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Nikolić M, di Plinio S, Sauter D, Keysers C, Gazzola V. The blushing brain: neural substrates of cheek temperature increase in response to self-observation. Proc Biol Sci 2024; 291:20240958. [PMID: 39013420 PMCID: PMC11251765 DOI: 10.1098/rspb.2024.0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Darwin proposed that blushing-the reddening of the face owing to heightened self-awareness-is 'the most human of all expressions'. Yet, relatively little is known about the underlying mechanisms of blushing. Theories diverge on whether it is a rapid, spontaneous emotional response that does not involve reflection upon the self or whether it results from higher-order socio-cognitive processes. Investigating the neural substrates of blushing can shed light on the mental processes underlying blushing and the mechanisms involved in self-awareness. To reveal neural activity associated with blushing, 16-20 year-old participants (n = 40) watched pre-recorded videos of themselves (versus other people as a control condition) singing karaoke in a magnetic resonance imaging scanner. We measured participants' cheek temperature increase-an indicator of blushing-and their brain activity. The results showed that blushing is higher when watching oneself versus others sing. Those who blushed more while watching themselves sing had, on average, higher activation in the cerebellum (lobule V) and the left paracentral lobe and exhibited more time-locked processing of the videos in early visual cortices. These findings show that blushing is associated with the activation of brain areas involved in emotional arousal, suggesting that it may occur independently of higher-order socio-cognitive processes. Our results provide new avenues for future research on self-awareness in infants and non-human animals.
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Affiliation(s)
- Milica Nikolić
- Institute for Child Development and Education, University of Amsterdam, Amsterdam1018 WS, The Netherlands
| | - Simone di Plinio
- Department of Neuroscience, Imaging, and Clinical Sciences, D'Annunzio University of Chieti–Pescara, Pescara66100, Italy
| | - Disa Sauter
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
| | - Christian Keysers
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
- Netherlands Institute for Neuroscience, KNAW, Amsterdam1105 BA, The Netherlands
| | - Valeria Gazzola
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
- Netherlands Institute for Neuroscience, KNAW, Amsterdam1105 BA, The Netherlands
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2
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Sabahi M, Yousefi O, Kehoe L, Sasannia S, Gerndt C, Adada B, Borghei-Razavi H, Shahlaie K, Palmisciano P. Correlation Between Pituitary Adenoma Surgery and Anxiety Disorder: Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:184-193.e6. [PMID: 38697260 DOI: 10.1016/j.wneu.2024.04.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE This study aims to evaluate the impact of surgical intervention on anxiety levels in patients with various types of pituitary adenoma (PA). METHOD A systematic review was conducted following PRISMA guidelines until October 2022, searching Embase, PubMed, Web of Sciences, and Scopus. RESULTS A total of 32 studies were included, encompassing 2,681 patients with the mean age of 53.33 ± 6.48 years (43.4% male). Among all subtypes, 664 diagnosed with Cushing's disease (25.8%), 612 with acromegaly (23.8%), 282 with prolactinoma (10.9%), and 969 with nonfunctional pituitary adenomas (37.6%). Pituitary insufficiency was the most common complication. Considering therapeutic modalities, 515 patients (29.8%) underwent endoscopic trans-sphenoidal surgery, while 222 (12.9%) underwent microscopic trans-sphenoidal surgery. The type of trans-sphenoidal surgery was not specified in 977 (56.6%) patients. A total of 17 studies including 1510 patients which mostly assessed anxiety using the Hospital Anxiety and Depression Scale (HADS) and Zung Self-Rating Anxiety Scale (SAS) were included in the meta-analysis. Preoperative evaluation using Hospital Anxiety and Depression Scale (HADS) questionnaire showed a pooled score of 8.27 (95%CI 4.54-12.01), while postoperative evaluation yielded a pooled score of 6.49 (95%CI 5.35-7.63), indicating no significant difference. Preoperative SAS assessment resulted in a pooled score of 50.43 (95%CI 37.40-63.45), with postoperative pooled score of 55.91 (95%CI 49.40-62.41), showing no significant difference. CONCLUSIONS Our analysis revealed no significant difference in anxiety scores pre- and postoperatively. While our findings suggest stability in anxiety levels following surgical intervention, it is imperative to recognize the limitations of the current evidence base. The observed lack of consensus may be influenced by factors such as the heterogeneous nature of the patient population, variations in the characteristics of pituitary adenomas, diverse therapeutic approaches, and potential confounding variables such as pre-existing mental health conditions and coping mechanisms. Further research is warranted to elucidate the nuanced relationship between surgical intervention for PA and anxiety outcomes, considering these complex interactions and employing rigorous methodologies to address potential sources of bias.
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Affiliation(s)
- Mohammadmahdi Sabahi
- Department of Neurologic Surgery, Pauline Braathen Neurologic Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Omid Yousefi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laura Kehoe
- School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, Ireland
| | - Sarvin Sasannia
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA; Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clayton Gerndt
- Department of Neurologic Surgery, University of California, Davis, Sacramento, California, USA
| | - Badih Adada
- Department of Neurologic Surgery, Pauline Braathen Neurologic Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Hamid Borghei-Razavi
- Department of Neurologic Surgery, Pauline Braathen Neurologic Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Kiarash Shahlaie
- Department of Neurologic Surgery, University of California, Davis, Sacramento, California, USA
| | - Paolo Palmisciano
- Department of Neurologic Surgery, University of California, Davis, Sacramento, California, USA.
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Macpherson MC, Brown AJ, Kallen RW, Richardson MJ, Miles LK. Partner gaze shapes the relationship between symptoms of psychopathology and interpersonal coordination. Sci Rep 2024; 14:14288. [PMID: 38906960 PMCID: PMC11192736 DOI: 10.1038/s41598-024-65139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
Interpersonal coordination is a key determinant of successful social interaction but can be disrupted when people experience symptoms related to social anxiety or autism. Effective coordination rests on individuals directing their attention towards interaction partners. Yet little is known about the impact of the attentional behaviours of the partner themselves. As the gaze of others has heightened salience for those experiencing social anxiety or autism, addressing this gap can provide insight into how symptoms of these disorders impact coordination. Using a novel virtual reality task, we investigated whether partner gaze (i.e., direct vs. averted) influenced the emergence of interpersonal coordination. Results revealed: (i) spontaneous coordination was diminished in the averted (cf. direct) gaze condition; (ii) spontaneous coordination was positively related to symptoms of social anxiety, but only when partner gaze was averted. This latter finding contrasts the extant literature and points to the importance of social context in shaping the relationship between symptoms of psychopathology and interpersonal coordination.
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Affiliation(s)
- M C Macpherson
- School of Psychological Science, University of Western Australia, Perth, Australia.
| | - A J Brown
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - R W Kallen
- School of Psychological Sciences and Performance and Expertise Research Centre, Macquarie University, Sydney, Australia
| | - M J Richardson
- School of Psychological Sciences and Performance and Expertise Research Centre, Macquarie University, Sydney, Australia
| | - L K Miles
- School of Psychological Science, University of Western Australia, Perth, Australia
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Baljé AE, Greeven A, Deen M, van Giezen AE, Arntz A, Spinhoven P. Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial. J Anxiety Disord 2024; 104:102860. [PMID: 38714138 DOI: 10.1016/j.janxdis.2024.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. METHODS We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). RESULTS Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. CONCLUSION GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.
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Affiliation(s)
- Astrid E Baljé
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Anja Greeven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Mathijs Deen
- Institute of Psychology/Leiden University, Leiden, the Netherlands; Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Anne E van Giezen
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands.
| | - Philip Spinhoven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
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Thunnissen MR, de Jong PJ, Rijkeboer MM, Voncken MJ, Rapee RM, Nauta MH. Targeting negative flashforward imagery in speech anxiety with a visuospatial dual-task: Do attenuated flashforwards lead to less anxiety and avoidance? J Behav Ther Exp Psychiatry 2024; 83:101940. [PMID: 38160573 DOI: 10.1016/j.jbtep.2023.101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/23/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND OBJECTIVES It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech. METHODS Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech. RESULTS Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech. LIMITATIONS The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample. CONCLUSIONS Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears.
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Affiliation(s)
- Marjolein R Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Child Study Center, Accare, PO Box 660, 9700 AR Groningen, the Netherlands.
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Marisol J Voncken
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, 16 University Ave, Sydney, New South Wales 2109, Australia
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Child Study Center, Accare, PO Box 660, 9700 AR Groningen, the Netherlands
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Wake S, Hedger N, van Reekum CM, Dodd H. The effect of social anxiety on threat acquisition and extinction: a systematic review and meta-analysis. PeerJ 2024; 12:e17262. [PMID: 38737738 PMCID: PMC11088819 DOI: 10.7717/peerj.17262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/28/2024] [Indexed: 05/14/2024] Open
Abstract
Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms.
