bonelli C, Massimetti E, Amatori G, Cremone IM, Pini S, Dell’Osso L. Presence and correlates of autistic traits among patients with social anxiety disorder. Front Psychiatry 2024; 14:1320558. [PMID: 38312918 PMCID: PMC10834675 DOI: 10.3389/fpsyt.2023.1320558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Due to their similar behavioral presentation, it can sometimes be challenging to distinguish between a social anxiety disorder (SAD) and the social avoidance that is frequently described in autism spectrum disorder (ASD). Moreover, a growing body of evidences is reporting that a significant proportion of subjects with ASD also meet the requirements for SAD and, vice versa, subjects with SAD tend to exhibit a higher prevalence of autistic traits. Aim In this framework, the current study aims to evaluate prevalence and correlates of autistic traits in a sample of adult subjects diagnosed with SAD and healthy controls (HC), also evaluating which autism spectrum dimensions may statistically predict higher SAD symptoms. Methods 56 subjects with a clinical diagnosis of SAD and 56 gender and age matched HC were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Social Anxiety Spectrum - Short Version (SHY- SV) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum). Results SAD group scored significantly higher in all AdAS Spectrum and SHY-SV domains and total score compared to the HC group with no significant gender difference. SHY-SV total and domain scores, were strongly and positively and strongly correlated with all AdAS Spectrum domains and total score. AdAS Spectrum total score and Childhood/Adolescence, Non-Verbal Communication, Empathy and Restricted interests and Rumination domain scores score were significant predictors of higher SHY-SV score. Conclusion Our results confirm the link between SAD and autistic traits also in adult population, describing not only high levels of autistic traits in SAD adults, but also significant correlations between many core features of the two disorders and a predictive role of autistic traits on higher SAD symptoms.
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Affiliation(s)
- Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Massimetti
- North-Western Tuscany Region NHS Local Health Unit, Department of Psychiatry, Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Dell'Osso L, Cremone IM, Nardi B, Amatori G, Bonelli C, Gravina D, Benedetti F, Del Prete L, Massimetti G, Carpita B. Measuring the neglected anxiety disorder: validation of the social anxiety spectrum-short version (SHY-SV) questionnaire. BMC Psychiatry 2023; 23:708. [PMID: 37784074 PMCID: PMC10544616 DOI: 10.1186/s12888-023-05137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND In the recent years, a growing body of literature stressed the importance of a dimensional perspective on mental disorders. In particular, since its conceptualization, one of the main concerns in the field of Social Anxiety Disorder (SAD) has been the definition of a diagnostic threshold, leading to the suggestion that SAD may be more properly classified as a spectrum of severity rather than a discrete disorder based on subjectively determined threshold. The purpose of the current research is to evaluate the psychometric qualities of the Social Anxiety Spectrum - Short Version (SHY-SV), a novel questionnaire designed to measure the complete range of social anxiety symptoms, from overt manifestations to subthreshold ones. METHODS 42 subjects with a clinical diagnosis of social anxiety disorder (SAD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 43 subjects with a clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, Liebowitz Social Anxiety Scale (LSAS) and the SHY-SV. RESULTS SHY-SV showed strong internal consistency, and both the total and domain scores had great test-retest reliability. The Pearson's coefficients for the SHY-SV domain scores ranged from 0.391 to 0.933, and they were positively and significantly correlated with one another (p 0.001). All the SHY-SV domain scores were highly correlated with the SHY-SV total score. Results from of the correlation coefficients between SHY-SV and alternative measures of SAD were all significant and positive. Significant differences among diagnostic groups on both SAD-SV domains and total scores were found. SAD-SV total score increased significantly and progressively from HCs, to the OCD up to the SAD group which showed the highest values. CONCLUSION The SHY-SV demonstrated significant convergent validity with other dimensional SAD measures, great internal consistency, and test-retest reliability. With an increasing score gradient from healthy controls to patients with OCD to those with SAD, the questionnaire performed differently in each of the three diagnostic categories.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy.
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Luca Del Prete
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56127, Italy
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Zha Y, Tang Q, Jin X, Cai X, Gong W, Shao Y, Weng X. Development of social anxiety cognition scale for college students: Basing on Hofmann's model of social anxiety disorder. Front Psychol 2023; 14:1080099. [PMID: 36743247 PMCID: PMC9892844 DOI: 10.3389/fpsyg.2023.1080099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction To develop the Chinese version of the Social Anxiety Cognition Scale for College Students (SACS-CS) based on Hofmann's model of social anxiety disorder and examine its reliability and validity. Methods Based on literature analysis and structured interviews, a theoretical model was constructed and behavioral examples were collected. According to the results of participants' and experts' evaluations, the initial SACS-CS was developed. The study data were collected from a total of 500 valid participants, randomly divided into two samples. Sample 1 (n = 200) and sample 2 (n = 300) were considered for exploratory factor analysis and confirmatory factor analysis (CFA), respectively. Internal reliability and validity were examined using all 500 participants, and temporal reliability was established using sample 3 (n = 70), who completed the scale again after 4 weeks. Results The SACS-CS consists of 21 items, grouped under four factors: self-perception, social skills, emotional control, and cost estimation. The four-factor model fits well. The internal consistency coefficient of the scale and the four factors ranged from 0.87 to 0.96, and the test-retest reliability ranged from 0.76 to 0.84. The scores of the scale and the four factors were significantly correlated with the score of the Interaction Anxiousness Scale (r = 0.54-0.64). Discussion The SACS-CS possesses good reliability and validity and can be applied in the cognitive assessment of college students' social anxiety. The scale could help people with different social anxiety disorder conditions receive more personalized interventions.
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Affiliation(s)
- Yuxin Zha
- School of Psychology, Beijing Sport University, Beijing, China
| | - Qin Tang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xiaoru Jin
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xinfei Cai
- School of Psychology, Beijing Sport University, Beijing, China
| | - Wen Gong
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing, China,*Correspondence: Yongcong Shao, ✉
| | - Xiechuan Weng
- Department of Neuroscience, Beijing Institute of Basic Medical Sciences, Beijing, China,Xiechuan Weng, ✉
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Tse ZWM, Emad S, Hasan MK, Papathanasiou IV, Rehman IU, Lee KY. School-based cognitive-behavioural therapy for children and adolescents with social anxiety disorder and social anxiety symptoms: A systematic review. PLoS One 2023; 18:e0283329. [PMID: 36940221 PMCID: PMC10027184 DOI: 10.1371/journal.pone.0283329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is prevalent among children and adolescents. Cognitive-behavioural therapy (CBT) has been used as the first-line treatment. However, evaluation of CBT conducted in a school setting has been scarce. OBJECTIVES This study aims to review the CBT and its effectiveness in the school setting for children and adolescents with SAD or social anxiety symptoms. Quality assessment on individual studies was conducted. METHODS Studies were identified through the search in PsycINFO, ERIC, PubMed and Medline targeting CBT conducted in a school setting with an aim to treat children and adolescents with SAD or social anxiety symptoms. Randomised controlled trials and quasi-experimental studies were selected. RESULTS A total of 7 studies met the inclusion criteria. Five studies were randomised controlled trials, and two were quasi-experimental studies with 2558 participants aged 6-16 years from 138 primary schools and 20 secondary schools. There were minor effects to reduce social anxiety symptoms for children and adolescents at post-intervention in 86% of the selected studies. Friend for Life (FRIENDS), Super Skills for Life (SSL) and Skills for Academic and Social Success (SASS) conducted in school were more effective than the control conditions. CONCLUSIONS There is a lack of quality of the evidence for FRIENDS, SSL and SASS, due to inconsistencies on the outcome assessments, statistical analyses, and the fidelity measures adopted in individual studies. Insufficient school funding and workforce with relevant health background, and the low level of parental involvement in the intervention would be the major challenges in school-based CBT for children and adolescents with SAD or social anxiety symptoms.
