Shame, personality, and social anxiety symptoms in Chinese and American nonclinical samples: a cross-cultural study

The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial

Background

Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT.

Objective

This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD.

Methods

The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS.

Results

Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS.

Conclusions

This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.

Social Anxiety and Peer Victimization and Aggression: Examining Reciprocal Trait-State Effects among Early Adolescents

As peer relationships become paramount during early adolescence, there's a normative rise in social anxiety, coinciding with a peak in peer victimization and aggression. Although previous studies have suggested reciprocal associations between changes in social anxiety and adolescent peer victimization and aggression, the mechanics of these associations at the personal trait and time-varying state levels remains unclear. This study examined the longitudinal relations between social anxiety and adolescent peer victimization and aggression by disentangling between-person trait differences from within-person state processes. A total of 4731 Chinese early adolescents (44.9% girls; M age = 10.91 years, SD = 0.72) participated in a four-wave longitudinal study with 6-month intervals. Random-intercept cross-lagged panel model (RI-CLPM) was applied. The results revealed higher levels of social anxiety are associated with more peer victimization and aggression at the between-person trait level. At the within-person state level, adolescent social anxiety, and adolescent physical victimization and physical aggression, reciprocally predicted each other. Relational victimization significantly predicted an increase of social anxiety, but not vice versa. Social anxiety positively predicted relational aggression over time, whereas the effect of relational aggression on social anxiety was only observed at the initial stage of early adolescence. These findings highlight that various types of victimization and aggression might exhibit unique reciprocal associations with social anxiety. Distinguishing between the within-person state and between-person trait effects is crucial in research that informs the co-development of adolescent peer victimization, aggression, and social anxiety.

Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study

Purpose

This study aimed to investigate the effects of different psychological personalities and pain catastrophizing levels on postoperative analgesia in patients undergoing cesarean section.

Patients and Methods

Puerperas who underwent cesarean section at our hospital between January and August 2023 were recruited into the study and assessed using the Eysenck Personality Questionnaire-Revised Short Scale (EPQRSC) and Pain Catastrophizing Scale (PCS). Data on the numerical pain intensity at rest and during activity 24 h after surgery, number and dosage of analgesia pumps, and satisfaction with analgesia were recorded. According to the numerical pain score during activity 24 h post-operation, the patients were divided into the analgesia incomplete group (≥4) and control group (<4). Univariate analysis, Spearman correlation analysis, and binary logistic regression analysis were used to evaluate the influence of personality characteristics and PCS on postoperative analgesia.

Results

A total of 778 women were included in the study. The incidence of inadequate analgesia was 89.8%. The satisfaction rate of analgesia was 66.8%. Univariate analysis showed that extraversion; neuroticism; PCS; numbers of previous cesarean delivery; ASA; analgesic satisfaction; and 24-h analgesia pump compressions and dosage were associated with postoperative analgesia after cesarean section (P<0.05). Using binary logistic regression analysis, the first cesarean section (odds ratio [OR]=0.056, 95% confidence interval [CI]=1.913-19.174), the number of 24-h analgesic pump compressions (OR=8.464, 95% CI=0.356-0.604), extraversion (OR=0.667, 95% CI=0.513-0.866), neuroticism (OR=1.427, 95% CI=1.104-1.844), and PCS (OR=7.718, 95% CI=0.657-0.783) were factors affecting postoperative analgesia.

Conclusion

The incidence of inadequate analgesia after a cesarean section was high (89.8% on the first day after surgery). Formulating accurate analgesia programs for women undergoing cesarean section with extraversion, neuroticism personality characteristics, and pain catastrophizing behaviors is necessary for improving their postoperative analgesia effects and satisfaction and promoting postpartum comfort.