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Affiliation(s)
- Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Nicholas Hedger
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Carien M. van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Helen Dodd
- University of Exeter, Exeter, United Kingdom
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Tan Y, Deng J, Zhang D, Peng C, Peng A. Social anxiety and suicidal ideation among middle-school students in China: a mediation model of internet addiction. Front Psychiatry 2024; 14:1337577. [PMID: 38239900 PMCID: PMC10794584 DOI: 10.3389/fpsyt.2023.1337577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
Background Suicide is a fatal public health issue for adolescents, and it is of great significance to explore the precursors of suicidal behaviors, especially suicidal ideation. However, the relationship between social anxiety and suicidal ideation and its mechanism are still unclear. The study aims to examine the association between social anxiety and suicidal ideation and the mediating effect through Internet addiction. Methods A total of 2,278 middle-school students aged 12 to 16 years were recruited through a multistage cluster sampling method in this cross-sectional study. Logistical regression analysis and structural equation modeling (SEM) were conducted to examine the direct and indirect effects of social anxiety. Results During the past year, 262 (11.50%) participants reported suicidal ideation. Females had a higher prevalence of suicidal ideation than males (12.9% vs. 10.0%, p = 0.034), and urban adolescents reported a higher prevalence than their rural counterparts (13.4% vs. 9.6%, p = 0.006). In the total sample, social anxiety and Internet addiction were independently associated with suicidal ideation (p < 0.05). In the subgroup analysis, the association between social anxiety and suicidal ideation was significant only among rural females and urban males (p < 0.05). SEM demonstrated that social anxiety had direct and indirect effects on suicidal ideation, and Internet addiction partially mediated the relationship, with a mediating ratio of 30.53%. The partial mediating effect was also significant only in rural females and urban males. Conclusion Adolescents may overuse the Internet to cope with social anxiety and further have suicidal ideation. Limiting Internet use and improving interpersonal skills in real life may be efficient for suicide prevention. In addition, targeted interventions should be tailored by different sexes across urban and rural regions.
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Affiliation(s)
- Yafei Tan
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Jingjing Deng
- College of Public Health and Health Professions, Hubei University of Science and Technology, Xianning, Hubei, China
| | - Dan Zhang
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Chang Peng
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anna Peng
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
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Herman R, Clark T. It's not a virus! Reconceptualizing and de-pathologizing music performance anxiety. Front Psychol 2023; 14:1194873. [PMID: 38022988 PMCID: PMC10667921 DOI: 10.3389/fpsyg.2023.1194873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.
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Affiliation(s)
- Rebecca Herman
- Centre for Performance Science, Royal College of Music, London, United Kingdom
| | - Terry Clark
- Mount Royal Conservatory, Calgary, AB, Canada
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Velleman SL, Guimaraes VN, Klein-Tasman BP, Huffman MJ, Becerra AM, Mervis CB. Relations Between Selective Mutism and Speech Sound Disorder in Children With 7q11.23 Duplication Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-11. [PMID: 37678220 DOI: 10.1044/2023_jslhr-22-00721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE The aim of this study was to explore relations between speech sound disorder severity and selective mutism in a group of children with 7q11.23 duplication syndrome (Dup7), a genetic condition predisposing children to childhood apraxia of speech (CAS) and other speech sound disorders and to anxiety disorders, including selective mutism and social anxiety disorder. METHOD Forty-nine children aged 4-17 years with genetically confirmed Dup7 completed the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2), the Expressive Vocabulary Test-Second Edition (EVT-2), and the Differential Ability Scales-Second Edition (DAS-II). Parents completed the Anxiety Disorders Interview Schedule-Parent (ADIS-P). RESULTS Mean standard scores (SSs) were 65.67 for the GFTA-2, 92.73 for the EVT-2, and 82.69 for the DAS-II General Conceptual Ability (GCA; similar to IQ). Standard deviations for all measures were larger than for the general population. GFTA-2 SS was significantly correlated with both EVT-2 SS and DAS-II GCA. Based on the ADIS-P, 22 participants (45%) were diagnosed with selective mutism and 29 (59%) were diagnosed with social anxiety disorder. No significant differences in performance on any of the measures were found either between the group with a selective mutism diagnosis and the group that did not have selective mutism or between the group with a selective mutism and/or social anxiety disorder diagnosis and the group that did not have either disorder. CONCLUSIONS For children with Dup7, neither the diagnosis of selective mutism nor the diagnosis of selective mutism and/or social anxiety disorder was related to severity of speech sound disorder, expressive vocabulary ability, or overall intellectual ability. Accordingly, treatment for speech sound disorder alone is unlikely to lead to remission of selective mutism or social anxiety disorder. Instead, selective mutism and/or social anxiety disorder should be treated directly. Further research is needed to determine if these findings generalize to other populations, such as children with idiopathic CAS.
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Affiliation(s)
- Shelley L Velleman
- Department of Communication Sciences and Disorders, The University of Vermont, Burlington
| | - Vitor N Guimaraes
- Department of Psychological and Brain Sciences, University of Louisville, KY
| | | | - Myra J Huffman
- Department of Psychological and Brain Sciences, University of Louisville, KY
| | - Angela M Becerra
- Department of Psychological and Brain Sciences, University of Louisville, KY
| | - Carolyn B Mervis
- Department of Psychological and Brain Sciences, University of Louisville, KY
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Lee M, Park IY, Park M, Tran PK, Cozier YC, Hahm HC. COVID-19-Related Racial Discrimination during Lockdown and Its Impact on Asian American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6546. [PMID: 37623132 PMCID: PMC10454441 DOI: 10.3390/ijerph20166546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
During the lockdown period of the COVID-19 pandemic, Asian American (AA) women have experienced a surge in anti-Asian hate crimes and racial discrimination, and a majority of studies have quantitatively shown the negative impact of these incidents on Asian Americans' well-being. Our research expands on the existing literature by qualitatively investigating types of COVID-19-related racial discrimination during lockdown and its impacts on changes in emotions, behaviors, well-being, and racial identity development among AA women. This study covered two timepoints (December 2019 to May 2020) and the data were collected using an open-ended survey with 40 AA women. Thematic analysis identified core themes related to types of racial discrimination, emotional and behavioral changes, and racial identity status that emerged due to COVID-19-related racial discrimination experiences. The findings shed light on the long-lasting impacts of racial discrimination on AA women's overall well-being and dynamic development of racial identity. Altogether, our findings underscore the need for systematic forms of advocacy to combat anti-Asian racism and call for solidarity for AA women's well-being.
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Affiliation(s)
- Mina Lee
- Department of Social Work, College of Community and Public Affairs, Binghamton University, Binghamton, NY 13902, USA;
| | - In Young Park
- School of Social Work, Boston College, Boston, MA 02467, USA;
| | - Michael Park
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Phuong Khanh Tran
- Department of Electrical and Computer Engineering, College of Engineering, Boston University, Boston, MA 02215, USA;
| | - Yvette C. Cozier
- School of Public Health, Boston University, Boston, MA 02215, USA;
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Min JY, Park S, Cho J, Huh Y. The anterior insular cortex processes social recognition memory. Sci Rep 2023; 13:10853. [PMID: 37407809 DOI: 10.1038/s41598-023-38044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023] Open
Abstract
Impaired social abilities are characteristics of a variety of psychiatric disorders such as schizophrenia, autism spectrum disorder, and bipolar disorder. Studies consistently implicated the relationship between the anterior insular cortex (aIC) and social ability, however, how the aIC involves in processing specific subtypes of social ability was uninvestigated. We, therefore, investigated whether the absence or presence of the aIC affects the social behaviors of mice. We found that electrolytic lesions of the aIC specifically impaired mice's ability to recognize a novel stranger mouse, while the sociability of the aIC-lesioned mice was intact. Interestingly, the aIC-lesioned mice were still distinguished between a mouse that had been housed together before the aIC lesion and a novel mouse, supporting that retrieval of social recognition memory may not involve the aIC. Additional behavioral tests revealed that this specific social ability impairment induced by the aIC lesion was not due to impairment in olfaction, learning and memory, locomotion, or anxiety levels. Together our data suggest that the aIC is specifically involved in processing social recognition memory, but not necessarily involved in retrieving it.
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Affiliation(s)
- Ji-You Min
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Sanggeon Park
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, 03760, Republic of Korea
- Brain Disease Research Institute, Ewha Brain Institute, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jeiwon Cho
- Department of Brain and Cognitive Sciences, Scranton College, Ewha Womans University, Seoul, 03760, Republic of Korea.
- Brain Disease Research Institute, Ewha Brain Institute, Ewha Womans University, Seoul, 03760, Republic of Korea.
| | - Yeowool Huh
- Department of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung‑si, 25601, Republic of Korea.
- Translational Brain Research Center, International St. Mary's Hospital, Catholic Kwandong University, Incheon, 22711, Republic of Korea.