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Affiliation(s)
- Zoie Wai Man Tse
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Shaista Emad
- Department of Biochemistry, Jinnah Medical & Dental College, Sohail University, Karachi, Pakistan
| | - Md Kamrul Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | | | - Ka Yiu Lee
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden Univerisity, Östersund, Sweden
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Mo QZL, Bai BY. Height dissatisfaction and loneliness among adolescents: the chain mediating role of social anxiety and social support. CURRENT PSYCHOLOGY 2022; 42:1-9. [PMID: 36277262 PMCID: PMC9579572 DOI: 10.1007/s12144-022-03855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/12/2022]
Abstract
Previous research on body dissatisfaction has mainly focused on the dissatisfaction with weight and appearance. Limited research has examined the dissatisfaction with another major body feature that is important to our social relationships and personal well-being, namely, body height. We hypothesized that height dissatisfaction would predict more intense loneliness among adolescents, and that this relationship is mediated by greater social anxiety and reduced social support. Participants of this study were 515 Chinese high school students. The Shortness subscale of the Negative Physical Self Scale, Social Anxiety Scale for Adolescents, Perceived Social Support Scale, and ULS-8 were integrated into a paper-and-pencil survey. The results revealed that adolescents with high levels of height dissatisfaction reported higher levels of loneliness. A chain mediation model showed that the relationship between height dissatisfaction and loneliness could be both sequentially mediated by social anxiety and social support, and mediated by social anxiety. However, no mediating role of social support was found. We also found that body height did not predict social anxiety or social support, but can predict loneliness. The current findings provide novel insights into the occurrence of loneliness among adolescents, and indicate that negative self-perceptions of body height and the resulting social anxiety can lead to loneliness.
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Affiliation(s)
- Qin-zi Li Mo
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, 430072 People’s Republic of China
| | - Bao-yu Bai
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, 430072 People’s Republic of China
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Arai H, Ishikawa SI, Okawa S, Kishida K, Korte KJ, Schmidt NB. Safety aid elimination as a brief, preventative intervention for social anxiety: A randomized controlled trial in university students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractAlthough there are a variety of treatment options for social anxiety, effective prevention strategies for those with subclinical social anxiety are limited. This study evaluated a single session group formatted prevention program focused on the reduction of safety behaviors in both a proof-of-concept study and a randomized controlled trial (RCT). Participants (N = 59) were nontreatment seeking Japanese university students with high levels of social anxiety. Participants were randomized to either an active treatment focused on identification and elimination of safety behavior or a control group involving the discussion of healthy coping strategies. Both conditions met for 120 min in small groups (4 to 6 participants per group). The preliminary proof-of-concept study as well as the RCT demonstrated high levels of acceptability. Findings from the RCT indicated significant improvement in social anxiety symptoms among those in the active treatment condition at post-treatment, which was maintained at follow-up. In addition, participants in the treatment condition showed significant improvement in levels of depression. The effect size difference in symptoms between conditions was in the large range. The present study provides preliminary support for the efficacy of a newly developed treatment program targeting safety behaviors in students with subclinical social anxiety. The current results also illustrate the promise of a brief, indicated prevention strategy focused on safety behavior among those with subclinical social anxiety.
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Wechsler TF, Pfaller M, van Eickels RE, Schulz LH, Mühlberger A. Look at the Audience? A Randomized Controlled Study of Shifting Attention From Self-Focus to Nonsocial vs. Social External Stimuli During Virtual Reality Exposure to Public Speaking in Social Anxiety. Front Psychiatry 2021; 12:751272. [PMID: 34970163 PMCID: PMC8712494 DOI: 10.3389/fpsyt.2021.751272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli. Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects. Results: Within the analysis sample (n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group. Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.
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Affiliation(s)
- Theresa F. Wechsler
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
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Swee MB, Hudson CC, Heimberg RG. Examining the relationship between shame and social anxiety disorder: A systematic review. Clin Psychol Rev 2021; 90:102088. [PMID: 34598054 DOI: 10.1016/j.cpr.2021.102088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
This paper is the first systematic review of the literature on the relationship between shame and social anxiety (SA). We reviewed a total of 60 peer-reviewed empirical articles that met criteria for inclusion. We begin by summarizing literature investigating the empirical association between shame and SA and review literature on whether this association is impacted by cultural or diagnostic differences. Next, we briefly describe the updated version of Rapee and Heimberg's (1997) cognitive-behavioral model of social anxiety disorder (SAD; Heimberg, Brozovich, & Rapee, 2014) and propose how shame may interact with five processes described therein: environmental experiences, observations/images of the self, perceived negative evaluation by others, post-event cognitive processes, and behavioral manifestations of SA. We review the current literature on shame and SA as it relates to each of these domains. Thereafter, we discuss existing research on the role of shame in the treatment of SAD and the implications of the research discussed in this review. Finally, we conclude with a discussion of some key limitations in the existing literature and areas for future research.
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Affiliation(s)
- Michaela B Swee
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
| | - Chloe C Hudson
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON K7L 3N6, Canada.
| | - Richard G Heimberg
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
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Anderl C, Dorrough AR, Rohrbeck M, Glöckner A. The effects of trait social anxiety on affective and behavioral reactions to others' resource allocations. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Christine Anderl
- Social Media Lab Leibniz‐Institut für Wissensmedien Tübingen Germany
- Department of Psychology University of British Columbia Vancouver British Columbia Canada
| | | | - Mariví Rohrbeck
- Department of Psychology FernUniversität Hagen Hagen Germany
| | - Andreas Glöckner
- Social Cognition Center Cologne University of Cologne Cologne Germany
- Department of Psychology FernUniversität Hagen Hagen Germany
- Behavioral Law and Economics Max Planck Institute for Research on Collective Goods Bonn Germany
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Hahn CM, Hahn IG, Campbell LJ. Social Anxiety and Depression in Romantic Relationships: A Three-Sample Exploration. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Social anxiety contributes to a variety of interpersonal difficulties and dysfunctions. Socially anxious adults are less likely to marry and more likely to divorce than are non-anxious adults. The present pre-registered study investigated incremental variance accounted for by social anxiety in relationship satisfaction, commitment, trust, and social support. Methods: Three independent samples of adults (N = 888; 53.7% female; Mage = 35.09 years) involved in a romantic relationship completed online self-report questionnaires. Both social anxiety and depression were significantly correlated with relationship satisfaction, commitment, dyadic trust, and social support. Hierarchical regression analyses were conducted with each sample to investigate the incremental variance accounted for by each of social anxiety and depression in relationship satisfaction, commitment, dyadic trust, and social support. Subsequent meta-analyses were run to determine the strength and replicability of the hierarchical models. Results: Results suggest that social anxiety is a robust predictor of unique variance in both perceived social support and commitment. Depression was a robust predictor of unique variance in relationship satisfaction, dyadic trust, social support, and commitment. Discussion: These results help to further understanding of social anxiety in romantic relationships and provide direction for future research and clinical intervention.