Social anxiety and celebrity worship: the mediating effects of mobile phone dependence and moderating effects of family socioeconomic status

The Absorption-addiction model suggests that people worship celebrities to compensate for some personal or social defects, so poor mental state is related to celebrity worship. The current study aimed to explore the underlying mechanisms influencing celebrity worship. A total of 1,147 participants (aged 19-26 years) completed online questionnaires to assess social anxiety, mobile phone dependence, parental income and celebrity worship. Results showed that: (1) social anxiety, socioeconomic status (SES) and celebrity worship were positively correlated; (2) Social anxiety affected celebrity worship through mobile phone dependence; (3) SES played a moderating role in the mediation model. At higher levels of SES, individuals with high social anxiety showed reduced dependence on mobile phones. These findings highlight the importance of mobile phone dependence and family SES in celebrity worship. Additionally, the findings demonstrated that females are more likely to pay attention to celebrities, but the greater SES and reduced mobile phone dependence can mitigate their celebrity addiction.

The relationship between social anxiety and self-injury of junior high school students: Mediation by intolerance of uncertainty and moderation by self-esteem

Objective

The problem of adolescents' self-injury has gradually attracted social attention, however, a lack of research exists on the internal mechanism between social anxiety and self-injury. This study explored the relationship between social anxiety and self-injury in Chinese junior high school students.

Method

An adolescent self-injury questionnaire, social anxiety scale, intolerance of uncertainty questionnaire and self-injury questionnaire were used to survey 614 junior high school students.

Results

The results showed that: (1) social anxiety had a significant positive predictive effect on self-injury; (2) intolerance of uncertainty had a significant mediating effect between social anxiety and self-injury; and (3) self-esteem had a significant moderating effect on the mediating effect of intolerance of uncertainty.

Conclusion

The study suggested that social anxiety in junior high school students has an impact on self-injury through mediation of intolerance of uncertainty and modulation of self-esteem.

Emotions in social anxiety disorder: A review

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

The Development of an Interpersonal Stressors Scale: Identifying Self-Imposed and Other-Imposed Interpersonal Stressors

While there has been research focused on interpersonal relationships and their impact on stress and well-being, no instrument has been developed to comprehensively evaluate interpersonal stressors. This research sought to develop and validate an Interpersonal Stressors Scale (ISS) for Chinese college students through three studies. Focus groups were used to generate the initial item pool (Study 1). Then two large samples (N₁ = 511; N₂ = 330) were collected to explore the factor structure of the ISS and subsequently examine its reliability and validity estimates (study 2 and 3). Initial results indicated a model with 27 items and five first-order factors (interaction difficulty, behaving as expected, social criticism, relationship maintenance, and indebtedness avoidance) as well as two second-order factors (self-imposed stressors and other-imposed stressors) with strong psychometric properties. Criterion-related validity estimates indicated these two kinds of stressors were both associated with stress while having different relationships with general anxiety, depression, social anxiety, interpersonal satisfaction, and self-efficacy in social interactions. The nature and function of the structure for the ISS were discussed as well as the practical and research implications.

Validity and reliability of safety behaviors questionnaire for Persian adults who stutter: A cultural perspective

INTRODUCTION

Adults who stutter (AWS) are reported to have higher social anxiety compared to those who do not stutter. Previous studies have suggested that safety behaviors, which are cognitive or behavioral strategies used by people with anxiety to prevent negative consequences, are important factors in maintaining anxiety. However, the frequency and types of such behaviors might vary in different cultures. Therefore, the aim of the present study was to develop a transcultural adaptation of Safety Behaviors Questionnaire (Helgadottir et al., 2014) for Persian-speaking AWS and assess its validity and reliability.

METHODS

In the first step, the original English questionnaire was translated into Persian using the International Quality of Life Assessment (IQOLA) method. Then, 17 speech and language pathologists (SLPs) and 5 AWS evaluated all questionnaire items using Likert scales to determine face validity. Finally, 167 Persian-speaking AWS completed the questionnaire to assess its construct validity and reliability. Their responses were analyzed using factor analysis and Cronbach's Alpha.