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Burnley A, St Clair M, Bedford R, Wren Y, Dack C. Understanding the prevalence and manifestation of anxiety and other socio-emotional and behavioural difficulties in children with Developmental Language Disorder. J Neurodev Disord 2023; 15:17. [PMID: 37322422 PMCID: PMC10268478 DOI: 10.1186/s11689-023-09486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND It is well-documented that children with Developmental Language Disorder (DLD) have a higher likelihood of experiencing anxiety, as well as other socio-emotional and behavioural (SEB) difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand the prevalence of broader SEB difficulties and anxiety, informing intervention development by understanding the relationships between them. METHODS A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD ("DLD sample"; n = 57) or typically developing children ("typical sample"; n = 50), aged 6-12 years old. Binary SEB statements informed by previous qualitative work (e.g. "my child requires routine/sameness"; "my child has frequent tantrums") provided an insight into the prevalence of SEB difficulties in both DLD and typical samples. Validated measures of anxiety, emotion regulation, intolerance of uncertainty, insistence on sameness, family stress and coping mechanisms were also collected. Correlation and mediation analyses were run using these validated measures to understand the manifestation of anxiety in children with DLD in more detail. Qualitative interviews were then carried out with a select panel of survey respondents (n = 4). RESULTS The DLD sample scored significantly higher on all binary SEB statements than the typical sample: experiencing anxiety (80.7%, p < .05), requiring routine and sameness (75.4%, p < .001) and emotional dysregulation (75.4%; p < .001) were the most common difficulties reported for children with DLD. Using the validated scales, family stress and coping mechanisms were found to only correlate with the manifestation of anxiety in the typical group, not the DLD group. "Intolerance of uncertainty" and "insistence on sameness" were found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Parent's interviews provided contextual support for the analysis, as well as highlighting sensory sensitivities as a focus for future research. CONCLUSIONS Parents of children with DLD appear to cope well with their children's complex SEB needs. Intervention focussing on intolerance of uncertainty may help the management of difficulties with anxiety. Behaviours such as insistence on sameness should be investigated further, as potential indicators for anxiety amongst children with DLD.
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Affiliation(s)
- Annabel Burnley
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Michelle St Clair
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Rachael Bedford
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Yvonne Wren
- Bristol Dental School, University of Bristol, Bristol, Bristol County UK
| | - Charlotte Dack
- Department of Psychology, University of Bath, Bath, Somerset County UK
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13
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Jin S, Liu W, Hu Y, Liu Z, Xia Y, Zhang X, Ding Y, Zhang L, Xie S, Ma C, Kang Y, Hu Z, Cheng W, Yang Z. Aberrant functional connectivity of the bed nucleus of the stria terminalis and its age dependence in children and adolescents with social anxiety disorder. Asian J Psychiatr 2023; 82:103498. [PMID: 36758449 DOI: 10.1016/j.ajp.2023.103498] [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: 11/10/2022] [Revised: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a prevalent and impairing mental disorder among children and adolescents. The bed nucleus of the stria terminalis (BNST) plays a critical role in anxiety disorders, including valence surveillance and hypervigilance for potential threats. However, the role of BNST and its related functional network in children and adolescents with SAD has not been fully investigated. This study examined the aberration of BNST's functional connectivity and its age dependence in adolescents with SAD. METHODS Using a sample of 75 SAD patients and 75 healthy controls (HCs) children aged 9-18 years old, we delineated the group-by-age interaction of BNST-seeded functional connectivity (FC) during resting state and movie-watching. The relationships between BNST-seeded FC and clinical scores were also examined. RESULTS During movie viewing, the FC between the right BNST and the left amygdala, bilateral posterior cingulate cortex (PCC), bilateral superior temporal cortex, and right pericalcarine cortex showed a diagnostic group-by-age interaction. Compared to HCs, SAD patients showed a significant enhancement of the above FC at younger ages. Meanwhile, they showed an age-dependent decrease in FC between the right BNST and left amygdala. Furthermore, for SAD patients, FC between the right BNST and left amygdala during movie viewing was positively correlated with separation anxiety scores. CONCLUSIONS The right BNST plays an essential role in the aberrant brain functioning in children and adolescents with SAD. The atypicality of BNST's FC has remarkable age dependence in SAD, suggesting an association of SAD with neurodevelopmental traits.
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Affiliation(s)
- Shuyu Jin
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yang Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhen Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yufeng Xia
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaochen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yue Ding
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lei Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shuqi Xie
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Changminghao Ma
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yinzhi Kang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhishan Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychological and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
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14
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Melkam M, Segon T, Nakie G. Social phobia of Ethiopian students: meta-analysis and systematic review. Syst Rev 2023; 12:41. [PMID: 36918994 PMCID: PMC10012574 DOI: 10.1186/s13643-023-02208-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Social anxiety disorder is defined as the fear of social situations, incorporating situations that involve contact with strangers. People highly fear embarrassing themselves which includes situations like social gatherings, oral presentations, and meeting new people. People with social phobia have nonspecific fears of practicing vague or, performing specific tasks like eating or speaking in front of others. In people with social anxiety disorder, worry can arise from both the circumstance itself and embarrassment from others, for students, social phobia is an overwhelming fear of speaking in front of others or giving presentations in class. The prevalence of social phobia among different studies in Ethiopia was inconsistent and inconclusive therefore, this study showed the cumulative burden of social phobia among students in Ethiopia. METHOD Observational studies published on social phobia and associated factors among students in Ethiopia were included in this study based on the criteria after independent selection by two authors. Data were extracted by Microsoft Excel spreadsheet to be exported to Stata version 11 for further analysis. The random-effect model was used to estimate the pooled effect size of social phobia and its effect on the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. Sub-group analysis and sensitivity analysis were done. RESULT A total of 2878 study participants from seven studies were included in this meta-analysis and systematic review. The pooled prevalence of social phobia among students in Ethiopia was 26.81% with a 95% CI (22.31-31.30). The pooled effect size of social phobia in Oromia, Amhara, and SNNPs regions was 24.76%, 24.76%, and 29.47%, respectively. According to the subgroup analysis, university, and college/high school students were 28.05% and 25.34% respectively. Being female [AOR = 2.11 (95% CI 1.72-2.60)], having poor social support [AOR = 2.38 (95% CI 1.54-3.70)], substance use [AOR = 2.25 (95% CI 1.54-3.30)], single parent [AOR = 5.18 (95% CI 3.30-8.12)], and rural residence [AOR = 2.29 (95% CI 1.91-2.75)] were significantly associated in this meta-analysis in Ethiopia. CONCLUSION The pooled prevalence of social phobia in this meta-analysis and systematic review was high (26.81%) among students therefore, the educational bureau needs to work on decreasing the burden of social phobia to raise the academic achievement and creativity of the students. In therapeutic advice like exposure to presentations, family members take the responsibility for the students' therapy and expose them to various social interactions.
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Affiliation(s)
- Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tesfaye Segon
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Ogrodniczuk JS, Kealy D, Cox DW, Mielimąka M, Joyce AS. A Preliminary Study of the Interactive Effect of Avoidant Personality Disorder Symptoms and Expressive Suppression on the Outcome of a Psychodynamically Oriented Day Treatment Program. Psychodyn Psychiatry 2023; 51:114-123. [PMID: 36867187 DOI: 10.1521/pdps.2023.51.1.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Patients with avoidant personality disorder (AvPD) pathology tend to have poor prognosis in psychotherapy, yet there has been little research conducted to better understand why their outcomes are limited, making it difficult to improve treatments for them. Expressive suppression is a dysfunctional emotion regulation strategy that may exacerbate avoidant tendencies, further complicating the therapeutic process. Methods: Using data from a naturalistic study (N = 34) of a group-based day treatment program, we examined whether there was an interactive effect of AvPD symptoms and expressive suppression on treatment outcome. Results: Findings revealed a significant moderating effect of expressive suppression on the association between AvPD symptoms and treatment outcome. The outcome for patients with more severe AvPD symptoms was particularly poor when they engaged in high levels of expressive suppression. Discussion: The findings suggest that the combination of significant AvPD pathology and high expressive suppression is associated with poorer responsiveness to treatment.
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Affiliation(s)
- John S Ogrodniczuk
- Professor, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - David Kealy
- Associate Professor, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Daniel W Cox
- Associate Professor, Counselling Psychology Program, University of British Columbia, Vancouver, Canada
| | - Michał Mielimąka
- Chair, Department of Psychotherapy, Jagiellonian University Medical College, Krakow, Poland
| | - Anthony S Joyce
- Clinical Professor, Department of Psychiatry, University of Alberta, Edmonton, Canada
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16
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Synchrony and mental health: Investigating the negative association between interpersonal coordination and subclinical variation in autism and social anxiety. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2023. [DOI: 10.1016/j.jesp.2022.104439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Zhu X, Zhou H, Geng F, Wang J, Xu H, Hu Y. Functional Connectivity Between Basal Forebrain and Superficial Amygdala Negatively Correlates with Social Fearfulness. Neuroscience 2023; 510:72-81. [PMID: 36572173 DOI: 10.1016/j.neuroscience.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Social anxiety is characterized by an intense fear of evaluation from others and/or withdrawal from social situations. Extreme social anxiety can lead to social anxiety disorder. There remains an urgent need to investigate the neural substrates of subclinical social anxiety for early diagnosis and intervention to reduce the risk to develop social anxiety disorder. Twenty-nine young adults were recruited (10 males/19 females; mean age (SD) = 20.34 (2.29)). Trait-like social anxiety was assessed by Liebowitz Social Anxiety Scale. Functional magnetic resonance imaging was used with an emotional face-matching paradigm to probe brain activation in response to emotional stimuli including angry, fearful, and happy faces, with shape-matching as a control condition. Behavioral results showed positive correlations between Liebowitz Social Anxiety Scale scores and the reaction time in both angry and fearful conditions. The activation of superficial amygdala and the deactivation of basal forebrain in response to angry condition showed positive correlations with the level of social anxiety. In addition, the resting-state functional connectivity between these two regions was negatively correlated with the level of social anxiety. These results may help to understand the individual difference and corresponding neural underpinnings of social anxiety in the subclinical population, and might provide some insight to develop strategies for early diagnosis and interventions of social anxiety to reduce the risk of deterioration from subclinical to clinical level of social anxiety.
