Linking Social Anxiety and Adolescent Romantic Relationship Functioning: Indirect Effects and the Importance of Peers

The link between anxiety and theory of mind in children: A meta-analysis

BACKGROUND

The ability to reason about someone else's mental states, an ability known as theory of mind, is essential to help children navigate social life. However, not all children are socially skilled. Given socialisation is key for healthy development in children, finding what might exacerbate these difficulties is important. Emerging research suggests a potential link between anxiety and theory of mind abilities in children. This meta-analysis aims to characterise that link.

METHOD

Four electronic databases were systematically searched to identify relevant studies. Search terms included variations of terms for theory of mind, anxiety, and children. Studies were screened with inclusion and exclusion criteria for eligibility and identified papers were appraised on quality.

RESULTS

The search returned 3674 papers of which 20 were included in the analysis. These included a total of 3110 participants, aged 4-19. Overall, it was found that anxiety had a negative relationship with theory of mind and this appeared to be more pronounced in theory of mind processes related to affective states. There were no differences in the negative relationship between subtypes of anxiety or between studies with autistic and neurotypical children.

CONCLUSION

The findings suggest that anxious children may have difficulties using theory of mind abilities. Heterogeneity was substantial in the data, which limits the confidence in conclusions. Quality appraisal identified that the quality of theory of mind and anxiety measures varied between studies.

Can an Universal School-Based Social Emotional Learning Program Reduce Adolescents' Social Withdrawal and Social Anxiety?

There is a lack of studies analyzing if universal school-based Social and Emotional Learning programs can reduce social withdrawal and social anxiety. This study analyzed the effectiveness of one such program on those variables, and the role of individual school climate perceptions. In this nationwide study, 704 seventh to eighth-grade Portuguese students (Mage = 12.96, SD = 1.09, 48% girls), of which 215 (30.6%) in the comparison group, were assessed at pretest, post-test, and follow-up seven months later. Analyses showed positive intervention results in self- and teacher-reported social withdrawal and social anxiety. Regarding school climate, intervention group students with more positive teacher-student relationships benefitted more from program participation in social anxiety. These results support the program's effectiveness for addressing social withdrawal and social anxiety.

Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample

Social Anxiety Disorder (SAD) has its usual onset during adolescence when it is a highly prevalent and debilitating condition. Evidence regarding the processes that underline social anxiety and SAD is not compelling, especially in adolescents. Within an Acceptance and Commitment Therapy (ACT) framework, the causal role of ACT processes on adolescents' social anxiety and how these processes contribute to sustain social anxiety over time is still unknown. Hence, this study explored the role of psychological inflexibility (PI) and acceptance and committed action (as psychological flexibility processes) on social anxiety over time, in a clinical sample of adolescents. Twenty-one adolescents (Mage = 16.19, SD = 0.750) with a primary diagnosis of SAD completed a set of self-report measures assessing PI, acceptance (i.e., willingness to experience social anxiety symptoms), action (i.e., moving towards valued life directions despite social anxiety symptoms) and social anxiety. Path analysis was used to investigate a mediation model linking acceptance, committed action, and PI to social anxiety, directly and indirectly. Findings revealed that acceptance and action were negatively and directly associated with PI after 10-weeks. In turn, PI yielded a positive and direct effect on social anxiety after another 12-weeks. PI totally mediated the relation between acceptance and action and social anxiety, with significant indirect effects. Overall, findings offer evidence for the applicability of the ACT model to adolescent SAD and support the use of clinical interventions targeting PI to understand and alleviate adolescents' social anxiety.