RESULTS

Some items of the original questionnaire were modified or combined with other similar items after assessing the face validity of the Persian-translated questionnaire. Construct validity analysis categorized the remaining 29 questionnaire items into four factors: general avoidance, practice and control, rehearsal, and choosing safe and easy people. The high Cronbach's Alpha of 0.89 for all items confirmed the internal reliability of the Persian-translated questionnaire.

DISCUSSION/CONCLUSIONS

The results confirmed the psychometric characteristics of the Persian- translated version of the Safety Behaviors Questionnaire (Helgadottir et al., 2014); therefore, speech pathologists can apply it in future clinical and research settings. Similar to Australian AWS, Persian participants of this study self-reported use of various types of safety behaviors frequently.

Prevalence of social anxiety disorder and symptoms among Chinese children, adolescents and young adults: A systematic review and meta-analysis

The objective of the study is to provide a reliable estimate of the pooled prevalence of social anxiety disorder (SAD) and social anxiety symptoms (SAS) among children, adolescents, and young adults (CAYA) in China. Meta-analysis is used to provide pooled-prevalence rate of SAD and SAS. Literature searches were conducted in both English and Chinese databases from the database's inception to April 2019. Eleven studies were identified for SAD, and 17 were included for SAS. The results revealed a pooled prevalence of SAD of 2.1% (95% CI: 1.2-3.8%) with high between-studies heterogeneity (Q = 1,055.2, I 2 = 99.1%, p < 0.001). The pooled prevalence estimate of SAS was 23.5% (95% CI: 18.6-29.3%), also with significant heterogeneity (Q = 1,019.3, I 2 = 98.4%, p < 0.001). Different diagnostic tools or self-report scales reported significant different prevalence of SAD or SAS. Further analysis stratified by gender, age, sampling methods, economic status, and risk of bias were performed. Limitations include the high level of heterogeneity between studies, inadequate number of the studies, and significant differences in prevalence caused by measurements.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149591, identifier: PROSPERO CRD42020149591.

Hide and seek – the role of personality, sense of coherence and experiential information in hidden information needs

Purpose

The aim of this study is to assess the impact of personality traits and sense of coherence (SOC) on concealing information needs out of shame. The study also investigates the link between concealed information needs and the use of experiential information for psychological wellbeing.

Design/methodology/approach

A Partial Least Square ‐ Structural Equation Modelling (PLS-SEM) approach is used to assess and analyse the proposed conceptual model, which is based on the responses of 412 upper secondary school students.

Findings

The findings reveal that personality traits not only have direct significant effects on concealing information needs but that their effects are also mediated by SOC. The positive relationship between concealed information needs and the use of experiential information is confirmed in the study.

Originality/value

This study is the first to show that personality and SOC influence concealing information needs. Two pathways are found. Firstly, negative emotionality and a low SOC lead to a heightened sense of shame. Secondly, introversion induces a more guarded behaviour. The study, moreover, quantitatively demonstrates a link between concealed information needs and the use of experiential information for psychological wellbeing.

Examining the relationship between shame and social anxiety disorder: A systematic review

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.

Cognitive vulnerabilities to anxiety symptoms among Chinese adolescents: A 3-year longitudinal study

OBJECTIVE

This study established cognitive vulnerability of anxiety symptoms among high school students.

METHOD

A total of 72 grade 9-11 students completed measures on levels of anxiety sensitivity (AS), selective attentional processing, and anxiety symptoms annually between 2016 and 2018.

RESULTS

Latent class growth analysis (unconditional model) showed a four-class model: High (stable) (6.94%), low (stable) (11.11%), medium (decreasing) (61.11%), and medium (increasing) (20.83%). The conditioned model controlling for the physical-concerns dimension of AS and negative attentional bias demonstrated that a two-class model consisted of a low anxiety class (n = 59, 81.9%) and a high anxiety class (n = 13, 18.1%) provided the best fit for the data. Negative attentional bias is a significant factor related to the development of anxiety trajectories.

CONCLUSION

Attentional bias modification to disengage from negative stimuli may serve as a potential target of intervention to reduce chronic anxiety among high school students.