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Affiliation(s)
- Xiao Zhu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310027, China
| | - Hui Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310027, China
| | - Fengji Geng
- Department of Curriculum and Learning Sciences, College of Education, Zhejiang University, Hangzhou 310007, China
| | - Jun Wang
- Department of Neurobiology and Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, China
| | - Han Xu
- Department of Neurobiology and Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, China; Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou 310015, China
| | - Yuzheng Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310027, China; Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou 310015, China.
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18
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Baroni D, Caccico L, Ciandri S, Di Gesto C, Di Leonardo L, Fiesoli A, Grassi E, Lauretta F, Lebruto A, Marsigli N, Policardo GR, Rosadoni M, Chiorri C. Measurement invariance of the Liebowitz Social Anxiety Scale-Self-Report. J Clin Psychol 2023; 79:391-414. [PMID: 35809258 DOI: 10.1002/jclp.23413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/03/2022] [Accepted: 06/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) is a self-report measure of social anxiety (SA), which has shown adequate psychometric properties across cultures. However, no study has systematically evaluated its measurement invariance (MI) between (a) individuals with and without a diagnosis of social anxiety disorder (SAD) and (b) males and females. The current study addresses this issue. METHODS We collected data on 257 (158 females) Italian individuals diagnosed with SAD and 356 (232 females) community-dwelling adults. RESULTS We initially found support for the unidimensionality of the Italian LSAS-SR measurement model in all samples. Using the Graded Response Model, we obtained evidence of partial MI and differential item functioning between community-dwelling and SAD-diagnosed individuals and evidence of strong MI between male and female participants. CONCLUSIONS The results of this study suggest that the Italian LSAS-SR measures the same trait in the same way across the symptom continuum and sexes, making it a psychometrically sound tool for assessment, screening, and research purposes.
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Affiliation(s)
- Duccio Baroni
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy.,Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Laura Caccico
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Serena Ciandri
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Cristian Di Gesto
- Department of Health Sciences, University of Florence, Florence, Italy.,Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Laura Di Leonardo
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Alice Fiesoli
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Elena Grassi
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Francesco Lauretta
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Antonella Lebruto
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Nicola Marsigli
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Giulia Rosa Policardo
- Department of Health Sciences, University of Florence, Florence, Italy.,Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Martina Rosadoni
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, Genova, Italy
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19
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Huang L, Huang J, Chen Z, Jiang W, Zhu Y, Chi X. Psychometric Properties of the Chinese Version of the Brief Interpersonal Competence Questionnaire for Adolescents. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010059. [PMID: 36670610 PMCID: PMC9857256 DOI: 10.3390/children10010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
This study aimed to evaluate the psychometric properties of the Brief Interpersonal Competence Questionnaire (ICQ-15) administered to Chinese adolescents. A sample of 1705 adolescents (Mean age = 14.08, SD = 3.22, 46.5% male) completed a questionnaire including the Chinese version of the ICQ-15, as well as measurements of well-being, psychological resilience, and depression. To examine the psychometric properties of the ICQ-15, item analyses (item-total correlation and normality test), confirmatory factor analysis, concurrent validity analyses, multi-group analyses, and internal consistency analyses were performed. The results of the item analyses suggested a good item-total correlation, and the item scores were distributed approximately normally. The confirmatory factor analysis showed that the five-factor model had acceptable fit indices. The concurrent validity analyses indicated that the Chinese version of the ICQ-15 had a satisfactory concurrent validity. The multi-group analyses proved the measurement invariance across females and males, as well as participants in early, middle, and late adolescence. The ICQ-15 demonstrated satisfactory internal consistency reliability among Chinese adolescents. The ICQ-15 presents good psychometric properties and can be used to assess interpersonal competence in Chinese adolescents.
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Affiliation(s)
- Liuyue Huang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao 999078, China
- Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao 999078, China
| | - Junrun Huang
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Zhichao Chen
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Weiwei Jiang
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Yi Zhu
- School of Early-Childhood Education, Nanjing Xiaozhuang University, Nanjing 210017, China
- Correspondence: (Y.Z.); (X.C.)
| | - Xinli Chi
- School of Psychology, Shenzhen University, Shenzhen 518060, China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen 518060, China
- Correspondence: (Y.Z.); (X.C.)
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20
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Jin Y, Xu S, Chen C, Wilson A, Gao D, Ji Y, Sun X, Wang Y. Symptom association between social anxiety disorder, appearance anxiety, and eating disorders among Chinese University students: A network analysis to conceptualize comorbidity. Front Public Health 2022; 10:1044081. [PMID: 36620231 PMCID: PMC9814491 DOI: 10.3389/fpubh.2022.1044081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Incidences of social anxiety disorder (SAD), appearance anxiety, and eating disorders (ED) show an increased prevalence among young people. However, symptoms' associations between these disorders have not been investigated in depth. Network analysis is an approach that can be used to explain the relationship(s) between symptoms of different psychological disorders. Using network analysis, this study aimed to explore the association and potential interacting mechanisms between SAD, appearance anxiety, and ED. Methods This study included 96,218 University students from Jilin Province, China. SAD, appearance anxiety and ED were assessed using the Social Anxiety Subscale of the Self-Consciousness Scale (SASS), the Appearance Anxiety Scale Brief Version (AASBV), and the Sick, Control, One, Fat, Food questionnaire (SCOFF), Chinese versions. Network analysis was employed to investigate the symptom associations, while the stability of the network model was analyzed using statistical measures. Results The prevalence of ED among the total sample was 38% (95% CI: 38.1-38.8%), while this figure was 31.2% (95% CI: 30.7-31.6%) in males and 43.6% (95% CI: 43.2-44.0%) in females. Additionally, the total score of SAD was significantly higher in females (11.83 ± 5.37) than it in males (10.02 ± 5.46) (P < 0.001). While the total score of appearance anxiety was also different significantly in gender (39.21 ± 9.49 in females vs. 38 ± 9.42 in males) (P < 0.001). Results showed that ED was associated with all three aspects of appearance anxiety, including "appearance concern," "appearance satisfaction," and "wish for good looks." Appearance anxiety and SAD were also associated; specifically, symptoms of "appearance satisfaction" were significantly associated with the symptoms "easily talk to strangers" and "appearance concern", which was also significantly associated with "embarrassed". Compared with males, females showed significantly stronger associations with appearance anxiety symptoms, while ED symptoms were associated with "troubled by being watched" and "appearance concern". Conclusion Appearance anxiety was associated with both ED and SAD symptoms. ED may have a potential relationship with SAD, affecting appearance anxiety indirectly. Significant differences were found among males and females in symptom associations between appearance anxiety and SAD. This study therefore clarified that young people should have body-positive interventions and challenge the normative body image discourse, which may help alleviate symptoms of SAD and ED.
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Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, Zhuhai, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China,Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China,China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China,*Correspondence: Shicun Xu ✉
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China,Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Desheng Gao
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Yan Ji
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Xi Sun
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China,Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China,Yuanyuan Wang ✉
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21
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Apostolakis M, Theodorou M, Neophytou K, Panayiotou G. Measuring social phobia symptoms in a community sample of adolescents: An examination of the psychometric properties of the SPAI-23. Front Psychol 2022; 13:1002221. [PMID: 36619081 PMCID: PMC9811410 DOI: 10.3389/fpsyg.2022.1002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
A number of studies to date examine dimensions of social phobia and anxiety in adolescents. A variety of tools has been developed, along with their abbreviated versions, that are used to assess Social Anxiety (SA) but little research has been devoted to the types of fears they each assess. Due to differences in the content of the multitude of instruments, different aspects of SA are addressed and this leads to confusion when the relationship between SA and other constructs is being investigated. The aim of the present study was to examine the psychometric properties of the abbreviated Social Phobia and Anxiety Inventory SPAI-23 in Greek-Cypriot community adolescents and describe dimensions of social fears at that age. Seven hundred twenty-one adolescent students from Cyprus, (Mean Age: 15.5, Range: 13-19, SD: 1.12, 64% female) participated in the study. Participants completed, among others, an abbreviated version of the Social Phobia and Anxiety Inventory (SPAI-23). Exploratory Factor Analysis on the SPAI-23 revealed a quite similar structure to the original questionnaire (SPAI). Three Social Phobia factors, describing distinct socially fearful situations, were identified (Performance, Interaction, and Presence in a social context) and one Agoraphobia factor after the evaluation of alternative solutions. Findings were verified by means of Confirmatory Factor Analysis, testing alternative models. Overall, findings were in line with recent evidence on youth samples, and contribute to significant insights towards more sophisticated and personalized assessments.