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Vilaplana-Pérez A, Pérez-Vigil A, Sidorchuk A, Brander G, Isomura K, Hesselmark E, Kuja-Halkola R, Larsson H, Mataix-Cols D, Fernández de la Cruz L. Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan. Psychol Med 2021; 51:861-869. [PMID: 31907098 PMCID: PMC8108394 DOI: 10.1017/s0033291719003908] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) has been linked to academic underachievement, but previous studies had methodological limitations. We investigated the association between SAD and objective indicators of educational performance, controlling for a number of covariates and unmeasured confounders shared between siblings. METHODS This population-based birth cohort study included 2 238 837 individuals born in Sweden between 1973 and 1997, followed-up until 2013. Within the cohort, 15 755 individuals had a recorded ICD-10 diagnosis of SAD in the Swedish National Patient Register. Logistic regression models tested the association between SAD and educational performance. We also identified 6488 families with full siblings discordant for SAD. RESULTS Compared to unexposed individuals, individuals diagnosed with SAD were less likely to pass all subjects in the last year of compulsory education [adjusted odds ratios (aOR) ranging from 0.19 to 0.44] and less likely to be eligible for a vocational or academic programme in upper secondary education [aOR = 0.31 (95% confidence interval [CI] 0.30-0.33) and aOR = 0.52 (95% CI 0.50-0.55), respectively], finish upper secondary education [aOR = 0.19 (95% CI 0.19-0.20)], start a university degree [aOR = 0.47 (95% CI 0.45-0.49)], obtain a university degree [aOR = 0.35 (95% CI 0.33-0.37)], and finish postgraduate education [aOR = 0.58 (95% CI 0.43-0.80)]. Results were attenuated but remained statistically significant in adjusted sibling comparison models. When psychiatric comorbidities were taken into account, the results were largely unchanged. CONCLUSIONS Treatment-seeking individuals with SAD have substantially impaired academic performance throughout the formative years. Early detection and intervention are warranted to minimise the long-term socioeconomic impact of the disorder.
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Affiliation(s)
- Alba Vilaplana-Pérez
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Departament de Personalitat, Avaluació i Tractaments Psicològics, Universitat de València, València, Spain
| | - Ana Pérez-Vigil
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Sidorchuk
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Hesselmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Golombek K, Lidle L, Tuschen-Caffier B, Schmitz J, Vierrath V. The role of emotion regulation in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1479-1501. [PMID: 31201527 DOI: 10.1007/s00787-019-01359-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/27/2019] [Indexed: 01/04/2023]
Abstract
While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.
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Affiliation(s)
- Kristin Golombek
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Leonie Lidle
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Julian Schmitz
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Verena Vierrath
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany.
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Hur J, DeYoung KA, Islam S, Anderson AS, Barstead MG, Shackman AJ. Social context and the real-world consequences of social anxiety. Psychol Med 2020; 50:1989-2000. [PMID: 31423954 PMCID: PMC7028452 DOI: 10.1017/s0033291719002022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Social anxiety lies on a continuum, and young adults with elevated symptoms are at risk for developing a range of psychiatric disorders. Yet relatively little is known about the factors that govern the hour-by-hour experience and expression of social anxiety in the real world. METHODS Here we used smartphone-based ecological momentary assessment (EMA) to intensively sample emotional experience across different social contexts in the daily lives of 228 young adults selectively recruited to represent a broad spectrum of social anxiety symptoms. RESULTS Leveraging data from over 11 000 real-world assessments, our results highlight the central role of close friends, family members, and romantic partners. The presence of such close companions was associated with enhanced mood, yet socially anxious individuals had fewer confidants and spent less time with the close companions that they do have. Although higher levels of social anxiety were associated with a general worsening of mood, socially anxious individuals appear to derive larger benefits - lower levels of negative affect, anxiety, and depression - from their close companions. In contrast, variation in social anxiety was unrelated to the amount of time spent with strangers, co-workers, and acquaintances; and we uncovered no evidence of emotional hypersensitivity to these less-familiar individuals. CONCLUSIONS These findings provide a framework for understanding the deleterious consequences of social anxiety in emerging adulthood and set the stage for developing improved intervention strategies.
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Affiliation(s)
- Juyoen Hur
- Department of Psychology, University of Maryland, College Park, MD 20742 USA
| | - Kathryn A. DeYoung
- Department of Psychology, University of Maryland, College Park, MD 20742 USA
- Department of Family Science, University of Maryland, College Park, MD 20742 USA
- Department of Center for Healthy Families, University of Maryland, College Park, MD 20742 USA
| | - Samiha Islam
- Department of Psychology, University of Maryland, College Park, MD 20742 USA
| | - Allegra S. Anderson
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN 37240 USA
| | - Matthew G. Barstead
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742
USA
| | - Alexander J. Shackman
- Department of Psychology, University of Maryland, College Park, MD 20742 USA
- Department of Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742
USA
- Department of Maryland Neuroimaging Center, University of Maryland, College Park, MD 20742 USA
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14
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Barnett MD, Maciel IV, Johnson DM, Ciepluch I. Social Anxiety and Perceived Social Support: Gender Differences and the Mediating Role of Communication Styles. Psychol Rep 2020; 124:70-87. [PMID: 31959096 DOI: 10.1177/0033294119900975] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Social anxiety has been linked with lower perceived social support, and there is some evidence that communication styles may explain this relationship. In addition, a body of literature has found gender differences in social anxiety, communication, and perceived social support. The purpose of this exploratory study was to investigate six communication styles as mediators of the relationship between social anxiety and perceived social support and whether such relationships vary by gender. College men and women (N = 813) completed an online survey. Among men and women, social anxiety was associated with lower social support through lower expressiveness. Among men, social anxiety was associated with lower perceived social support through lower preciseness; among women, this link was through lower verbal aggressiveness and higher emotionality. Psychotherapy may function as an environment in which socially anxious individuals can learn communication skills and acquire the confidence to use them in order to increase perceived social support.
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Affiliation(s)
- Michael D Barnett
- Department of Psychology and Counseling, The University of Texas at Tyler, TX, USA
| | - Idalia V Maciel
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, TX, USA
| | - Dylan M Johnson
- Department of Industrial Organizational Psychology, University of Houston at Clear Lake, TX, USA
| | - Ilona Ciepluch
- Department of Psychology, University of North Texas, TX, USA
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15
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Yang L, Zhou X, Pu J, Liu L, Cuijpers P, Zhang Y, Zhang H, Yuan S, Teng T, Tian L, Xie P. Efficacy and acceptability of psychological interventions for social anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. Eur Child Adolesc Psychiatry 2019; 28:79-89. [PMID: 30006672 DOI: 10.1007/s00787-018-1189-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
Abstract
Social anxiety disorder (SAD) is highly prevalent and persistent in children and adolescents. However, evidence for the efficacy and acceptability of psychological interventions for SAD in children and adolescents remains unclear. Seven electronic databases (PubMed, CENTRAL, Embase, Web of Science, PsycINFO, CINAHL, and ProQuest) were searched. Randomized controlled trials (RCTs) that compared psychological interventions for SAD with control conditions in children and adolescents were included. Primary outcomes were the efficacy (mean change in anxiety symptom scores) and acceptability (dropouts for all reasons). Secondary outcomes were remission, quality of life/functional improvement, and depressive symptoms measures. Seventeen RCTs were included in this meta-analysis. Psychological interventions (including cognitive behavioral therapy and behavioral therapy) were significantly more effective than control conditions, with a standardized mean difference (SMD) of - 1.13, and remission with a risk ratio (RR) of 8.99, the number needed to treat was 3.3. There was no statistically significant difference between psychological interventions and control conditions for all-cause dropouts (RR = 1.00). Psychological interventions were superior to control conditions in improving quality of life/functioning (SMD = 0.79) and reducing depressive symptoms (SMD = - 0.39). Given considerable heterogeneity of primary efficacy outcome, a series of subgroup analyses of different variables were conducted. Psychological interventions are probably efficacious in the treatment of SAD among children and adolescents, and may markedly improve quality of life and functioning in this population. However, this finding should be interpreted with caution because of the high heterogeneity of trials and low literature quality.