Are comparisons of mental disorders between Chinese and German students possible? An examination of measurement invariance for the PHQ-15, PHQ-9 and GAD-7

BACKGROUND

The Patient Health Questionnaire (PHQ) is one of the most commonly used instruments to assess mental disorders. However, research on its cross-cultural measurement invariance is not yet sufficient. This study examined the measurement invariance of the Chinese and German versions of the PHQ's somatic symptom severity scale (PHQ-15), depressive symptom severity scale (PHQ-9) and seven-item Generalized Anxiety Disorder (GAD-7) scale as a prerequisite for their use in cross-cultural comparisons.

METHODS

We used online data collected from groups of Chinese students in China (n = 413) and German students in Germany (n = 416). Separate measurement models for each group were examined using confirmatory factor analysis and measurement invariance testing was conducted to test the cross-cultural equivalence.

RESULTS

Findings demonstrated that the PHQ-9 and GAD-7 had partial scalar measurement invariance, but the cross-cultural measurement invariance of the PHQ-15 could not be confirmed. Comparisons of latent means did not indicate differences in the levels of depression and anxiety symptoms between Chinese and German samples.

CONCLUSION

The PHQ-9 and GAD-7 can be used in cross-cultural comparison of prevalence, but the intercultural use of PHQ-15 is more problematic. Findings are discussed from intercultural and methodological perspectives.

Crazy Rich Chinese? A Mixed-Methods Examination of Perceived Stereotypes and Associated Psychosocial Adaptation Challenges among Chinese International Students in the United States

BACKGROUND

Prior research observes associations between race-based stressors (e.g. stereotypes) and the compromised psychological and sociocultural adaptation of international students.

METHODS

Using an explanatory sequential mixed-methods design (196 survey responses and 51 in-depth interviews), this study examined stereotypes perceived by Chinese students arriving on US college campuses after 2010, their interpretations of the new stereotypes, and the associated psychosocial adaptation challenges they had to navigate.

RESULTS

Our findings suggested multiple dimensions of the stereotypes this recent wave of Chinese students perceived from their American peers, including stereotypes pertinent to their financial background (frequency effect sizes = 37.6% and 51% for quantitative and qualitative results, respectively), academic abilities (20.1% and 13.7%), personality characteristics (16.5% and 19.6%), and social attitudes and behaviors (12.9% and 9.8%). Further, this study observed that the new, prevalent stereotypes (e.g. being wealthy) might foster intergroup tension and pit Chinese students against their American peers and that some Chinese students experienced psychological issues (e.g. lower levels of collective self-esteem and feelings of shame) due to the stereotypes of wealth-flaunting Chinese students.

CONCLUSIONS

This study contributes uniquely to the literature by unpacking the new stereotypes using a mixed-methods design and points to important practical implications for university services.

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents. Design: Cross-sectional design was utilized. Methods: IB, measured by the Adolescents' Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n = 25) and a control group (n = 29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation. Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn't have more negative interpretations of non-social situations, after controlling for depression. Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.

Sleep quality mediating the association of personality traits and quality of life among underground workers and surface workers of Chinese coal mine: A multi-group SEM with latent response variable mediation analysis

The aim of this study was to examine whether the association between personality traits and quality of life (QOL) was mediated by sleep quality in coal miners and to explore whether the relationship between surface workers and underground workers was different. The cross-sectional study including 3090 coal mine workers aged 20 to 65 years from Shanxi province of China was conducted. Personality traits, QOL and sleep quality were respectively assessed using Eysenck Personality Questionnaire-Revised Short Scale for Chinese, World Health Organization Quality of Life-BREF, and sleep status questionnaire. The multi-group SEM with latent response variable method was conducted to evaluate the association between personality traits and QOL mediated by sleep quality. The difference of indirect effects between two subgroups was examined by Wald chi-square test. For surface workers, underground workers and overall sample, passive personality traits had a negative impact on QOL through poor sleep quality, whereas the active personality traits acted the opposite. However, the difference of indirect effect between two subgroups was not statistically significant. These results indicated that sleep quality may act as a partial mediator in the relationship between personality traits and QOL, and the relationship may not be affected by working environment.