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Affiliation(s)
- Markos Apostolakis
- Department of Psychology, University of Cyprus, Nicosia, Cyprus,Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus,*Correspondence: Markos Apostolakis,
| | - Marios Theodorou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus,Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Klavdia Neophytou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus,Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus,Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
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22
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Song S, Zhao S, Jiang T, Li S, Zhang M, Ren W, Zheng Y, Ge R. Positive attention bias in high socially anxious individuals: Evidence from an ERP study. J Affect Disord 2022; 319:300-308. [PMID: 36162660 DOI: 10.1016/j.jad.2022.09.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022]
Abstract
The Bivalent Fear of Evaluation (BFEO) model posits that the fear of positive evaluation (FPE) is a core feature of social anxiety. As such, high socially anxious individuals may show attention bias when faced with positive stimuli. However, most of the previous studies focused on the negative attention bias of social anxiety, and less on the attention bias of positive stimuli. Meanwhile, the effect of stimulus presentation time on the attention bias pattern was unclear. In order to investigate this question, we used a dot-probe paradigm with facial expressions (happy, fearful, angry, neutral) presented for 100 ms and 500 ms. The ERP results showed: (1) For high socially anxious group, happy faces elicited a larger N1 for valid than for invalid cued probes, whereas for healthy control group, angry faces elicited a larger N1 for valid than for invalid cued probes. (2) When valid cues following happy faces presented for 500 ms, the N1 amplitude was larger than that of invalid cues. However, when valid cues following angry and fear faces presented for 100 ms, the N1 amplitude was larger than that of invalid cues. The results showed difficulty in attention disengagement of high socially anxious individuals from positive stimuli, as reflected by N1, illustrating the positive attention bias in social anxiety. These results prove that FPE may contribute to maintaining social anxiety.
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Affiliation(s)
- Sutao Song
- School of Information Science and Engineering, Shandong Normal University, Jinan, China; School of Education and Psychology, University of Jinan, Jinan, China.
| | - Shimeng Zhao
- School of Education and Psychology, University of Jinan, Jinan, China
| | - Ting Jiang
- School of Education and Psychology, University of Jinan, Jinan, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Shuang Li
- School of Education and Psychology, University of Jinan, Jinan, China; Centre for Cognition and Brain Disorders, Affiliated Hospital of Hangzhou Normal University; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments
| | - Mingxian Zhang
- School of Education and Psychology, University of Jinan, Jinan, China; Center for Study of Applied Psychology, School of Psychology, South China Normal University, Guangzhou, China
| | - Wangang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Jinan, China.
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada
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Vogel F, Reichert J, Schwenck C. Silence and related symptoms in children and adolescents: a network approach to selective mutism. BMC Psychol 2022; 10:271. [DOI: 10.1186/s40359-022-00956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Silence in certain situations represents the core symptom of selective mutism (SM). However, it is unclear what additional symptoms are part of this disorder. Although knowledge of symptoms is essential for diagnostics and intervention, to date, only scarce research exists on circumscribed symptoms of SM. Given the large overlap between SM and social anxiety disorder (SAD), it remains also unclear which symptoms can differentiate both disorders.
Methods
A network analysis of potential symptoms of SM was performed based on a mixed sample of N = 899 children and adolescents with and without indication of SM (n = 629 with silence in certain situations). In a preliminary analysis, we demonstrated that children with and without silence in certain situations do not differ with respect to their network structure, justifying an analysis on the entire mixed sample. Possible communities (symptom clusters) within the network and thus potential latent variables were examined, and symptoms were analyzed in terms of their centrality (the extent to which they are associated with other symptoms in the network). To investigate the differentiability of symptoms of the SM network from symptoms of SAD, we computed a network that additionally contains symptoms of SAD.
Results
In the resulting network on symptoms of SM, silence was, as expected, the symptom with the highest centrality. We identified two communities (symptom cluster): (1) symptoms associated with the fear response of freezing, (2) symptoms associated with speech production and avoidance. SM network symptoms and SAD symptoms largely formed two separate symptom clusters, with only selectivity of speaking behavior (more talkative at home and taciturn or mute outside the home) falling into a common cluster with SAD symptoms.
Conclusions
Silence appears to have been confirmed by analysis as a core symptom of SM. Additional anxiety-related symptoms, such as avoidance behavior or motor inhibition associated with freezing, seem to co-occur with silence. The two communities of SM potentially indicate different mechanisms of silence. The symptoms of SM appear to be distinguishable from those of SAD, although there seems to be overlap in terms of difficulty speaking in situations outside the home.
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Thunnissen MR, Nauta MH, de Jong PJ, Rijkeboer MM, Voncken MJ. Flashforward imagery in speech anxiety: Characteristics and associations with anxiety and avoidance. Front Psychol 2022; 13:975374. [PMID: 36267078 PMCID: PMC9577331 DOI: 10.3389/fpsyg.2022.975374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Speech anxiety (SA) is a highly prevalent social fear. Prospective ‘flashforward’ (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (N = 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.
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Affiliation(s)
- Marjolein R. Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
- Accare, University Center for Child and Adolescent Psychiatry, Groningen, Netherlands
- *Correspondence: Marjolein R. Thunnissen,
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Marleen M. Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Marisol J. Voncken
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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Aluh DO, Azeredo-Lopes S, Cardoso G, Pedrosa B, Grigaitė U, Dias M, Xavier M, Caldas-de-Almeida JM. Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative. Psychiatry Res 2022; 315:114734. [PMID: 35872402 DOI: 10.1016/j.psychres.2022.114734] [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: 02/18/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Sofia Azeredo-Lopes
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Miguel Xavier
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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26
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Fraunfelter L, Gerdes ABM, Alpers GW. Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety. Neurosci Biobehav Rev 2022; 139:104707. [PMID: 35643120 DOI: 10.1016/j.neubiorev.2022.104707] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
It is a defining feature of anxiety disorders that fear is elicited by a circumscribed class of stimuli rather than by only one specific exemplar of that class. Therefore, fear generalization, a mechanism by which associative fear extends from one conditioned stimulus to similar cues, has been central to theories on anxiety. Yet, experimental evidence for the link between generalization and pathological anxiety, as well as its moderators, has not been formally integrated. This systematic review and meta-analysis of empirical findings clarifies the relationship between fear generalization and pathological anxiety. In conclusion, enhanced fear generalization is associated with several anxiety disorders and stress-related disorders, which is supported statistically by a small, but robust effect size of g = 0.44 for risk ratings as an index of fear generalization. However, empirical results are inconsistent across disorders and they rarely allow for conclusions on their causality in the disorders' etiology. Therefore, based on theoretical considerations, we recommend directions for intensified research, especially on the causal relationship between overgeneralization and pathological fear.
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Affiliation(s)
- L Fraunfelter
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
| | - A B M Gerdes
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
| | - G W Alpers
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
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Hong N, Herrera A, Furr JM, Georgiadis C, Cristello J, Heymann P, Dale CF, Heflin B, Silva K, Conroy K, Cornacchio D, Comer JS. Remote Intensive Group Behavioral Treatment for Families of Children with Selective Mutism. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:439-458. [PMID: 38155719 PMCID: PMC10752620 DOI: 10.1080/23794925.2022.2062688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Selective mutism (SM) is a relatively rare, but highly interfering, child anxiety disorder characterized by a consistent failure to speak in certain situations, despite demonstrating fluent speech in other contexts. Exposure-based cognitive behavioral therapy and Parent-Child Interaction Therapy adapted for SM can be effective, but the broad availability and accessibility of such specialty care options remains limited. Stay-at-home guidelines to mitigate the spread of COVID-19 further limited the accessibility of office-based specialty care for SM. Building on separate lines of research supporting intensive treatments and telehealth service delivery models, this paper is the first to describe the development, preliminary feasibility, acceptability, and efficacy of a Remote Intensive Group Behavioral Treatment (IGBT) for families of young children with SM (N=9). Treatment leveraged videoconferencing technology to deliver caregiver training sessions, lead-in sessions, 5 consecutive daily IGBT sessions, and an individualized caregiver coaching session. Remote IGBT was found to be both feasible and acceptable. All families (100%) completed diagnostic assessments and caregiver-report questionnaires at four major study timepoints (i.e., intake, pre-treatment, post-treatment, 4-month follow-up) and participated in all treatment components. Caregivers reported high treatment satisfaction at post-treatment and 4-month follow-up and low levels of burden associated with treatment participation at post-treatment. Approximately half of participating children were classified as treatment responders by independent evaluators at post-treatment and 4-month follow-up. Although these pilot results should be interpreted with caution, the present work underscores the potential utility of using videoconferencing to remotely deliver IGBT to families in their natural environments.
