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Hur J, Tillman RM, Kim HC, Didier P, Anderson AS, Islam S, Stockbridge MD, De Los Reyes A, DeYoung KA, Smith JF, Shackman AJ. Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety in the bed nucleus of the stria terminalis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.30.564701. [PMID: 38853920 PMCID: PMC11160578 DOI: 10.1101/2023.10.30.564701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Social anxiety-which typically emerges in adolescence-lies on a continuum and, when extreme, can be devastating. Socially anxious individuals are prone to heightened fear, anxiety, and the avoidance of contexts associated with potential social scrutiny. Yet most neuroimaging research has focused on acute social threat. Much less attention has been devoted to understanding the neural systems recruited during the uncertain anticipation of potential encounters with social threat. Here we used a novel fMRI paradigm to probe the neural circuitry engaged during the anticipation and acute presentation of threatening faces and voices in a racially diverse sample of 66 adolescents selectively recruited to encompass a range of social anxiety and enriched for clinically significant levels of distress and impairment. Results demonstrated that adolescents with more severe social anxiety symptoms experience heightened distress when anticipating encounters with social threat, and reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis (BST), a key division of the central extended amygdala (EAc). Although the EAc-including the BST and central nucleus of the amygdala-was robustly engaged by the acute presentation of threatening faces and voices, the degree of EAc engagement was unrelated to the severity of social anxiety. Together, these observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness.
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Winter HR, Norton A, Wootton BM. Internet videoconferencing delivered cognitive behavioral therapy for social anxiety disoder: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 132:107298. [PMID: 37482329 DOI: 10.1016/j.cct.2023.107298] [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: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a fear of scrutiny in social or performance situations. Due to a number of barriers, many individuals do not seek treatment for SAD, resulting in a chronic and debilitating course. Cognitive behaviour therapy (CBT), and more recently Imagery Rescripting (ImR), have been found to be efficacious in the treatment of SAD when delivered face-to-face. However, the efficacy of these treatment approaches when delivered remotely, have not yet been examined in controlled trials. METHODS The authors propose a two-group randomized controlled trial comparing the efficacy of videoconferencing delivered CBT (vCBT) for SAD against a waitlist control group. The study will recruit 78 adults in total with a primary diagnosis of SAD of at least moderate severity. The manualised high-intensity vCBT intervention will be delivered weekly over an 8-week period. After treatment completion, the waitlist participants will receive a high-intensity videoconferencing delivered ImR (vImR) intervention also delivered weekly over an 8-week period. Treatment for both groups will be delivered in real time via an online videoconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. CONCLUSION This trial will report findings on the efficacy of a remote synchronous high-intensity vCBT and vImR intervention for SAD and benchmark the two different treatment methodologies against standard face-to-face CBT. The results have the potential to inform best-practice remote psychological treatment for SAD. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry; ACTRN12623000313639 (5 April 2023).
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Affiliation(s)
- Halaina R Winter
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alice Norton
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia..
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Yu J, Chen W, Liu Q, Mi J. Investigating 3D-printed disk compressing against skin for pain relief in intradermal infiltration anesthesia: a randomized controlled trial. BMC Anesthesiol 2023; 23:144. [PMID: 37118673 PMCID: PMC10148480 DOI: 10.1186/s12871-023-02088-y] [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: 11/10/2022] [Accepted: 04/10/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pain intensity may be varied during the needle advancing through different skin layers, injection into the intradermal layer may exclude mixed pain from deeper planes. This study aimed to investigate whether compressing a three-dimensional (3D)-printed disk against the skin may relieve pain associated with intradermal injection of local anesthetic which mimics the skin test procedure. METHODS After institutional review board approval, 3D-printed disks with projections were designed for this study. Enrolled patients were randomized to receive either a disk compressing against the axillary skin during the intradermal injection of local anesthesia (compressing disk group) or an intradermal injection of local anesthesia without any compression (no compressing disk group). The primary outcomes were pain intensity (100-mm visual analog scale) and satisfaction (5-point Likert scale) as assessed by patients. RESULTS Ninety patients with American Society of Anesthesiologists I-II physical status receiving intradermal local anesthesia prior to an ultrasound-guided axillary approach were included. Eighty-seven patients completed the study, with 44 and 43 patients in disk and no disk groups, respectively. Pain scores were significantly different (P < 0.001) in compressing disk (median, 10; IQR, 5-20) and no compressing disk (median, 30; IQR, 20-40) groups. The median satisfaction score was 5 in both groups. No complications occurred during follow-up. CONCLUSION Compressing a 3D-printed disk against the skin may reduce intradermal needle pain and offers an effective alternative for nerve block induction.
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Affiliation(s)
- Jiong Yu
- Department of Sports Medicine, Wuxi 9Th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China.
| | - Wenxuan Chen
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Qianyuan Liu
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9Th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China.