Remotely delivered cognitive therapy for social anxiety disorder in adolescence: Preliminary efficacy evidence based on changes throughout treatment

Cognitive therapy has been established as the frontline treatment for adults with social anxiety disorder (SAD); its efficacy with socially anxious adolescents is incipient but promising. This work investigated change in social anxiety symptoms reported by adolescents and their therapist as they go through remotely delivered 10-session cognitive therapy (i.e., CT@TeenSAD). Participants were 21 adolescents (81% females; M _age = 16.10) diagnosed with SAD. They reported on change on their social anxiety symptoms at the beginning of each session; their therapist reported on how their symptoms had improved at the end of each session. Results, though preliminary, show that sessions had a significant impact on self- and therapist reported change, with consistent and continuous improvement across intervention sessions. Gender did not impact on that change, but therapist did: though the same pattern of change emerged for both therapists, it was more evident for the therapist with the greatest previous clinical experience. Overall, current findings align with the cognitive therapy framework of progressive gains throughout therapy. They also add evidence on the applicability and usefulness of an online cognitive approach to adolescents diagnosed with SAD.

Measuring social phobia symptoms in a community sample of adolescents: An examination of the psychometric properties of the SPAI-23

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.

The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts

Social fears arise when fearing to be judged in social events. When these fears are intense, persistent, and debilitating, the individual may suffer from social anxiety disorder (SAD), which has its most frequent onset during adolescence and tends to be chronic. Still, evidence on the prevalence of social fears and SAD in adolescence is scarce. This study analyzed the prevalence of social fears and of SAD in Portuguese adolescents. Of the initial sample (n = 1495), 26% presented with intense self-reported social fears. Of those, 53.9% accepted to be further assessed for diagnosis, resulting in a point-estimate prevalence of adolescent SAD of 9.4%; this is slightly higher than previously found. Social performance was the most feared social event. Of the adolescents with SAD, 12.9% were receiving psychological intervention, 12.1% refused intervention, and 92 (65.7%) accepted intervention. Findings confirm SAD as a highly prevalent mental disorder among adolescents, particularly girls, and additionally, that most of these adolescents did not seek treatment but are willing to receive help if made available. Hence, schools should be invested not only in identifying vulnerable adolescents but also in providing diverse intervention options, tailored to their needs, and directing them to successful developmental trajectories.

Romantic relationship quality and functioning for individuals with clinical and sub-clinical social anxiety: a scoping review

BACKGROUND

Social Anxiety Disorder (SAD) is associated with pervasive functional impairments and chronicity. Romantic relationship functioning and quality for individuals with SAD has been previously explored but existing studies have not been synthesised.

AIMS

This scoping review charted existing literature regarding the quality and functioning of romantic relationships for people with SAD and high sub-clinical social anxiety (SA).

METHODS

The review used a scoping approach to explore the current evidence base relating to SA, romantic relationship quality and functioning. Articles published in English after 1980 that reported either clinical or high sub-clinical SA were eligible. Double screening, data extraction, quality assessment, and thematic analysis of studies was conducted.

RESULTS

50 studies from 46 articles were identified, involving a range of community, college, adolescent, and clinical samples. Thematic analysis identified four themes; Relationship Quality, Satisfaction and Commitment; Communication and Self-Disclosure; Conflict, Social Support and Trust; Intimacy, Closeness and Sexual Satisfaction.

CONCLUSIONS

The review highlights that evidence relating to romantic relationship functioning for individuals with SAD and high sub-clinical SA is heterogeneous, with relationship initiation in particular relatively under-explored. Further research is required to elucidate key constructs and interpersonal processes related to relationship functioning, and to inform treatment approaches with this group.

Talking About Sexuality With Youth: A Taboo in Psychiatry?

BACKGROUND

Young people who have psychiatric problems are more likely than their peers to endure difficulties during their sexual and gender identity development.

AIM

This study aims to examine the communication between mental health care providers and their patients about the topics of relations, sexuality and gender identity, including a description of professionals' attitudes toward these topics and the factors that contribute to and inhibit communication.

METHODS

Study participants (n = 242, response rate = 31%) were a representative sample of a large multicenter cohort of 768 mental health care professionals (eg, medical doctors, psychiatrists, psychologists, group counselors, parent counselors) of 7 institutions and 5 solo practices in the Netherlands, who completed a survey on communication about sexuality and gender identity with their young patients (age 12-21 years).