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Affiliation(s)
- Lining Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Juncai Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Lanxiang Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Yuqing Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Hanping Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Shuai Yuan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Teng Teng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Lu Tian
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
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16
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Porter E, Chambless DL, Keefe JR, Allred KM, Brier MJ. Social Anxiety Disorder and Perceived Criticism in Intimate Relationships: Comparisons With Normal and Clinical Control Groups. Behav Ther 2019; 50:241-253. [PMID: 30661563 DOI: 10.1016/j.beth.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in socially anxious individuals' relationships. In the present study, we compared levels of perceived, expressed, and observed criticism and reactions to criticism among individuals with SAD and their partners (n = 21), individuals with other anxiety disorders and their partners (n = 35), and couples free of psychopathology (n = 30). Participants rated both global criticism and criticism during a 10-minute problem-solving task, which was also coded for criticism by observers. Individuals with anxiety disorders showed elevated levels of interaction-specific perceived criticism, expressed criticism, and upset and stress due to criticism relative to normal controls; they also reported that the interaction was more stressful. However, there were no group differences on global measures of criticism, and the two anxious groups did not differ on any measures. Findings suggest that the high levels of criticism anxious individuals perceive and their corresponding negative reactions to criticism, though not specific to SAD, may account for some of the relationship difficulties that have been identified in SAD. Results also indicate that anxious individuals may contribute to their relationship difficulties by being highly critical themselves. Overall, our findings point to the need for a clinical focus on decreasing perceived criticism among individuals with anxiety disorders.
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17
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Reduced reciprocal giving in social anxiety - Evidence from the Trust Game. J Behav Ther Exp Psychiatry 2018; 59:12-18. [PMID: 29121505 DOI: 10.1016/j.jbtep.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/16/2017] [Accepted: 10/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Social anxiety is known to impair interpersonal relationships. These impairments are thought to partly arise from difficulties to engage in affiliative interactions with others, such as sharing favors or reciprocating prosocial acts. Here, we examined whether individuals high compared to low in social anxiety differ in giving towards strangers in an economic game paradigm. METHODS One hundred and twenty seven non-clinical participants who had been pre-screened to be either particularly high or low in social anxiety played an incentivized Trust Game to assess trustful and reciprocal giving towards strangers in addition to providing information on real life interpersonal functioning (perceived social support and attachment style). RESULTS We found that reciprocal, but not trustful giving, was significantly decreased among highly socially anxious individuals. Both social anxiety and reciprocal giving furthermore showed significant associations with self-reported real life interpersonal functioning. LIMITATIONS Participants played the Trust Game with the strategy method; results need replication with a clinical sample. CONCLUSIONS Individuals high in social anxiety showed reduced reciprocal, but intact trustful giving, pointing to a constraint in responsiveness. The research may contribute to the development of new treatment and prevention programs to reduce the interpersonal impairments in socially anxious individuals.
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Cohen JN, Taylor Dryman M, Morrison AS, Gilbert KE, Heimberg RG, Gruber J. Positive and Negative Affect as Links Between Social Anxiety and Depression: Predicting Concurrent and Prospective Mood Symptoms in Unipolar and Bipolar Mood Disorders. Behav Ther 2017; 48:820-833. [PMID: 29029678 PMCID: PMC6028186 DOI: 10.1016/j.beth.2017.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022]
Abstract
The co-occurrence of social anxiety and depression is associated with increased functional impairment and a more severe course of illness. Social anxiety disorder is unique among the anxiety disorders in sharing an affective profile with depression, characterized by low levels of positive affect (PA) and high levels of negative affect (NA). Yet it remains unclear how this shared affective profile contributes to the covariation of social anxiety and depressive symptoms. We examined whether self-reported PA and NA accounted for unique variance in the association between social anxiety and depressive symptoms across three groups (individuals with remitted bipolar disorder, type I [BD; n = 32], individuals with remitted major depressive disorder [MDD; n = 31], and nonpsychiatric controls [n = 30]) at baseline and follow-ups of 6 and 12 months. Low levels of PA, but not NA, accounted for unique variance in both concurrent and prospective associations between social anxiety and depression in the BD group; in contrast, high levels of NA, but not PA, accounted for unique variance in concurrent and prospective associations between social anxiety and depression in the MDD group. Limitations include that social anxiety and PA/NA were assessed concurrently and all measurement was self-report. Few individuals with MDD/BD met current diagnostic criteria for social anxiety disorder. There was some attrition at follow-up assessments. Results suggest that affective mechanisms may contribute to the high rates of co-occurrence of social anxiety and depression in both MDD and BD. Implications of the differential role of PA and NA in the relationship between social anxiety and depression in MDD and BD and considerations for treatment are discussed.
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19
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Cooper D, Anderson T. Interpersonal Subtypes Within Social Anxiety: The Identification of Distinct Social Features. J Pers Assess 2017; 101:64-72. [PMID: 28980830 DOI: 10.1080/00223891.2017.1373116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although social anxiety disorder is defined by anxiety-related symptoms, little research has focused on the interpersonal features of social anxiety. Prior studies (Cain, Pincus, & Grosse Holtforth, 2010; Kachin, Newman, & Pincus, 2001) identified distinct subgroups of socially anxious individuals' interpersonal circumplex problems that were blends of agency and communion, and yet inconsistencies remain. We predicted 2 distinct interpersonal subtypes would exist for individuals with high social anxiety, and that these social anxiety subtypes would differ on empathetic concern, paranoia, received peer victimization, perspective taking, and emotional suppression. From a sample of 175 undergraduate participants, 51 participants with high social anxiety were selected as above a clinical cutoff on the social phobia scale. Cluster analyses identified 2 interpersonal subtypes of socially anxious individuals: low hostility-high submissiveness (Cluster 1) and high hostility-high submissiveness (Cluster 2). Cluster 1 reported higher levels of empathetic concern, lower paranoia, less peer victimization, and lower emotional suppression compared to Cluster 2. There were no differences between subtypes on perspective taking or cognitive reappraisal. Findings are consistent with an interpersonal conceptualization of social anxiety, and provide evidence of distinct social features between these subtypes. Findings have implications for the etiology, classification, and treatment of social anxiety.
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20
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Cheng SH, Sun ZJ, Lee IH, Lee CT, Chen KC, Tsai CH, Yang YK, Yang YC. Factors related to self-reported social anxiety symptoms among incoming university students. Early Interv Psychiatry 2017; 11:314-321. [PMID: 26011588 DOI: 10.1111/eip.12247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/12/2015] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Shu Hui Cheng
- Office of Student Affairs, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - I Hui Lee
- Office of Student Affairs, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Ting Lee
- Department of Family Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Chung Hung Tsai
- Department of Family Medicine, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Yi Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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21
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Porter E, Chambless DL, Keefe JR. Criticism in the Romantic Relationships of Individuals With Social Anxiety. Behav Ther 2017; 48:517-532. [PMID: 28577587 DOI: 10.1016/j.beth.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Social anxiety is associated with difficulties in intimate relationships. Because fear of negative evaluation is a cardinal feature of social anxiety disorder, perceived criticism and upset due to criticism from partners may play a significant role in socially anxious individuals' intimate relationships. In the present study, we examine associations between social anxiety and perceived, observed, and expressed criticism in interactions with romantic partners. In Study 1, we collected self-report data from 343 undergraduates and their romantic partners on social anxiety symptoms, perceived and expressed criticism, and upset due to criticism. One year later couples reported whether they were still in this relationship. Results showed that social anxiety was associated with being more critical of one's partner, and among women, being more upset by criticism from a partner. Social anxiety was not related to perceived criticism, nor did criticism variables predict relationship status at Time 2. In Study 2, undergraduate couples with a partner high (n = 26) or low (n = 26) in social anxiety completed a 10-minute, video-recorded problem-solving task. Both partners rated their perceived and expressed criticism and upset due to criticism following the interaction, and observers coded interactions for criticism. Results indicated that social anxiety was not significantly related to any of the criticism variables, but post hoc analyses cast doubts upon the external validity of the problem-solving task. Results are discussed in light of known difficulties with intimacy among individuals with social anxiety.