“Being Unfilial Condemns You to Hell”: Integrative Treatment for Social Anxiety Shaped by Domestic Abuse, Confucian Values, and Taoist Beliefs

Social anxiety is a common and treatable condition but less is known about how to adapt evidence-based approaches in a culture-sensitive way to Asian clients. We present the case of “Sally,” a 25-year-old Chinese Singaporean female who suffered from severe and long-standing social anxiety disorder (SAD), and secondary low mood. Contributing factors included a history of domestic abuse, as well as culturally influenced authoritarian parenting emphasizing the Confucian value of filial piety and reinforced by Taoist beliefs of karmic retribution and supernatural punishment. Treatment was based on Clark and Wells’s cognitive model of SAD with a focus on behavioral experiments, and was enhanced using a schema mode formulation and imagery rescripting to address relevant early memories that were at the origin of the social anxiety. Sally received a total of 42 sessions over the course of 21 weeks, during which she made steady progress toward recovery. Her self-reported depression and social phobia fell from the “severe clinical” range pretreatment to the “non-clinical” range posttreatment; these gains were maintained at 6 months follow-up. Sally’s functioning fully recovered, and she returned to work and school. While behavioral experiments for dropping safety behaviors were useful for overcoming the social anxiety, schema formulation was important for providing Sally with insight to her thought process, and imagery rescripting was crucial for weakening her self-criticism and internalized black and white thinking on filial piety. The significance of culture and religion in SAD, and the potential of adapting cognitive therapy in a culture-sensitive way is discussed.

Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London)

BACKGROUND

According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds.

AIMS

To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds.

METHOD

Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context.

RESULTS

Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations.

CONCLUSIONS

Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.

Shame, culture and mental health

BACKGROUND

Shame is a powerful negative emotion, associated with many mental disorders, both as an aetiological factor and as a consequence affecting symptoms, psychological defences and therapeutic outcomes.

AIM

To summarise some of the findings to date regarding cultural influences on the role of shame within mental disorders.

METHODS

This lecture explores the concept of shame and its impact on mental disorders from a transcultural perspective.

RESULTS

Although there has been growing interest in recent years in the role of shame in mental disorders, there has been little research examining the links between shame, mental health and culture. Guilt and shame are often used interchangeably, but there are differences in their respective meanings in different cultures.

CONCLUSIONS

Addressing patients' experiences of shame is an important part of the culturally competent treatment of mental disorders.

Shame as a Culture-Specific Emotion Concept

On the assumption that shame is a universal emotion, cross-cultural research on shame relies on translations assumed to be equivalent in meaning. Our studies here questioned that assumption. In three studies (Ns, 108, 120, 117),shamewas compared to its translations in Spanish (vergüenza) and in Malayalam (nanakedu). American English speakers usedshamefor the emotional reaction to moral failures and its use correlated positively withguilt, whereasvergüenzaandnanakeduwere used less for moral stories and their use correlated less with the guilt words. In comparison with Spanish and Malayalam speakers’ ratings of their translations, American English speakers ratedshameandguiltto be more similar to each other.

The Relationship Between Personality and Somatic and Psychological Distress: A Comparison of Chinese and Australian Adolescents

The extent to which correlations between personality domains and physical and psychological health generalize cross-culturally is unclear. We compared the strength of associations between the personality domains and somatic and psychological distress in Chinese (N = 2069) and a genetically informative sample of Australian (N = 2936) adolescents. We also examined the genetic and environmental etiology between personality, somatic and psychological distress in an Australian sample of 390 monozygotic twins and 698 dizygotic twins. In both populations, personality was assessed using the Junior Eysenck Personality Questionnaire. Somatic and psychological distress was assessed using the Somatic and Psychological Health Report. We found significant cultural differences in the relationship between adolescents' personality traits and somatic and psychological distress. Extraversion was positively associated with somatic distress in the Chinese but not in Australian adolescents. In the Australian twins, genetic covariation between neuroticism and somatic and psychological distress was stronger compared to the genetic associations between either psychoticism or extraversion with psychological distress.