OUTCOMES

Sexuality and gender identity are infrequently discussed by mental health care providers with their young patients or their patients' parents.

RESULTS

Of the study sample, 99.5 % valued sexuality as an important topic to discuss with their patients. However, only 17.1% of the professionals reported that they discussed sexuality-related issues with the majority (>75%) of their patients (adolescents: 19.9%, parents: 14.4%) Additionally, only 2.3 % of the participants discussed gender nonconformity regularly with patients. Information about sexual side effects of prescribed medication was infrequently (20.3%) provided: antidepressants (40.0%), antipsychotics (34.0%), benzodiazepines (5.1%) and stimulants (2.4%). The most frequently cited reasons for not discussing these topics were a lack of awareness, own feelings of discomfort, and the patients' supposed feelings of shame. There was no gender differences observed.

CLINICAL IMPLICATIONS

Recommendations for professionals include to be aware of these topics, initiating age-appropriate conversation and use inclusive language.

STRENGTHS AND LIMITATIONS

The present study included a diverse and representative group of mental health care professionals. Frequency of sexual communication was based on self-report, which brings a risk of bias.

CONCLUSION

Despite a recognized need to engage in age-appropriate communication about sexuality and gender identity in youth mental health care, mental health providers seem to remain hesitant to discuss such topics. Bungener SL, Post L, Berends I, et al. Talking About Sexuality With Youth: A Taboo in Psychiatry?. J Sex Med 2022;19:421-429.

A Meta-Analysis of Friendship Qualities and Romantic Relationship Outcomes in Adolescence

Romantic relationships are one of the most significant interpersonal ties in adolescence, thus understanding factors that may contribute to their formation and quality are important. The current meta-analysis focuses on links between friendship quality and romantic relationship outcomes for adolescents up to 18 years. In a series of meta-analyses (k = 28 studies, N's = 946-4,040), friendship qualities were not related to romantic involvement. However, we did find robust evidence of continuity between friendship qualities and romantic relationship qualities. Additionally, adolescents experienced more negative quality in their romantic relationships than in their friendships. These findings suggest that friendships have implications for adolescents' romantic relationships, although more research is needed on specific quality associations, and the mediators of these relations.

Online Social anxiety Cognitive therapy for Adolescents (OSCA): protocol for a randomised controlled trial

BACKGROUND

Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of psychological therapists in child and adolescent mental health services, there is a substantial gap in service provision. Delivering therapy via the Internet may provide part of the solution to this problem. An Internet version of adult Cognitive Therapy for SAD has been developed, with outcomes similar to face-to-face therapy. We have recently adapted this treatment for use with adolescents with SAD. Here, we describe a randomised controlled trial designed to test the efficacy of Internet Cognitive Therapy for adolescent SAD compared to waitlist.

METHODS/DESIGN

Forty adolescents aged 14-18 years with a diagnosis of SAD will be recruited via schools. Participants will be randomly allocated to Internet Cognitive Therapy or to waitlist. All participants will be assessed three times during the study-at baseline (pretreatment/wait), midtreatment/wait (week 8) and posttreatment/wait (week 15). Participants in the experimental arm will also complete weekly measures as part of the online program and they will be assessed at 3 and 6 months. Postwait, participants in the waitlist arm will be offered Internet Cognitive Therapy, and weekly and posttreatment data will also be collected for them. The trial aims to test whether Internet Cognitive Therapy is superior to waitlist in reducing social anxiety symptoms and in reducing the proportion of adolescents meeting criteria for SAD. Other outcomes of interest include depression and general anxiety symptoms. Acceptability of the online treatment will also be evaluated.

DISCUSSION

This randomised controlled trial will provide preliminary evidence on whether this intervention, requiring relatively low levels of therapist input, is safe and clinically effective. If this is shown to be the case, Internet Cognitive Therapy for adolescents has the potential to provide a service to the large population of adolescents with untreated SAD.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN15079139 . Version 1 registered on 06/02/2019.

Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students: A randomized controlled trial

BACKGROUND

Anxiety is a common disorder which refers to a significant and persistent fear of one or more social or performance situations. This study investigated the impacts of cognitive-behavioral intervention on anxiety and depression among undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria.

METHODS

Participants were 55 undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria. The adequacy of the sample size used was determined using GPower software. Cognitive-behavioral treatment manuals on anxiety and depression were used to deliver the intervention. Data analyses were completed using repeated measures analysis of variance.

RESULTS

Results indicated a significant positive impact of cognitive-behavioral intervention on anxiety and depression among social science education students exposed to the cognitive-behavioral intervention when compared to the waitlisted group. Results also showed that there was a significant time × group interaction for anxiety and depression. Follow-up tests showed that significant reduction in anxiety and depression persisted after 3 months for the cognitive-behavioral intervention group in comparison to the waitlisted control group.

CONCLUSION

We concluded that cognitive-behavioral intervention was a successful intervention which decreased the symptoms of anxiety and depression in social science education students who participated in the study. Additional studies are recommended to further corroborate the influence of cognitive-behavioral intervention in the reduction of anxiety and depressive symptoms in the Nigerian undergraduate student population.

Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995)

Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.

Parent–child positivity and romantic relationships in emerging adulthood

Romantic relationship quality in adolescence and early adulthood has often been linked to earlier parent–child relationship quality but it is possible that these links are nonlinear. Moreover, the role of social skills as mediator of associations between parent–child and romantic relations has been discussed but not rigorously tested. Using data from 2,230 participants of the longitudinal TRAILS (TRacking Adolescents’ Individual Lives Survey) sample, this study examined whether parent–child positivity assessed at age 11 predicted romantic involvement, commitment and satisfaction in emerging adulthood. Moreover, indirect effects via cooperation, assertion and self-control were tested. Parent–child positivity did not predict romantic involvement as such. However, in those who were romantically involved, linear and, by trend, nonlinear associations between parent–child positivity and commitment were found, suggesting higher levels of commitment in those who had reported positive parent–child relationships but also in individuals with particularly low levels of parent–child positivity. Satisfaction was linearly linked to parent–child positivity. Little support was found for the assumption that the association between parent–child positivity and romantic relationship quality in emerging adulthood are partly explained by social skills. These results show that neither congruence nor compensation alone are sufficient to explain the associations between parent–child and romantic relationship quality.

Two dimensions of social anxiety disorder: a pilot study of the Questionnaire for Social Anxiety and Social Competence Deficits for Adolescents

BACKGROUND

The Questionnaire for Social Anxiety and Social Competence Deficits for Adolescents (SASKO-J) was developed as an instrument for clinical diagnostics of social anxiety disorder in youths by measuring social anxiety and social deficits in two separate dimensions. The study provides an initial assessment of the scale's psychometric properties in a clinical sample.

METHOD

The reliability and validity of the SASKO-J were assessed in a mixed clinical sample of 12- to 19-year-old German adolescents (N = 85; mean age 15.71 years; SD = 1.92; 62.4 % girls). In a second step, the diagnostic validity was evaluated in a clinical sample of 31 adolescent patients with social anxiety disorder (mean age 16.10 years; SD = 1.54; 74.2 % girls) and a sample of 115 German high school students (mean age 15.84 years; SD = 1.65; 60.9 % girls) via Receiver Operating Characteristic (ROC) analysis.

RESULTS

The internal consistencies of the total scale and the subscales were good to excellent (0.80 ≤ α ≤ 0.96), and the results indicated a good convergent and divergent validity. The ROC analysis revealed a satisfying area under curve (AUC = 0.866), and a cutoff of 41.5 for the SASKO-J total score represented the best balance of sensitivity (0.806) and specificity (0.826).

CONCLUSIONS

The results of this pilot study provide initial support for the clinical use of the SASKO-J in the diagnostic process. Future research should address the question of psychometric properties in a social anxiety disorder sample as well as the questionnaire's sensitivity for detecting change in symptoms during therapy.