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22
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Porter E, Chambless DL. Social Anxiety and Social Support in Romantic Relationships. Behav Ther 2017; 48:335-348. [PMID: 28390497 DOI: 10.1016/j.beth.2016.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 10/17/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022]
Abstract
Little is known about the quality of socially anxious individuals' romantic relationships. In the present study, we examine associations between social anxiety and social support in such relationships. In Study 1, we collected self-report data on social anxiety symptoms and received, provided, and perceived social support from 343 undergraduates and their romantic partners. One year later couples were contacted to determine whether they were still in this relationship. Results indicated that men's social anxiety at Time 1 predicted higher rates of breakup at Time 2. Men's and women's perceived support, as well as men's provided support, were also significantly predictive of breakup. Social anxiety did not interact with any of the support variables to predict breakup. In Study 2, a subset of undergraduate couples with a partner high (n=27) or low (n=27) in social anxiety completed two 10-minute, lab-based, video-recorded social support tasks. Both partners rated their received or provided social support following the interaction, and trained observers also coded for support behaviors. Results showed that socially anxious individuals received less support from their partners during the interaction according to participant but not observer report. High and lower social anxiety couples did not differ in terms of the target's provision of support. Taken together, results suggest that social anxiety is associated with difficulties even in the context of established romantic relationships. Clinical implications are discussed.
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Watson NL, Heffner JL, McClure JB, Mull KE, Bricker JB. Differential prevalence of established risk factors for poor cessation outcomes among smokers by level of social anxiety. Am J Addict 2017; 26:176-182. [PMID: 28191916 DOI: 10.1111/ajad.12509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/26/2017] [Accepted: 01/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite clear associations between social anxiety (SA), high prevalence of smoking, and cessation failure, little is known about factors contributing to these relationships. Moreover, the extent to which smokers with moderate SA represent an at-risk group of smokers is also unknown. This study examined the extent to which established risk factors for poor cessation (eg, sociodemographic, smoking history, mental health comorbidity) are prevalent among smokers with low, moderate, and high levels of SA. METHODS Participants (N = 2,637) were adult smokers from a web-based smoking cessation trial. Nineteen characteristics considered risk factors for poor cessation outcomes were assessed at baseline. Those associated with social anxiety were subsequently compared by SA level. RESULTS Regression models indicated that 10/19 risk factors were associated with SA. Compared to smokers with low SA, those with moderate and high SA endorsed 4/10 and 10/10 risk factors as more prevalent or severe, respectively. Compared to smokers with low SA, High SA was associated with greater sociodemographic risk factors, while both moderate and high SA was associated with more severe mental health symptoms. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Smokers with moderate and high levels of SA endorse more risk factors for poor cessation outcomes than those with low levels of SA, particularly mental health symptoms. These factors may help explain the differential smoking outcomes of socially anxious smokers. Results suggest that smokers with both moderate and high levels of SA would likely benefit from cessation interventions that address and consider these risk factors. (Am J Addict 2017;26:176-182).
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Affiliation(s)
- Noreen L Watson
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | | | - Kristen E Mull
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington.,University of Washington, Seattle, Washington
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24
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Dalrymple KL, Herbert JD. Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder. Behav Modif 2016; 31:543-68. [PMID: 17699117 DOI: 10.1177/0145445507302037] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in a 12-week program integrating exposure therapy and ACT. Results revealed no changes across a 4-week baseline control period. From pretreatment to follow-up, significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains. Significant changes also were found in ACT-consistent process measures, and earlier changes in experiential avoidance predicted later changes in symptom severity. Results suggest the acceptability and potential efficacy of ACT for SAD and highlight the need for future research examining both the efficacy and mechanisms of change of acceptance-based programs for SAD.
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Affiliation(s)
- Kristy L Dalrymple
- Brown Medical School and Rhode Island Hospital, Providence, RI 02905, USA.
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25
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Härtling S, Klotsche J, Heinrich A, Hoyer J. Cognitive Therapy and Task Concentration Training Applied as Intensified Group Therapies for Social Anxiety Disorder with Fear of Blushing-A Randomized Controlled Trial. Clin Psychol Psychother 2015; 23:509-522. [DOI: 10.1002/cpp.1975] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Samia Härtling
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
- German Rheumatism Research Center Berlin, Leibniz Institute; Berlin Germany
- Institute for Social Medicine, Epidemiology and Health Economics; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Anke Heinrich
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
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Correlates of Facebook usage patterns: The relationship between passive Facebook use, social anxiety symptoms, and brooding. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2015.02.003] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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27
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Camuri G, Oldani L, Dell'Osso B, Benatti B, Lietti L, Palazzo C, Altamura AC. Prevalence and disability of comorbid social phobia and obsessive-compulsive disorder in patients with panic disorder and generalized anxiety disorder. Int J Psychiatry Clin Pract 2014; 18:248-54. [PMID: 25289805 DOI: 10.3109/13651501.2014.959972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) and panic disorder (PD) are disabling conditions, often comorbid with other anxiety disorders. The present study was aimed to assess prevalence and related disability of comorbid social phobia (SP) and obsessive-compulsive disorder (OCD) in 115 patients with GAD (57) or PD (58). METHODS Patients were classified as having threshold, subthreshold, or no comorbidity, and related prevalence rates, as well as disability (Sheehan Disability Scale, SDS), were compared across diagnostic subgroups. RESULTS SP and OCD comorbidities were present in 30.4% of the sample, with subthreshold comorbidities present at twice the rate of threshold ones (22.6% vs. 11.3%). Compared with GAD patients, PD patients showed significantly higher subthreshold and threshold comorbidity rates (27.6% and 13.8% vs. 17.5% and 8.8%, respectively). Comorbid PD patients had higher SDS scores than the comorbid and non-comorbid GAD subjects. The presence of threshold SP comorbidity was associated with the highest SDS scores. CONCLUSIONS SP and OCD comorbidities were found to be prevalent and disabling among GAD and PD patients, with higher subthreshold than threshold rates, and a negative impact on quality of life. Present findings stress the importance of a dimensional approach to anxiety disorders, the presence of threshold and subthreshold comorbidity being the rule rather than the exception.