Cultural aspects of anxiety disorders in India

Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents, prevalence, phenomenology, and treatment modalities of anxiety disorders in the Indian cultural context. It covers the history of the depiction of anxiety in India and the concept of culture in the classification of anxiety disorders, and examines the cultural factors influencing anxiety disorders in India. We review the prevalence and phenomenology of various disorders, such as generalized anxiety disorder, panic disorder, social anxiety, and phobic disorder, as well as culture-specific syndromes such as dhat and koro in India. Finally, the review examines the wide range of therapeutic modalities practiced in India, such as faith healing, psychotherapy, ayurveda, psychopharmacology, Unani medicine, homeopathy, yoga, meditation, and mindfulness. We conclude by emphasizing the significance of cultural factors in making relevant diagnoses and offering effective and holistic treatments to individuals with anxiety disorders.

Shame on Me! Self-Conscious Emotions and Big Five Personality Traits and Their Relations to Anxiety Disorders Symptoms in Young, Non-Clinical Adolescents

This study explored the relations between self-conscious emotions, personality traits, and anxiety disorders symptoms in non-clinical youths. One-hundred-and-eighteen adolescents aged 12-15 years completed the brief shame and guilt questionnaire for children (BSGQ-C) and items of the youth self-report (YSR) to measure shame and guilt, the big five personality questionnaire for children, and the youth anxiety measure for DSM-5. Results for shame indicated that this self-conscious emotion-either measured by the BSGQ-C or the YSR-was uniquely and positively associated with a broad range of anxiety disorders symptoms, and correlated positively with neuroticism and negatively with extraversion. Guilt did not show significant associations with anxiety disorders symptoms once controlling for the influence of shame, and links with personality traits varied dependent on the assessment instrument that was used (BSGQ-C or YSR). Finally, when controlling for neuroticism and extraversion, shame consistently remained a significant correlate of anxiety disorders symptoms. Altogether, these results add to the growing body of evidence indicating that high levels of shame are clearly associated with anxiety pathology.

The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children

The aim of this study was to explore the change and associated risk and protective factors of social anxiety symptoms among Chinese children. A 2-year longitudinal study was performed in a general primary and secondary school population in Anhui Province, China including 816 children in grades 3, 4, and 7. Children's social anxiety symptoms were assessed using the Social Anxiety Scales for Children (SASC) at three assessments. The overall prevalence of children's elevated social anxiety symptoms ranged from 15.2% to 16.4% across three assessments. Children's overall mean SASC scores were 5.6 (SD =3.7), 5.3 (SD =3.8), and 5.3 (SD =4.1) at three assessments, respectively, but the difference was not statistically significant. However, children's social anxiety symptom levels and change among different subgroups was not stable across 2-year follow-up. Multivariable logistic regression analysis indicated that age, severe family dysfunction, quality of life, positive coping, negative coping, depressive symptoms and self-esteem were predictive factors for childhood elevated social anxiety symptoms. The findings suggested that the overall social anxiety symptoms showed a relatively stable pattern over time. The identified risk and protective factors may provide scientific evidence for school, family, and health authorities to conduct necessary intervention.

Factor structure of the Chinese version of the geriatric anxiety inventory

BACKGROUND

As China's population ages, the mental health of older people has been increasingly focused on by academic circles.

PURPOSE

The aim of this study was to identify the factor structure of the Chinese version of the geriatric anxiety inventory (GAI-CV).

METHODS

This study used data collected from Investigation on the anxiety symptoms of the elderly in the city of Beijing supported by scientific research fund project of Renmin University of China. Cronbach's α was used to test internal consistency reliability. Both confirmatory and exploratory factor analyses were performed separately for factor analysis.