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Tang X, Liu Q, Cai F, Tian H, Shi X, Tang S. Prevalence of social anxiety disorder and symptoms among Chinese children, adolescents and young adults: A systematic review and meta-analysis. Front Psychol 2022; 13:792356. [PMID: 36072051 PMCID: PMC9442033 DOI: 10.3389/fpsyg.2022.792356] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of the study is to provide a reliable estimate of the pooled prevalence of social anxiety disorder (SAD) and social anxiety symptoms (SAS) among children, adolescents, and young adults (CAYA) in China. Meta-analysis is used to provide pooled-prevalence rate of SAD and SAS. Literature searches were conducted in both English and Chinese databases from the database's inception to April 2019. Eleven studies were identified for SAD, and 17 were included for SAS. The results revealed a pooled prevalence of SAD of 2.1% (95% CI: 1.2-3.8%) with high between-studies heterogeneity (Q = 1,055.2, I 2 = 99.1%, p < 0.001). The pooled prevalence estimate of SAS was 23.5% (95% CI: 18.6-29.3%), also with significant heterogeneity (Q = 1,019.3, I 2 = 98.4%, p < 0.001). Different diagnostic tools or self-report scales reported significant different prevalence of SAD or SAS. Further analysis stratified by gender, age, sampling methods, economic status, and risk of bias were performed. Limitations include the high level of heterogeneity between studies, inadequate number of the studies, and significant differences in prevalence caused by measurements. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149591, identifier: PROSPERO CRD42020149591.
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Affiliation(s)
- Xinfeng Tang
- Department of Psychology, Renmin University of China, Beijing, China
| | - Qiwen Liu
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
| | - Fangtong Cai
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
| | - Hui Tian
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
| | - Xincheng Shi
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
| | - Suqin Tang
- School of Psychology, Shenzhen University, Shenzhen, China
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5
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Soltani E, Wong QJJ, Sahraian A, Dastgheib SA, Mani A, Shekarpoor A, Bahmanpoori S. Psychometric Properties of the Persian Version of the Core Beliefs Questionnaire (CBQ). Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Tyson PJ, Davies SK, Scorey S, Greville WJ. Fear of clowns: An investigation into the prevalence of coulrophobia in an international sample. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2046925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Philip John Tyson
- Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Shakiela K. Davies
- Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Sophie Scorey
- Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - William James Greville
- Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
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Wong QJJ, Heeren A. Understanding the Dynamic Interaction of Maladaptive Social-Evaluative Beliefs and Social Anxiety: A Latent Change Score Model Approach. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Al-Ezzi A, Kamel N, Faye I, Gunaseli E. Analysis of Default Mode Network in Social Anxiety Disorder: EEG Resting-State Effective Connectivity Study. SENSORS (BASEL, SWITZERLAND) 2021; 21:4098. [PMID: 34203578 PMCID: PMC8232236 DOI: 10.3390/s21124098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022]
Abstract
Recent brain imaging findings by using different methods (e.g., fMRI and PET) have suggested that social anxiety disorder (SAD) is correlated with alterations in regional or network-level brain function. However, due to many limitations associated with these methods, such as poor temporal resolution and limited number of samples per second, neuroscientists could not quantify the fast dynamic connectivity of causal information networks in SAD. In this study, SAD-related changes in brain connections within the default mode network (DMN) were investigated using eight electroencephalographic (EEG) regions of interest. Partial directed coherence (PDC) was used to assess the causal influences of DMN regions on each other and indicate the changes in the DMN effective network related to SAD severity. The DMN is a large-scale brain network basically composed of the mesial prefrontal cortex (mPFC), posterior cingulate cortex (PCC)/precuneus, and lateral parietal cortex (LPC). The EEG data were collected from 88 subjects (22 control, 22 mild, 22 moderate, 22 severe) and used to estimate the effective connectivity between DMN regions at different frequency bands: delta (1-3 Hz), theta (4-8 Hz), alpha (8-12 Hz), low beta (13-21 Hz), and high beta (22-30 Hz). Among the healthy control (HC) and the three considered levels of severity of SAD, the results indicated a higher level of causal interactions for the mild and moderate SAD groups than for the severe and HC groups. Between the control and the severe SAD groups, the results indicated a higher level of causal connections for the control throughout all the DMN regions. We found significant increases in the mean PDC in the delta (p = 0.009) and alpha (p = 0.001) bands between the SAD groups. Among the DMN regions, the precuneus exhibited a higher level of causal influence than other regions. Therefore, it was suggested to be a major source hub that contributes to the mental exploration and emotional content of SAD. In contrast to the severe group, HC exhibited higher resting-state connectivity at the mPFC, providing evidence for mPFC dysfunction in the severe SAD group. Furthermore, the total Social Interaction Anxiety Scale (SIAS) was positively correlated with the mean values of the PDC of the severe SAD group, r (22) = 0.576, p = 0.006 and negatively correlated with those of the HC group, r (22) = -0.689, p = 0.001. The reported results may facilitate greater comprehension of the underlying potential SAD neural biomarkers and can be used to characterize possible targets for further medication.