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Affiliation(s)
- Giulia Camuri
- Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
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Dell'Osso L, Abelli M, Pini S, Carlini M, Carpita B, Macchi E, Gorrasi F, Mengali F, Tognetti R, Massimetti G. Dimensional assessment of DSM-5 social anxiety symptoms among university students and its relationship with functional impairment. Neuropsychiatr Dis Treat 2014; 10:1325-32. [PMID: 25075191 PMCID: PMC4106966 DOI: 10.2147/ndt.s59348] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Social anxiety disorder is a common condition often associated with severe impairment in educational career. The aim of this paper was to evaluate prevalence rates and correlates of mild, moderate, and severe forms of social anxiety spectrum in a large sample of university students. Overall, 717 university students were assessed with the Social Anxiety Spectrum Self-Report questionnaire. Using two cut-off scores, 61.4% of subjects were classified as low scorers, 10% as medium scorers, and 28.6% as high scorers. Both high and medium scorers reported fears related to social situations. Interpersonal sensitivity and specific phobias were more common among women with low scores. Childhood/adolescence social anxiety features were more common among males with medium scores. Behavioral inhibition was more common among males with high scores. Functional impairment was severe among high scorers and, to a lesser extent, among medium scorers. Social anxiety spectrum is largely represented among university students. Future studies should investigate whether sufferers of social phobia underachieve or end their professional objectives prematurely.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Marina Carlini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Elisabetta Macchi
- Prorectorate to Students Affairs and Right to Education, University of Pisa, Pisa, Italy
| | - Federica Gorrasi
- Prorectorate to Students Affairs and Right to Education, University of Pisa, Pisa, Italy
| | - Francesco Mengali
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rosalba Tognetti
- Prorectorate to Students Affairs and Right to Education, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Abstract
Depression and social anxiety disorder (SAD) are two of the most common mental health conditions, and often occur together. Depression is usually identified as the presenting problem, which may result in SAD being overshadowed and undertreated among those with this particular comorbidity. In this case study, diagnostic overshadowing results in successful treatment of depression but delayed identification of SAD, causing an attenuated anxiety treatment response. We present recommendations on how clinicians may more thoroughly assess for comorbid Axis I diagnoses, avoid diagnostic overshadowing, and better integrate treatment approaches for SAD–major depressive disorder (MDD) comorbidity. Mechanisms underlying cognitive-behavioral treatments such as behavioral activation and exposure hold particular promise for promoting improvement in SAD and major depression simultaneously.
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Porter E, Chambless DL. Shying Away From a Good Thing: Social Anxiety in Romantic Relationships. J Clin Psychol 2013; 70:546-61. [DOI: 10.1002/jclp.22048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Knappe S, Klotsche J, Strobel A, Lebeau RT, Craske MG, Wittchen HU, Beesdo-Baum K. Dimensional anxiety scales for DSM-5: sensitivity to clinical severity. Eur Psychiatry 2013; 28:448-56. [PMID: 23541345 DOI: 10.1016/j.eurpsy.2013.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/15/2013] [Accepted: 02/01/2013] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels. METHODS The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n=83) and threshold anxiety disorders (n=49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder). RESULTS Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders. CONCLUSION The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.
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Affiliation(s)
- S Knappe
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
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Dahl AA, Olssøn I. Unfavorable health conditions associated with high social anxiety in the elderly: a community-based study. Nord J Psychiatry 2013; 67:30-7. [PMID: 22429103 DOI: 10.3109/08039488.2012.668935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is little knowledge concerning unfavorable health conditions (UHC) associated with high level of social phobia/anxiety symptoms (SPAS) in the elderly. AIMS This cross-sectional community-based study examines five categories of UHC related to high SPAS in individuals aged 75/76 years compared with controls with lower SPAS. METHODS The study was based on data from the Oslo Health Study. Based on self-rating of the MINI-SPIN screening instrument, 246 individuals (9%) had high SPAS (cases) and 2464 (91%) had lower SPAS (controls). The socio-demographic, somatic, lifestyle, social and mental categories of UHC were compared between cases and controls. RESULTS A significantly higher proportion of cases were in non-paired relationships, had low level of education and low income compared with controls. Among cases, a significantly higher proportion had poor self-rated health, more somatic morbidity, regular use of analgesics and frequent drinking. All indicators of social UHC, except low community activism, were significantly more common among cases compared with controls. Except for use of hypnotics, the same was true for the indicators of mental UHC. Stepwise multivariate logistic regression analysis showed that the socio-demographic, somatic, social and mental UHC steps were significantly associated with high SPAS. CONCLUSIONS Individuals aged 75/76 years with high level of SPAS showed multiple UHC within several areas. Identification and interventions like exposure and though modification geared at such anxiety should be considered.
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Affiliation(s)
- Alv A Dahl
- Department of Oncology, Oslo University Hospital; Radiumhospitalet and the University of Oslo, Nydalen, Oslo, Norway.
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Beesdo-Baum K, Knappe S, Fehm L, Höfler M, Lieb R, Hofmann SG, Wittchen HU. The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatr Scand 2012; 126:411-25. [PMID: 22632172 DOI: 10.1111/j.1600-0447.2012.01886.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the natural course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long-term outcomes. METHOD A community sample of N = 3021 subjects aged 14-24 was followed-up over 10 years using the DSM-IV/M-CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow-up. RESULTS SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow-up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow-up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co-occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and - less impressively - diagnostic stability. CONCLUSION A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.
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Affiliation(s)
- K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
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Baptista CA, Loureiro SR, de Lima Osório F, Zuardi AW, Magalhães PV, Kapczinski F, Filho AS, Freitas-Ferrari MC, Crippa JAS. Social phobia in Brazilian university students: prevalence, under-recognition and academic impairment in women. J Affect Disord 2012; 136:857-61. [PMID: 22018945 DOI: 10.1016/j.jad.2011.09.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 07/02/2011] [Accepted: 09/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the fact that public speaking is a common academic activity and that social phobia has been associated with lower educational achievement and impaired academic performance, little research has examined the prevalence of social phobia in college students. The aim of this study was to evaluate the prevalence of social phobia in a large sample of Brazilian college students and to examine the academic impact of this disorder. METHODS The Social Phobia Inventory (SPIN) and the MINI-SPIN, used as the indicator of social phobia in the screening phase, were applied to 2319 randomly selected students from two Brazilian universities. For the second phase (diagnostic confirmation), four psychiatrists and one clinical psychologist administered the SCID-IV to subjects with MINI-SPIN scores of 6 or higher. RESULTS The prevalence of social phobia among the university students was 11.6%. Women with social phobia had significantly lower grades than those without the disorder. Fear of public speaking was the most common social fear. Only two of the 237 students with social phobia (0.8%) had previously received a diagnosis of social phobia and were under treatment. LIMITATIONS Social phobia comorbidities were not evaluated in this study. The methods of assessment employed by the universities (written exams) may mask the presence of social phobia. This was not a population-based study, and thus the results are not generalizable to the entire population with social phobia. CONCLUSION Preventive strategies are recommended to reduce the under-recognition and the adverse impact of social phobia on academic performance and overall quality of life of university students.
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Affiliation(s)
- Carlos Alberto Baptista
- Department of Neurosciences and Behavior, Division of Psychiatry, Faculty of Medicine of Ribeirão Preto, University of São Paulo and INCT Translational Medicine (INCT-TM, CNPq), Brazil
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36
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Chagas MHN, Nardi AE, Manfro GG, Hetem LAB, Andrada NC, Levitan MN, Salum GA, Isolan L, Ferrari MCF, Crippa JAS. [Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder]. ACTA ACUST UNITED AC 2011; 32:444-52. [PMID: 21308267 DOI: 10.1590/s1516-44462010005000029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/14/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.
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Affiliation(s)
- Marcos Hortes N Chagas
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, and Hospital das Clínicas-Terceiro Andar, Ribeirão Preto, SP, Brazil
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Evaluation of a DVD-based self-help program in highly socially anxious individuals--pilot study. Behav Ther 2011; 42:439-48. [PMID: 21658526 DOI: 10.1016/j.beth.2010.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 11/08/2010] [Accepted: 11/09/2010] [Indexed: 11/24/2022]
Abstract
High social anxiety is a risk factor for the incidence of social anxiety disorder (SAD). Early diagnosis and intervention may prevent more severe psychiatric courses. Self-help programs may be a convenient, accessible, and effective intervention. This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety. A total of 24 highly socially anxious individuals were randomly assigned to a DVD-based self-help program or to a wait-list control group. The self-help program is based on the cognitive model according to Clark and Wells (1995; adapted to German by Stangier, Clark, & Ehlers, 2006) and comprises eight sessions. ANOVAs based on an intention-to-treat model were used for data analyses. The self-help program was well accepted; just one person withdrew during the intervention. There were significant Time× Group interactions on all primary outcome measures. For the intervention group moderate to high within-groups effect sizes up to Cohen's d = 1.05 were obtained. Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention. The newly developed DVD-based self-help program seems to be a promising intervention for highly socially anxious individuals as it reduces social anxiety symptoms.