RESULTS

1318 subjects with mean age 71.35 ± 7.44 years (male 40.6 %) were involved. Principal components analysis revealed a three-factor structure of the GAI-CV. GAI-CV scales exhibited good internal consistency (Cronbach's α = 0.937) and a three-factor model fit the data well [comparative fit index (CFI) = 0.891, root mean square error of approximation (RMSEA) = 0.084].

CONCLUSIONS

The Chinese version of the GAI appears to be reliable and valid to measure anxiety for elderly people in China.

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

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

Civilizing Humans with Shame: How Early Confucians Altered Inherited Evolutionary Norms through Cultural Programming to Increase Social Harmony

To say Early Confucians advocated the possession of a sense of shame as a means to moral virtue underestimates the tact and forethought they used successfully to mold natural dispositions to experience shame into a system of self, familial, and social governance. Shame represents an adaptive system of emotion, cognition, perception, and behavior in social primates for measurement of social rank. Early Confucians understood the utility of the shame system for promotion of cooperation, and they build and deploy cultural modules – e.g., rituals, titles, punishments – with this in mind. These policies result in subtle alterations to components of the evolved shame system that are detectable in data form contemporary cross-cultural psychology that show that populations in the Confucian diaspora have a unique shame profile compared to Western and non-Western populations. The status of Confucian diaspora populations as outliers in the context of shame is partially explained by appeal to the cultural transmission and historical endurance of relevant Early Confucian cultural modules.

Jikoshu-kyofu in Singapore

OBJECTIVE

Jikoshu-kyofu (JKF), a condition characterised by a fear of offending others through emitting foul body odour, was first described in Japan in the 1960s. Although initially thought to be a culture-bound syndrome, it has been described in other countries. It is well established that there are two variants, a non- delusional and a delusional variant.

METHOD

We describe two cases of JKF who sought treatment from a hospital in Singapore, compare and contrast their characteristics, and in view of overlaps with other conditions, discuss differential diagnoses.

RESULTS

Both cases involved women with fairly similar symptomatology except that the first case was younger, had overvalued ideas (but not delusions), an earlier age of onset and good treatment response, while the other had delusions, late age of onset, became too distressed to continue working and was initially resistant to treatment.

CONCLUSION

It appears that the delusional variant may have a longer symptomatic duration before presentation, poorer insight, more resistance to treatment and multiple physician consultations, as well as greater impairment of socio-occupational functioning in contrast to the non-delusional variant.

Relations among behavioral inhibition, shame- and guilt-proneness, and anxiety disorders symptoms in non-clinical children

This study examined relationships between the self-conscious emotions of shame and guilt, behavioral inhibition (as an index of anxiety proneness), and anxiety disorder symptoms in non-clinical children aged 8-13 years (N = 126), using children's self-report data. Results showed that there were positive and significant correlations between shame and guilt, behavioral inhibition, and anxiety disorders symptoms. When controlling for the overlap between shame and guilt, it was found that shame (but not guilt) remained significantly associated with higher levels of anxiety proneness and anxiety symptoms. Further, when controlling for the effect of behavioral inhibition, shame still accounted for a significant proportion of the variance of total anxiety and generalized anxiety scores. For these anxiety problems, support emerged for a model in which shame acted as a partial mediator in the relation between behavioral inhibition and anxiety. These results indicate that the self-conscious emotion of shame is a robust correlate of anxiety pathology in children.

Depressogenic thinking and shame proneness in the development of internalizing problems

This study examined depressogenic thinking and shame proneness as factors in the development of internalizing problems in a longitudinal sample of 174 children (99 boys, 75 girls). At 7.6-9.4 years of age (Time 1), mothers assessed general internalizing problems in their children and depressogenic thinking, shame proneness, and anxiety were assessed by child self report. At 10.2-11.8 years of age (Time 2), mothers reassessed internalizing problems, and children reported their anxiety and depression. At 12.3-13.1 years of age (Time 3), children who had been high on any Time 2 measure of internalizing problems were selected for assessment of anxiety and depressive disorders. Depressogenic thinking and shame were significantly correlated and predicted subsequent problems. Depressogenic thinking predicted internalizing problems and anxious and depressive symptoms. Shame directly predicted boys' depressive symptoms, and indirectly predicted boys' general internalizing problems and girls' social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. Findings suggest that both shame and depressive thinking contribute to the development of children's internalizing problems.