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28
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Aune T, Nordahl HM, Beidel DC. Social anxiety disorder in adolescents: Prevalence and subtypes in the Young-HUNT3 study. J Anxiety Disord 2022; 87:102546. [PMID: 35248811 DOI: 10.1016/j.janxdis.2022.102546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined the prevalence of social anxiety disorder (SAD) among adolescents and the associated sex-specific fears. No previous studies have reported variance in SAD prevalence among adolescents based on a stepwise diagnostic approach. METHODS Using various diagnostic thresholds from the Anxiety Disorders Interview Schedule child version, and the diagnostic criteria from both the 4th and 5th editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), we explored the point prevalence of SAD among a population-based sample of 8216 adolescents aged 13-19 years. RESULTS Overall, 2.6% of adolescents met the SAD diagnostic criteria. The prevalence varied from 2.0% to 5.7% depending on the criteria-set. Twice as many females met the overall SAD criteria. The DSM-IV generalized SAD subtype was assigned to 86.5% of the sample, while 3.5% met the DSM-5 performance-only subtype. Compared with males aged 16-19 years, significantly more of those aged 13-15 years met the SAD criteria; no significant age group differences were found among females. CONCLUSIONS This is the first study to demonstrate variance in SAD prevalence among adolescents based on the diagnostic threshold method. Depending on the threshold applied, SAD prevalence among adolescents varied from 2.0% to 5.7%. Age and sex differences in social fear experiences highlight the importance of considering developmental heterogeneity in SAD, especially for adapting prevention and treatment interventions.
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Affiliation(s)
- Tore Aune
- Norwegian Directorate for Children, Youth and Family Affaires, Bomvegen 3, 7725 Steinkjer, Norway; Faculty of Nursing and Health Sciences, Nord University, Norway.
| | - Hans M Nordahl
- Department of Mental Health, NTNU, Trondheim, Norway; St. Olavs Hospital, Division of Psychiatry, Nidaros DPS, Trondheim, Norway
| | - Deborah C Beidel
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA
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Schwenck C, Gensthaler A, Vogel F, Pfeffermann A, Laerum S, Stahl J. Characteristics of person, place, and activity that trigger failure to speak in children with selective mutism. Eur Child Adolesc Psychiatry 2022; 31:1419-1429. [PMID: 33893894 PMCID: PMC9402505 DOI: 10.1007/s00787-021-01777-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
Selective Mutism (SM) is an anxiety disorder with predictable and circumscribed situations in which children remain silent while they speak unaffectedly in others. However, core features of anxiety inducing stimuli have rarely been studied so far. Parents of children with elevated SM symptomatology participated in an online-based study and answered open ended questions about specific characteristics of a person, place, and activity that elicit failure to speak in their child. The final sample consisted of n = 91 parents with children aged between 3 and 17 years (M = 8.02 years, SD = 3.94). Answers were analyzed by qualitative content analysis. Characteristics of a person were assigned to five categories with lack of distance as the most frequently reported feature. With respect to a place, the majority of parents mentioned unknown places as a silence trigger. The most frequently mentioned feature of an activity that was designated to be associated to silence was new activity. There were only few associations between the designation of these features, age, and gender. For the first time, anxiety inducing triggers related to person, place, and activity were comprehensively assessed in children with SM. This allows a differentiated and deeper understanding of an understudied disorder. The majority of characteristics can be associated with proposed etiological factors such as increased behavioral inhibition, conditioning processes, social anxiety, and a strong need for control. Implications for effective treatments are discussed.
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Affiliation(s)
- Christina Schwenck
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394, Giessen, Germany.
| | - Angelika Gensthaler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Felix Vogel
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394 Giessen, Germany
| | - Anke Pfeffermann
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394 Giessen, Germany
| | - Sabine Laerum
- Department of Linguistik/Patholinguistik, University of Potsdam, Potsdam, Germany
| | - Julia Stahl
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394 Giessen, Germany
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Vogel F, Schwenck C. Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal. Child Adolesc Psychiatry Ment Health 2021; 15:81. [PMID: 34963482 PMCID: PMC8715622 DOI: 10.1186/s13034-021-00430-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. In contrast, children with SAD are characterized by a combination of a chronically elevated physiological arousal and a blunted physiological fear response to social stress. Due to the large overlap between SM and SAD, similar mechanisms might apply to both disorders, while differences might explain why children with SM fail to speak. The aim of our study is to investigate psychophysiological mechanisms of the failure to speak in children with SM. METHODS We assessed in a total of N = 96 children [8-12 years, SM: n = 31, SAD: n = 32, typical development (TD): n = 33] resting baseline arousal in absence of social threat and the course of physiological fear response in two social stress paradigms, differing in terms of whether the children are expected to speak (verbal task) or not (nonverbal task). RESULTS Children with SM were characterized by increased tonic arousal compared to the other two groups, and by a more inflexible stress response in the nonverbal but not in the verbal task compared to TD-children. Further analyses revealed that children with SM who did not speak during the verbal task already demonstrated reduced arousal in anticipation of the verbal task. CONCLUSION The increased tonic arousal generalized to non-social situations in SM could indicate a long-term alteration of the autonomic nervous system. Furthermore, the differential physiological stress response may indicate that silence acts as a maladaptive compensatory mechanism reducing stress in verbal social situations, which does not function in nonverbal situations. Our findings support the idea that the failure to speak might function as an avoidance mechanism, which is already active in anticipation of a verbal situation. Treatment of SM should take into account that children with SM may suffer from chronically elevated stress levels and that different mechanisms might operate in verbal and nonverbal social situations.
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Affiliation(s)
- Felix Vogel
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University Giessen, Otto-Behaghel-Straße 10, 35394, Giessen, Germany.
| | - Christina Schwenck
- grid.8664.c0000 0001 2165 8627Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University Giessen, Otto-Behaghel-Straße 10, 35394 Giessen, Germany
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Garcia-Lopez LJ, Espinosa-Fernandez L, Muela-Martinez JA, Piqueras JA. Screening Social Anxiety in Adolescents Through the Eyes of Their Carers. Front Psychol 2021; 12:769006. [PMID: 34925170 PMCID: PMC8676051 DOI: 10.3389/fpsyg.2021.769006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the availability of efficacious treatment and screening protocols, social anxiety disorder (SAD) in adolescents is considerably under-detected and undertreated. Our main study objective was to examine a brief, valid, and reliable social anxiety measure already tested to serve as self-report child measure but administered via Internet aimed at listening to the ability of his or her parent to identify social anxiety symptomatology in his or her child. This parent version could be used as a complementary measure to avoid his or her overestimation of children of social anxiety symptomatology using traditional self-reported measures. We examined the psychometric properties of brief and valid social anxiety measure in their parent format and administered via the Internet. The sample included 179 parents/legal guardians of adolescents (67% girls) with a clinical diagnosis of SAD (mean age: 14.27; SD = 1.33). Findings revealed good factor structure, internal consistency, and construct validity. Data support a single, strength-based factor on the SPAIB-P, being structure largely invariant across age and gender. The limited number of adolescents with a performance-only specifier prevented examining the utility of scale to screen for this recently established specifier. It is crucial to evaluate if these results generalize to different cultures and community samples. The findings suggest that the SPAIB-P evidences performance comparable with child-reported measure. Parents can be reliable reports of the social anxiety symptomatology of the adolescent. The SPAIB-P may be useful for identifying clinically disturbed socially anxious adolescents.
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Lee H, Choi J, Jung D, Hur JW, Cho CH. The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study. J Med Internet Res 2021; 23:e31844. [PMID: 34801979 PMCID: PMC8726045 DOI: 10.2196/31844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. OBJECTIVE The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). METHODS Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant's self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant's self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). RESULTS We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=-2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=-2.93, P<.001; left: t=-2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=-2.10, P=.045; left: t=-2.21, P=.04) while watching video 2. CONCLUSIONS Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. TRIAL REGISTRATION Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp.