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Treatment-seeking for social anxiety disorder in a general outpatient psychiatry setting. Psychiatry Res 2011; 187:375-81. [PMID: 21310497 DOI: 10.1016/j.psychres.2011.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 11/16/2010] [Accepted: 01/08/2011] [Indexed: 11/22/2022]
Abstract
Many individuals with social anxiety disorder (SAD) seek treatment principally for another psychiatric disorder, but when directly asked, a majority of these individuals also desire treatment for SAD. Several reasons may exist for why individuals with SAD do not seek treatment for it, such as the severity or functional impairment related to SAD. The aim of the current study was to examine factors related to SAD severity, impairment, and comorbidity, to gain a better understanding of what factors may be related to treatment-seeking for SAD. In 819 psychiatric outpatients with SAD, initial results showed that age, duration of SAD illness, number of social fears endorsed, Clinical Global Impression score, Sheehan Disability Scale ratings for social life and distress, presence of major depressive disorder, and presence of depressive disorder not otherwise specified (DDNOS) were associated with treatment-seeking for SAD status. However, a regression analysis found that DDNOS was the most robust predictor of treatment-seeking for SAD status, followed by the number of feared social situations. Other factors should be examined in the future, such as knowledge of SAD and available treatment options.
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Marques L, Weingarden HM, LeBlanc NJ, Siev J, Wilhelm S. The relationship between perceived social support and severity of body dysmorphic disorder symptoms: the role of gender. REVISTA BRASILEIRA DE PSIQUIATRIA 2011; 33:238-44. [DOI: 10.1590/s1516-44462011000300006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/16/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Whether social support is associated with severity of body dysmorphic symptoms is unknown. To address this gap in the literature, the present study aims to examine the association between three domains of perceived social support (i.e., family, friends, and significant others) and severity of body dysmorphic disorder symptoms. METHOD: Participants (N = 400) with symptoms consistent with diagnosis of body dysmorphic disorder completed measures of symptomatology and social support via the internet. RESULTS: More perceived social support from friends and significant others was associated with less severe body dysmorphic disorder symptoms for males, and more perceived social support from family and friends was associated with less severe body dysmorphic disorder symptoms among females. Additionally, gender moderated the association between perceived social support from significant others and symptom severity, such that perceived social support from a significant other was significantly negatively associated with body dysmorphic symptom severity in males, but not females. CONCLUSION: The present study implicates social support as an important area of future body dysmorphic disorder research.
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Affiliation(s)
- Luana Marques
- Massachusetts General Hospital, USA; Harvard Medical School, USA
| | | | | | - Jedidiah Siev
- Massachusetts General Hospital, USA; Harvard Medical School, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital, USA; Massachusetts General Hospital
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Ruscio AM. The latent structure of social anxiety disorder: consequences of shifting to a dimensional diagnosis. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 119:662-71. [PMID: 20853918 DOI: 10.1037/a0019341] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite longstanding debate over the nature of the boundary between social anxiety disorder (SAD) and less severe social anxiety, no study has tested directly whether the defining features of the disorder correspond to a latent category or dimension. The present study examined this question using data from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the U.S. household population. Indicators representing the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for SAD were submitted to taxometric analyses in a subsample of adults (n = 2,166) who reported excessive social fear in their lifetime. Multiple taxometric procedures and consistency tests converged on a dimensional solution, suggesting that SAD is continuous with milder social anxiety. In follow-up analyses, a dimensional SAD diagnosis outperformed the DSM-IV diagnosis in predicting the subsequent onset of a range of clinically important outcomes. Large differences in associations with comorbid mood disorders, suicidality, and treatment seeking in particular favored the prognostic value of dimensional over categorical diagnosis. These findings support the validity and potential utility of a dimensional conceptualization of SAD that may inform efforts to revise the diagnosis for DSM-V.
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Affiliation(s)
- Ayelet Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Dalrymple KL, Zimmerman M. Age of onset of social anxiety disorder in depressed outpatients. J Anxiety Disord 2011; 25:131-7. [PMID: 20832989 PMCID: PMC3006477 DOI: 10.1016/j.janxdis.2010.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/11/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
Onset of social anxiety disorder (SAD) often precedes that of major depressive disorder (MDD) in patients with this comorbidity pattern. The current study examined the association between three SAD onset groups (childhood, adolescent, adulthood) and clinical characteristics of 412 psychiatric outpatients diagnosed with MDD and SAD based on a semi-structured diagnostic interview. Childhood and adolescent SAD onset groups were more likely to report an onset of MDD prior to age 18 and have made at least one prior suicide attempt compared to the adulthood onset group. The childhood SAD onset group also was more likely to have chronic MDD, poorer past social functioning, and an increased hazard of MDD onset compared to the adulthood onset group. Findings suggest that patients with an onset of SAD in childhood or adolescence may be particularly at risk for a more severe and chronic course of depressive illness.
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Dahl AA, Dahl CF. Are there gender differences in impairment associated with high social anxiety? A community-based study. J Anxiety Disord 2010; 24:487-93. [PMID: 20378310 DOI: 10.1016/j.janxdis.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 11/25/2022]
Abstract
This comparative, cross-sectional community-based study examines sex differences in associations between various types of impairment and high level of social phobia/anxiety symptoms (SPAS) in adults aged 30, 40, and 45 years and their controls. Men with high SPAS had higher rates of non-paired relationships, alcohol problems, low intake of fruit/vegetables, risk for future fatal cardiac events, but lower rate for low annual income than women. The pattern of differences in impairment variables cases and controls did not show sex differences. Stepwise multivariate logistic regression analysis showed that the socio-demographic and lifestyle impairment steps made significant contributions to the model which explained 41.6% of the variance. The individual variables significant at the last step were lower level of education, more smokers, less alcohol problems and lower risk of fatal cardiac events in women compared to men. In conclusion, few significant sex differences concerning impairment were observed in individuals with high SPAS.
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Affiliation(s)
- Alv A Dahl
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, N-310 Oslo, Norway.
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Filho AS, Hetem LAB, Ferrari MCF, Trzesniak C, Martín-Santos R, Borduqui T, de Lima Osório F, Loureiro SR, Busatto Filho G, Zuardi AW, Crippa JAS. Social anxiety disorder: what are we losing with the current diagnostic criteria? Acta Psychiatr Scand 2010; 121:216-26. [PMID: 19694635 DOI: 10.1111/j.1600-0447.2009.01459.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the rate of comorbidities and the functional impairment associated with the social anxiety disorder (SAD), with an emphasis on the so-called subthreshold clinical signs and symptoms. METHOD Psychiatric comorbidities and psychosocial functioning were evaluated in 355 volunteers (college students) who had been diagnosed as SAD (n = 141), Subthreshold SAD (n = 92) or Controls (n = 122). RESULTS The rate of comorbidities was 71.6% in the SAD group and 50% in subjects with Subthreshold SAD, both significantly greater than Controls (28.7%). Concerning psychosocial functioning, the SAD group had higher impairment than the other two groups in all domains evaluated, and subjects with Subthreshold SAD presented intermediate values. CONCLUSION The rates of psychiatric comorbidities and the impairment of psychosocial functioning increase progressively along the spectrum of social anxiety. The fact that Subthreshold SAD causes considerable disability and suffering in comparison with control subjects justifies a review of the validity of the diagnostic criteria.