Psychometric properties of the Chinese version of the fear of negative evaluation scale-brief (BFNE) and the BFNE-straightforward for middle school students

Background

The 12-item brief version of the Fear of Negative Evaluation Scale (BFNE) is one of the most widely used instruments to assess fear of negative evaluation. Recent evidence strongly supports the version composed of 8 straightforward items (BFNE-S), which possessesstronger psychometric properties. The purpose of the current study is to examine the psychometric prop-erties of the Chinese versions of the BFNE and BFNE-S for middle school students.

Methodology

A total of 1009 middle school students were recruited in this study. The BFNE, the BFNE-S, the Friedman-Bendas Text Anxiety Scale (FBTAS), and the Social Anxiety Scale (SAS) were administered to 497 participants, and 52 participants were re-tested after four weeks. The BFNE, the BFNE-S, the Rosenberg Self-Esteem Scale (RSES), and the Balanced Inventory of Desirable Responding (BIDR) wereadministered to 492 participants. The BFNE and BFNE-S significantly cor-related with all the scales, supporting their convergent, divergent and concurrent validity.

Principal Findings

The Cronbach's alpha of the BFNE (BFNE-S) was 0.864 (0.867) with 497 par-ticipants and 0.886 (0.844) with 492 participants, and the test-retest reliability coefficient was 0.791 (0.855) (ICC). Although the EFA identified a two-factor solution in which the 8 straightfor-ward items loaded on one factor and the 4 reversed items loaded on the other, the CFA, using a random intercept model to control the wording effect, supported a unidimensional factor struc-ture of the BFNE. Both EFA and CFA supported the unidimensional assumption of the BFNE-S. The correlations of the BFNE and BFNE-S were 0.929 and 0.952 in two samples.

Conclusions

The Chinese versions of the BFNE and BFNE-S demonstrate adequate psychometric properties for assessing fear of negative evaluation. The results support their use among the Chinese middle school students. Considering its greater parsimony and excellent reliability and validity, the BFNE-S is a better tool.

Social Anxiety Scale for Adolescents

Social anxiety is a common psychological disorder that often emerges during adolescence and is associated with significant impairment. Efforts to prevent social anxiety disorder require sound assessment measures for identifying anxious youth, especially those from minority backgrounds. We examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in Hispanic American adolescents ( N = 1,191; 56% girls; 15-18 years) using multigroup confirmatory factor analyses. Results indicated that the factorial configuration of the correlated three-factor model of the SAS-A was invariant across gender and age. Analyses of latent mean differences revealed that boys exhibited higher structured means than girls on the Social Avoidance and Distress–General (SAD-General) subscale. On all SAS-A subscales, Fear of Negative Evaluation, Social Avoidance and Distress-New, and SAD-General, estimates of the structured means decreased with adolescent age. Implications for further research and clinical practice are discussed.

The importance of perceived care and connectedness with friends and parents for adolescent social anxiety

Nonclinical social anxiety in adolescence can be highly problematic, as it likely affects current and especially new social interactions. Relationships with significant others, such as close friends, mothers, and fathers, could aid socially anxious adolescents' participation in social situations, thereby helping reduce feelings of social anxiety. We examined whether making friends as well as high friendship quality help reduce social anxiety over time, and whether friends', mothers', and fathers' care interact in reducing social anxiety. Using longitudinal data from 2,194 participants in a social network (48% girls; Mage  = 13.58) followed for 3 years, we estimated friendship selection and influence processes via a continuous time-modeling approach using SIENA. We controlled for the effects of depressive symptoms, self-esteem, gender, age, and family structure. Our findings suggest that perceived care by friends mediated the effect of making friends on social anxiety. Perceptions of mother and father, as well as friend care and connectedness, respectively, did not interact in decreasing social anxiety. Nonetheless, care and connectedness with mothers, fathers, and friends jointly predicted decreases in social anxiety. Caring relationships with friends and parents each play a role in mutually protecting early adolescents against increasing in social anxiety over time.