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Affiliation(s)
- Hojun Lee
- Department of Psychiatry, School of Medicine, Keimyung University, Daegu, Republic of Korea.,Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | | | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Ji-Won Hur
- School of Psychology, Korea University, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.,Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
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Lin XB, Lee TS, Man REK, Poon SH, Fenwick E. Rasch analysis reveals multidimensionality in the public speaking anxiety scale. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021. [DOI: 10.1007/s10742-021-00265-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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34
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Okuno H, Rezeppa T, Raskin T, De Los Reyes A. Adolescent Safety Behaviors and Social Anxiety: Links to Psychosocial Impairments and Functioning with Unfamiliar Peer Confederates. Behav Modif 2021; 46:1314-1345. [PMID: 34763552 DOI: 10.1177/01454455211054019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Socially anxious adolescents often endure anxiety-provoking situations using safety behaviors: strategies for minimizing in-the-moment distress (e.g., avoiding eye contact, rehearsing statements before entering a conversation). Studies linking safety behaviors to impaired functioning have largely focused on adults. In a sample of one hundred thirty-four 14 to 15 year-old adolescents, we tested whether levels of safety behaviors among socially anxious adolescents relate to multiple domains of impaired functioning. Adolescents, parents, and research personnel completed survey measures of safety behaviors and social anxiety, adolescents and parents reported about adolescents' evaluative fears and psychosocial impairments, and adolescents participated in a set of tasks designed to simulate social interactions with same-age, unfamiliar peers. Relative to other adolescents in the sample, adolescents high on both safety behaviors and social anxiety displayed greater psychosocial impairments, evaluative fears, and observed social skills deficits within social interactions. These findings have important implications for assessing and treating adolescent social anxiety.
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Affiliation(s)
- Hide Okuno
- University of Maryland at College Park, USA
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35
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Vogel F, Reichert J, Hartmann D, Schwenck C. Cognitive Variables in Social Anxiety Disorder in Children and Adolescents: A Network Analysis. Child Psychiatry Hum Dev 2021; 54:625-638. [PMID: 34708304 PMCID: PMC10150579 DOI: 10.1007/s10578-021-01273-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Clark and Wells' prominent model of social anxiety disorder (SAD) assumes that cognitive variables such as negative expectations or dysfunctional cognitions play a central role in the symptomatology of SAD. In contrast to adults, it is less clear how well the cognitive model can be applied to children and adolescents. A network analysis with seven nodes was conducted to explore the importance of cognitive variables and their interaction with symptoms of SAD based on N = 205 children and adolescents (8-18 years, M = 11.54 years). Cognitive variables had a high but differential impact within the positively connected network of SAD. Dysfunctional cognitions were most strongly connected within the network. Dysfunctional cognitions, as predicted by Clark and Wells' model, seem to act as a hub affecting several symptoms. The association between negative expectations and avoidance indicates that negative expectations may particularly contribute to the maintenance of SAD.
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Affiliation(s)
- Felix Vogel
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10 E, 35394, Gießen, Germany.
| | - Julian Reichert
- Medical School Hamburg, University of Applied Science and Medical University, Hamburg, Germany.,Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Hartmann
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10 E, 35394, Gießen, Germany
| | - Christina Schwenck
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10 E, 35394, Gießen, Germany
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36
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Putwain DW, Stockinger K, von der Embse NP, Suldo SM, Daumiller M. Test anxiety, anxiety disorders, and school-related wellbeing: Manifestations of the same or different constructs? J Sch Psychol 2021; 88:47-67. [PMID: 34625210 DOI: 10.1016/j.jsp.2021.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.
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Affiliation(s)
- David W Putwain
- School of Education, Liverpool John Moores University, Liverpool, UK.
| | | | | | | | - Martin Daumiller
- Department of Psychology, University of Augsburg, Augsburg, Germany
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37
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Manippa V, Tommasi L. The shape of you: do individuals associate particular geometric shapes with identity? CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractFor more than a century, psychologists have been interested in how visual information can arouse emotions. Several studies have shown that rounded shapes evoke positive feelings due to their link with happy/baby-like expressions, compared with sharp angular shapes, usually associated with anger and threatening objects having negative valence. However, to date, no-one has investigated the preference to associate simple geometric shapes to personal identities, including one’s own, that of a close acquainted, or that of a stranger. Through 2 online surveys we asked participants to associate a geometric shape, chosen among a circle, a square and a triangle, to each of three identities, namely “you” (the self), “your best friend” or “a stranger”. We hypothesized that the circle would be more associated with the self, the square with the friend and the triangle with the stranger. Moreover, we investigated whether these associations are modulated by 3 personality traits: aggressivity, social fear and empathy. As predicted, we found that participants associate more often the circle with the self, both the circle and the square with the best friend, whereas they matched angular shapes (both the triangle and the square) to the stranger. On the other hand, the possibility that personality traits can modulate such associations was not confirmed. The study of how people associate geometric figures with the self or with other identities giving them an implicit socio-affective connotation, is interesting for all the disciplines interested in the automatic affective processes activated by visual stimuli.
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38
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Evaluation of Social Phobia among Syrian Refugees' Youth in Jordan. Psychiatr Q 2021; 92:1175-1185. [PMID: 33650045 DOI: 10.1007/s11126-021-09901-2] [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] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
Social phobia is one of the most common anxiety disorders in youth yet still under-recognized and undertreated. This study purposed to evaluate the level of social phobia and examine correlating selected socio-demographic factors (age, gender, marital status, working status, and educational level) among Syrian refugees' youth in Jordan. A cross-sectional, descriptive correlation design was selected to carry out this study. The convenience sample composed of 290 youth aged 15-25 years were recruited from Amman and Mafraq cities. The data was collected using a questionnaire which consists of socio-demographic data and social phobia scale. The findings found that the participants had a high level of social phobia. There was a correlation between social phobia and age (r = 0.64; p < 0.001), educational level (r = - 0.23; p < 0.001), and gender (r = -0.14; p < 0.05). The youth being males, elder youth (>19-25 years), and having low educational level had a higher level of social phobia. Age was the main significant predictor of social phobia. The current findings confirm the necessity of developing social and psychological strategies and interventions to minimize this problem among youth affected by social phobia.
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39
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Kealy D, Rice SM, Seidler ZE, Ogrodniczuk JS, Oliffe JL. Social anxiety and suicidality among men: examining the effects of loneliness and childhood trauma. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02235-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136709. [PMID: 34206415 PMCID: PMC8293810 DOI: 10.3390/ijerph18136709] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.
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41
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Unique Associations of Revised-Reinforcement Sensitivity Theory Constructs with Social Anxiety. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00552-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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42
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Muris P, Ollendick TH. Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2021; 24:294-325. [PMID: 33462750 PMCID: PMC8131304 DOI: 10.1007/s10567-020-00342-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Stellenbosch University, Stellenbosch, South Africa.
| | - Thomas H Ollendick
- Virginia Polytechnic Institute and State University, Blacksburg, USA
- Roehampton University, London, England
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43
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Muris P, Monait N, Weijsters L, Ollendick TH. Symptoms of Selective Mutism in Non-clinical 3- to 6-Year-Old Children: Relations With Social Anxiety, Autistic Features, and Behavioral Inhibition. Front Psychol 2021; 12:669907. [PMID: 34135829 PMCID: PMC8201984 DOI: 10.3389/fpsyg.2021.669907] [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] [Received: 02/19/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
Selective mutism (SM) is a psychiatric condition that is characterized by a failure to speak in specific social situations (e. g., at school) despite speaking normally in other situations (e.g., at home). There is abundant evidence that anxiety, and social anxiety in particular, is a prominent feature of SM, which is the main reason why this condition is currently classified as an anxiety disorder. Meanwhile, there is increasing support for the notion that autism-related problems are also involved in SM. The present study examined the relations between SM and social anxiety, autistic features, and behavioral inhibition to the unfamiliar (i.e., the tendency to react with restraint and withdrawal when confronted with unfamiliar stimuli and situations). Parents of 172 3- to 6-year-old preschool children completed an online survey for measuring the relevant constructs. Results showed that there were positive and statistically significant correlations between SM and social anxiety, autistic features, and behavioral inhibition. Regression analyses revealed that (1) both social anxiety and autistic features accounted for a significant and unique proportion of the variance in SM scores, and (2) that both of these variables no longer made a significant contribution once behavioral inhibition was added to the model. It can be concluded that while the involvement of social anxiety is unambiguous in SM, autism-related problems are also implicated. Furthermore, behavioral inhibition seems to play a key role in the non-speaking behavior of non-clinical young children.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Departement of Sielkunde, Stellenbosch University, Stellenbosch, South Africa
| | - Nona Monait
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Lotte Weijsters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic and State University, Blacksburg, VA, United States.,Department of Psychology, Roehampton University, London, United Kingdom
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44
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Intrusions in test anxiety. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-0167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Wake S, Morriss J, Johnstone T, van Reekum CM, Dodd H. Intolerance of uncertainty, and not social anxiety, is associated with compromised extinction of social threat. Behav Res Ther 2021; 139:103818. [PMID: 33567362 DOI: 10.1016/j.brat.2021.103818] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/11/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
Extinction-resistant threat is regarded as a central hallmark of pathological anxiety. However, it remains relatively under-studied in social anxiety. Here we sought to determine whether self-reported trait social anxiety is associated with compromised threat extinction learning and retention. We tested this hypothesis within two separate, socially relevant conditioning studies. In the first experiment, a Selective Extinction Through Cognitive Evaluation (SECE) paradigm was used, which included a cognitive component during the extinction phase, while experiment 2 used a traditional threat extinction paradigm. Skin conductance responses and subjective ratings of anxiety (experiment 1 and 2) and expectancy (experiment 2) were collected across both experiments. The findings of both studies demonstrated no effect of social anxiety on extinction learning or retention. Instead, results from experiment 1 indicated that individual differences in Intolerance of Uncertainty (IU) were associated with the ability to use contextual cues to decrease a conditioned response during SECE. However, during extinction retention, high IU predicted greater generalisation across context cues. Findings of experiment 2 revealed that higher IU was associated with impaired extinction learning and retention. The results from both studies suggest that compromised threat extinction is likely to be a characteristic of high levels of IU and not social anxiety.