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Affiliation(s)
- A S Filho
- Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Falk Dahl CA, Dahl AA. Lifestyle and social network in individuals with high level of social phobia/anxiety symptoms: a community-based study. Soc Psychiatry Psychiatr Epidemiol 2010; 45:309-17. [PMID: 19468662 DOI: 10.1007/s00127-009-0069-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 05/10/2009] [Indexed: 11/29/2022]
Abstract
AIM To study the lifestyle issues and social network in a community-based sample of individuals with a high level of social phobia/anxiety symptoms (SPAS) compared to controls, and to explore the factors that were most strongly associated with unhealthy lifestyle and a small social network. METHODS The MINI-SPIN test was administered in The Oslo Health Study (HUBRO), and the scores used to identify persons with a high level of SPAS. The SPAS group consisted of 446 individuals aged 30, 40 or 45 years defined by MINI-SPIN score > or =8. We randomly selected five controls for each case among those with a MINI-SPIN score of 0-7 (N = 2,230). Information was collected with questionnaires, physical measurements and blood samples. RESULTS The SPAS group showed significantly higher prevalence of unhealthy lifestyle than controls, which did not hold up in multivariate analyses. The SPAS group showed significantly more alcohol problems and higher future risk of coronary heart disease among females, but not in males. Low level of physical activity in general, and in spare time, was significantly associated with the SPAS group. Small social network was significantly more common in the SPAS group and that result held up in multivariate analysis. In that analysis not being in paired relationship and mental comorbidity were also significantly associated with a small social network. CONCLUSION Unhealthy lifestyle and a small social network places younger adults with SPAS under considerable risk for the development of future morbidity. This risk calls for counseling by general practitioners in such individuals.
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Ranta K, Kaltiala-Heino R, Rantanen P, Marttunen M. Social phobia in Finnish general adolescent population: prevalence, comorbidity, individual and family correlates, and service use. Depress Anxiety 2009; 26:528-36. [PMID: 19170089 DOI: 10.1002/da.20422] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the epidemiology of social phobia (SP) among early to middle adolescents, at the time of suggested mean onset of the disorder. The objective of this study was to investigate the prevalence, comorbidity, individual and familial correlates, and service use associated with SP among Finnish 12-17-year-old adolescents in general population. METHODS A sample of 784 adolescents was screened with the Social Phobia Inventory, and a sub-sample (n=350) was interviewed with a semi-structured clinical interview to identify SP, sub-clinical SP (SSP), and a range of other axis I DSM-IV disorders. Individual and familial correlates, and service use associated with SP were also inquired. RESULTS We found a 12-month prevalence of 3.2% for SP, and 4.6% for SSP. The prevalence rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41%). Adolescents with SP/SSP were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts. Two thirds (68%) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non-comorbid SP had been in contact with a mental health professional. CONCLUSIONS We conclude that adolescent SP is a relatively frequent, undertreated and highly comorbid condition, associated with educational impairment, depression and anxiety in parents, and peer victimization.
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Affiliation(s)
- Klaus Ranta
- Tampere School of Public Health, University of Tampere, Tampere, Finland.
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Does the form or the amount of exposure make a difference in the cognitive-behavioral therapy treatment of social phobia? J Nerv Ment Dis 2009; 197:507-13. [PMID: 19597358 DOI: 10.1097/nmd.0b013e3181aacc08] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exposure is considered to be an essential ingredient of cognitive-behavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure.
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Van Roy B, Kristensen H, Groholt B, Clench-Aas J. Prevalence and characteristics of significant social anxiety in children aged 8-13 years: a Norwegian cross-sectional population study. Soc Psychiatry Psychiatr Epidemiol 2009; 44:407-15. [PMID: 19015797 DOI: 10.1007/s00127-008-0445-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/23/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social anxiety has been frequently studied in both population- and clinical-based adult and adolescent samples. Corresponding research in children is scarce and is dominated by clinical studies. The aim of the present population-based study was to examine the prevalence of significant social anxiety (SSA) in preadolescent children and compare their characteristics with those of children without SSA. The spectrum of social anxiety is explored by comparing children with different levels of social anxiety, as defined by 1-2 versus 3-5 social situations feared. METHOD The sample consisted of 14,497 parents and their 3rd-7th grade children (8-13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A-D for social anxiety disorder (SAD). Socio-demographic data, social and school functioning, somatic complaints, parent-child relationships, and use of health services were added to a logistic regression model to explore characteristics associated with children with, and without SSA. Associated emotional and behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ) using parent and self-report. RESULTS Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The majority of children with SSA managed their everyday life well. However, compared with children without SSA, children with SSA struggled more often in different areas of life and showed a significantly higher prevalence of associated emotional and behavioural symptoms. Our findings also support the notion of social anxiety as a spectrum concept. CONCLUSIONS Social anxiety problems start in childhood and can be impairing, even in non-clinical populations and in reasonably young age groups. Increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.
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Affiliation(s)
- Betty Van Roy
- Institute of Psychiatry, University of Oslo, PB 1078 Blindern, Oslo 0316, Norway.
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Gren-Landell M, Tillfors M, Furmark T, Bohlin G, Andersson G, Svedin CG. Social phobia in Swedish adolescents : prevalence and gender differences. Soc Psychiatry Psychiatr Epidemiol 2009; 44:1-7. [PMID: 18665316 DOI: 10.1007/s00127-008-0400-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 06/10/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. METHODS Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). RESULTS Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone unfamiliar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. CONCLUSION Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.
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Affiliation(s)
- Malin Gren-Landell
- Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden.
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Knappe S, Beesdo K, Fehm L, Lieb R, Wittchen HU. Associations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder? J Neural Transm (Vienna) 2008; 116:639-48. [PMID: 18982243 PMCID: PMC2694921 DOI: 10.1007/s00702-008-0118-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 08/20/2008] [Indexed: 11/29/2022]
Abstract
We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIA-X/M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-to-offspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
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Yardley L, McDermott L, Pisarski S, Duchaine B, Nakayama K. Psychosocial consequences of developmental prosopagnosia: a problem of recognition. J Psychosom Res 2008; 65:445-51. [PMID: 18940375 DOI: 10.1016/j.jpsychores.2008.03.013] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 03/11/2008] [Accepted: 03/20/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To provide the first systematic in-depth description of the consequences of developmental prosopagnosia (DP; 'face blindness') for psychosocial functioning and occupational disability, in order to determine what kind of professional intervention may be needed. METHODS Semi-structured telephone interviews were carried out with 25 people whose self-reports of face recognition problems were confirmed by impaired scores on the Cambridge Face Recognition Test. Thematic analysis was used to inductively identify and understand common psychosocial consequences of DP. RESULTS All participants described recurrent and sometimes traumatic social interaction difficulties caused by recognition problems, such as failing to recognize close friends, work colleagues, and family members. These problems often led to chronic anxiety about offending others and feelings of embarrassment, guilt, and failure. Most participants described some degree of fear and avoidance of social situations in which face recognition was important, including family and social gatherings, and meetings at work. Long-term consequences could include dependence on others, a restricted social circle, more limited employment opportunities, and loss of self-confidence. CONCLUSION The potential for negative psychosocial consequences and occupational disability posed by DP is as great as that posed by conditions which are currently afforded professional recognition and support, such as stuttering and dyslexia. Wider recognition of the problems prosopagnosia can cause could reduce anxiety about social interaction difficulties by making it easier to explain and justify recognition problems to other people, including employers. Greater professional awareness could facilitate detection and referral of those requiring support with coping with social interactions.
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Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK.
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