Factors impacting the mental health of the caregivers of children with asthma in china: effects of family socioeconomic status, symptoms control, proneness to shame, and family functioning

Caregiver mental health is widely considered to be an important factor influencing children's asthma symptoms. The present study aimed to examine key factors that contribute to caregiver mental health in pediatric asthma with a Chinese sample. Two hundred participants reported their family socioeconomic status (SES), proneness to shame, asthma symptoms control of their child, family functioning, and their depression and anxiety symptoms. Results suggested that low family SES, low family functioning, and a high level of shame proneness were associated with high levels of anxiety and depression for caregivers. Family functioning mediated the effects of SES and shame on caregiver mental health and also moderated the effects of SES and shame on caregiver depression. This study highlights the importance of reducing experience of shame and enhancing family functioning in families affected by pediatric asthma.

Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms

Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt, depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD.

Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation

OBJECTIVE

To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.

METHOD

3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.

RESULTS

The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.

CONCLUSIONS

PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

Cultural aspects in social anxiety and social anxiety disorder

To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and SAD. This has direct relevance for the upcoming DSM-V.

Development and validation of a modified fecal incontinence quality of life scale for Japanese patients after intersphincteric resection for very low rectal cancer

PURPOSE

Fecal incontinence is a frequently observed symptom after lower rectal surgery with sphincter manipulation. The aim of this study was to evaluate a proposed modification to the fecal incontinence quality of life (FIQL) scale for the assessment of the quality of life among patients with very low rectal cancer who have undergone intersphincteric resection.

METHODS

A single 14-item composite scale was prepared that was derived from items in the "Lifestyle" and "Coping" subscales of the original FIQL. The scale was tested with a convenience sample of 152 postoperative patients. In addition to classic psychometric evaluation, newer statistical techniques, such as a multiple correspondence analysis and partial credit model, were performed to evaluate the item response patterns.

RESULTS

The proposed scale exhibited an item-rest correlation of 0.66-0.84 and a Cronbach's alpha of 0.96, and was correlated with concurrently measured Social Functioning subscale of the Medical Outcomes Study Short Form 36 (-0.70), physical role limitation (-0.61), and Wexner continence grading scale (-0.61). Multiple correspondence analysis supported a uni-dimensional construct, and the partial credit model showed a varying yet overlapping range of item response thresholds across items. Several items, such as "Locating bathroom whenever going out", reflected more a serious condition than items such as "Avoiding eating-out." Weighted item scores based on estimated thresholds provided results comparable with those based on non-weighted scores.

CONCLUSIONS

The proposed modification to the FIQL scale exhibited high internal consistency and satisfactory concurrent and convergence validity. The modified scale is practical to administer and is sensitive to a range of functional problems associated with fecal incontinence among patients who have undergone intersphincteric resection.

Penn State Worry Questionnaire: structure and psychometric properties of the Chinese version

The Penn State Worry Questionnaire (PSWQ) is a measure of worry phenomena and has been demonstrated valid in cross-cultural populations. The present study examined the factor structure and psychometric properties of the Chinese version of PSWQ (Ch-PSWQ) in a Chinese college sample (n=1243). Exploratory factor analysis of the Ch-PSWQ revealed a two-factor solution (engagement of worry and absence of worry). Confirmatory factor analysis and model comparison supported that the model of one factor with method effect provided the best fit to the data. The Ch-PSWQ and its factors evidenced good internal consistency and both convergent and discriminate validity. The present study supports the opinion that the second factor of PSWQ not only contains the component of evaluating pathological worry, but also might represent other traits.