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Affiliation(s)
- Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Jayne Morriss
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tom Johnstone
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK; Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
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46
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Zsido AN, Varadi-Borbas B, Arato N. Psychometric properties of the social interaction anxiety scale and the social phobia scale in Hungarian adults and adolescents. BMC Psychiatry 2021; 21:171. [PMID: 33771109 PMCID: PMC7995698 DOI: 10.1186/s12888-021-03174-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although social anxiety disorder is one of the most frequent disorders, it often remained unrecognized. Utilizing brief, yet reliable screening tools, such as the Social Interaction Anxiety Scale (SIAS-6) and the Social Phobia Scale (SPS-6) are helping to solve this problem in parts of Western Europe and the US. Still some countries, like Hungary, lag behind. For this purpose, previous studies call for further evidence on the applicability of the scales in various populations and cultures, as well as the elaborative validity of the short forms. Here, we aimed to provide a thorough analysis of the scales in five studies. We employed item response theory (IRT) to explore the psychometric properties of the SIAS-6 and the SPS-6 in Hungarian adults (n = 3213, age range:19-80) and adolescents (n = 292, age range:14-18). RESULTS In both samples, IRT analyses demonstrated that the items of SIAS-6 and SPS-6 had high discriminative power and cover a wide range of the latent trait. Using various subsamples, we showed that (1) the scales had excellent convergent and divergent validity in relation to domains of anxiety, depression, and cognitive emotion regulation in both samples. Further, that (2) the scales discriminated those with a history of fainting or avoidance from those without such history. Lastly, (3) the questionnaires can discriminate people diagnosed with social anxiety disorder (n = 30, age range:13-71) and controls. CONCLUSIONS These findings suggest that the questionnaires are suitable for screening for SAD in adults and adolescents. Although the confirmation of the two-factor structure may be indicative of the validity of the "performance only" specifier of SAD in DSM-V, the high correlation between the factors and the similar patter of convergent validity might indicate that it is not a discrete entity but rather a part of SAD; and that SAD is latently continuous.
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Affiliation(s)
- Andras N. Zsido
- Institute of Psychology, University of Pécs, 6, Ifjusag street, Pécs, Baranya H-7624 Hungary
| | - Brigitta Varadi-Borbas
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Nikolett Arato
- Institute of Psychology, University of Pécs, 6, Ifjusag street, Pécs, Baranya H-7624 Hungary
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47
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Li A, Jing D, Dellarco DV, Hall BS, Yang R, Heilberg RT, Huang C, Liston C, Casey BJ, Lee FS. Role of BDNF in the development of an OFC-amygdala circuit regulating sociability in mouse and human. Mol Psychiatry 2021; 26:955-973. [PMID: 30992540 PMCID: PMC6883137 DOI: 10.1038/s41380-019-0422-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/17/2019] [Accepted: 04/03/2019] [Indexed: 01/29/2023]
Abstract
Social deficits are common in many psychiatric disorders. However, due to inadequate tools for manipulating circuit activity in humans and unspecific paradigms for modeling social behaviors in rodents, our understanding of the molecular and circuit mechanisms mediating social behaviors remains relatively limited. Using human functional neuroimaging and rodent fiber photometry, we identified a mOFC-BLA projection that modulates social approach behavior and influences susceptibility to social anxiety. In humans and knock-in mice with a loss of function BDNF SNP (Val66Met), the functionality of this circuit was altered, resulting in social behavioral changes in human and mice. We further showed that the development of this circuit is disrupted in BDNF Met carriers due to insufficient BDNF bioavailability, specifically during a peri-adolescent timeframe. These findings define one mechanism by which social anxiety may stem from altered maturation of orbitofronto-amygdala projections and identify a developmental window in which BDNF-based interventions may have therapeutic potential.
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Affiliation(s)
- Anfei Li
- Sackler Institute for Developmental Psychobiology, Weill Cornell Medicine, New York, NY, USA
| | - Deqiang Jing
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Danielle V Dellarco
- Sackler Institute for Developmental Psychobiology, Weill Cornell Medicine, New York, NY, USA
| | - Baila S Hall
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Ruirong Yang
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Ross T Heilberg
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Chienchun Huang
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Conor Liston
- Sackler Institute for Developmental Psychobiology, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - B J Casey
- Department of Psychology, Yale University, New Haven, CT, USA.
| | - Francis S Lee
- Sackler Institute for Developmental Psychobiology, Weill Cornell Medicine, New York, NY, USA.
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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48
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Muris P, Ollendick TH. Current Challenges in the Diagnosis and Management of Selective Mutism in Children. Psychol Res Behav Manag 2021; 14:159-167. [PMID: 33623447 PMCID: PMC7896755 DOI: 10.2147/prbm.s274538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
Selective mutism (SM) is a childhood disorder characterized by a consistent failure to speak in specific social situations (eg, school) despite speaking normally in other settings (eg, at home). This article summarizes evidence supporting the recent classification of SM as an anxiety disorder and discusses the implications of this re-classification for the assessment and treatment of SM in clinical practice. Meanwhile, clinicians should also realize that SM sometimes is a heterogeneous disorder in which other problems are also present that complicate the management of children with SM. As examples, we discuss speech and language problems, developmental delay, and autism spectrum disorders.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Sciences, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Departement Sielkunde, Stellenbosch University, Stellenbosch, South Africa
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Department of Psychology, University of Roehampton London, London, UK
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49
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Bogaerts S, van Woerkom M, Erbaş Y, De Caluwé E, Garofalo C, Frowijn I, Jeandarme I, Masthoff E, Janković M. Associations Between Resilience, Psychological Well-Being, Work-Related Stress and Covid-19 Fear in Forensic Healthcare Workers Using a Network Analysis. Front Psychiatry 2021; 12:678895. [PMID: 34177662 PMCID: PMC8226029 DOI: 10.3389/fpsyt.2021.678895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.
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Affiliation(s)
- Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
| | - Marianne van Woerkom
- Department of Human Resource Studies, Tilburg University, Tilburg, Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Yasemin Erbaş
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Elien De Caluwé
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Carlo Garofalo
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Iris Frowijn
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Ingeborg Jeandarme
- Department of Criminal Law and Criminology, Katholieke Universiteit Leuven, Leuven, Belgium.,Knowledge Center Forensic Psychiatric Care, Openbaar Psychiatrisch Zorgcentrum Rekem, Rekem, Belgium
| | - Erik Masthoff
- Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
| | - Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
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50
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Schlund MW, Carter H, Cudd G, Murphy K, Ahmed N, Dymond S, Tone EB. Human social defeat and approach-avoidance: Escalating social-evaluative threat and threat of aggression increases social avoidance. J Exp Anal Behav 2020; 115:157-184. [PMID: 33369748 DOI: 10.1002/jeab.654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/11/2022]
Abstract
Basic research on avoidance by Murray Sidman laid the foundation for advances in the classification, conceptualization and treatment of avoidance in psychological disorders. Contemporary avoidance research is explicitly translational and increasingly focused on how competing appetitive and aversive contingencies influence avoidance. In this laboratory investigation, we examined the effects of escalating social-evaluative threat and threat of social aggression on avoidance of social interactions. During social-defeat learning, 38 adults learned to associate 9 virtual peers with an increasing probability of receiving negative evaluations. Additionally, 1 virtual peer was associated with positive evaluations. Next, in an approach-avoidance task with social-evaluative threat, 1 peer associated with negative evaluations was presented alongside the peer associated with positive evaluations. Approaching peers produced a positive or a probabilistic negative evaluation, while avoiding peers prevented a negative evaluation (and forfeited a positive evaluation). In an approach-avoidance task with social aggression, virtual peers gave and took money away from participants. Escalating social-evaluative threat and aggression increased avoidance, ratings of feeling threatened and threat expectancy and decreased ratings of peer favorableness. These findings underscore the potential of coupling social defeat and approach-avoidance paradigms for translational research on the neurobehavioral mechanisms of social approach-avoidance decision-making and anxiety.
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Affiliation(s)
- Michael W Schlund
- Department of Psychology, Georgia State University.,Department of Psychiatry and Behavioral Sciences, University of Pittsburgh
| | | | - Gloria Cudd
- Department of Psychology, Georgia State University
| | - Katie Murphy
- Department of Psychology, Georgia State University
| | - Nebil Ahmed
- Department of Psychology, Georgia State University
| | - Simon Dymond
- Department of Psychology, Swansea University.,Department of Psychology, Reykjavík University
| | - Erin B Tone
- Department of Psychology, Georgia State University
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