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Affiliation(s)
- Abdulhakim Al-Ezzi
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia; (A.A.-E.); (N.K.)
| | - Nidal Kamel
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia; (A.A.-E.); (N.K.)
| | - Ibrahima Faye
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia; (A.A.-E.); (N.K.)
| | - Esther Gunaseli
- Psychiatry Discipline Sub Unit, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh 30450, Malaysia;
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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: 3] [Impact Index Per Article: 1.0] [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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10
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Psychometric properties of the Self-Beliefs related to Social Anxiety (SBSA) scale in a sample of individuals with social anxiety disorder. J Anxiety Disord 2021; 78:102365. [PMID: 33535158 DOI: 10.1016/j.janxdis.2021.102365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/13/2023]
Abstract
The Self-Beliefs related to Social Anxiety (SBSA) scale assesses maladaptive social-evaluative beliefs, a key aspect in models of social anxiety disorder (SAD) that is frequently measured in research and clinical contexts. The SBSA has been evaluated psychometrically in student samples, but not in a large sample of individuals diagnosed with SAD. The current study tested the psychometric properties of the SBSA in a sample of individuals with SAD pooled from several studies (total N = 284). Results showed that the optimal factor structure for the SBSA was a correlated three-factor model (high standard beliefs factor, conditional beliefs factor, unconditional beliefs factor). The SBSA total and its subscales (formed based on the factors) exhibited good internal consistency. In terms of construct validity, the SBSA total, the high standard beliefs subscale, and conditional beliefs subscale had stronger associations with a measure of social anxiety than with a measure of depression, although the unconditional beliefs subscale was similarly related to both measures of social anxiety and depression. In terms of discriminative validity, the sample of individuals with SAD had higher SBSA total and subscale scores compared with a sample of individuals without SAD (N = 32). These findings provide a psychometric evidence base justifying the use of the SBSA for the assessment of maladaptive social-evaluative beliefs.
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11
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Zsido AN, Teleki SA, Csokasi K, Rozsa S, Bandi SA. Development of the short version of the spielberger state-trait anxiety inventory. Psychiatry Res 2020; 291:113223. [PMID: 32563747 DOI: 10.1016/j.psychres.2020.113223] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
The Spielberger State-Trait Anxiety Inventory (STAI) has been widely used to measure the state and trait components of anxiety. We sought to develop a short, yet reliable and valid form of these scales for use in circumstances where the full-form is not feasible. We abbreviated the scales using item response theory analyses to retain the items that could discriminate the best among participants. One sample (N = 922) completed the state scale, a second sample (N = 2227) completed the trait scale, while a third sample (N = 250) completed the short forms. Our participants completed the Hungarian version of STAI alongside other measures to observe external validity. We calculated cut-off scores for the state (>9.5,) and trait (>13.5) scales. A total of 19.5% and 20.1% of the respondents reached the cut-off scores. The five-item short forms of STAI had sound psychometric properties that are comparable to those obtained on the full-form. The external validity of the scales is also demonstrated. We report detailed descriptive statistics that could be used in further studies as standards. The short scales are reliable measures that could be used in clinical screening and behavioural research; especially where practical considerations preclude the use of a longer questionnaire.
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Affiliation(s)
- Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
| | | | | | - Sandor Rozsa
- Departments of Psychiatry, Genetics & Psychology, Washington University, St. Louis, USA
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12
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Wong QJJ, McEvoy PM, Rapee RM. The structure of social-evaluative threat detection in social anxiety disorder. J Anxiety Disord 2020; 74:102273. [PMID: 32682276 DOI: 10.1016/j.janxdis.2020.102273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
The integrated aetiological and maintenance (IAM) model of social anxiety disorder (SAD) conceptualises four social-evaluative cognitive processes (anticipatory processing, attention to the self, attention to threat in the environment, and post-event processing) as facets of a social-evaluative threat detection construct. The current study tested this by examining potential factor structures underlying the four social-evaluative cognitive processes. Baseline data from two randomised controlled trials, consisting of 306 participants with SAD who completed measures of the four social-evaluative cognitive processes in relation to a speech task, were subjected to confirmatory factor analysis. Model fit indices and bifactor model indices showed that the optimal factor structure was a bifactor model with a Social-evaluative Threat Detection General Factor and two group factors corresponding to anticipatory processing and post-event processing. Analyses also indicated that the Social-evaluative Threat Detection General Factor had moderate to large associations with other constructs in the IAM model, whereas the two group factors only had small associations with these constructs. These findings suggest that the four social-evaluative cognitive processes can be unified as facets of a social-evaluative threat detection process, consistent with the IAM model, although group factors for anticipatory processing and post-event processing need to be taken into account.
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Affiliation(s)
- Quincy J J Wong
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia.
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia, Australia; School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
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Cognitive Bias Modification for the Induction of Negative Versus Benign Interpretations of the Self in Individuals with Elevated Social Anxiety: Effects on Self-related and Anxiety Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-019-10074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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du Toit SA, Kade SA, Danielson CT, Schweizer S, Han J, Torok M, Wong QJJ. The effect of emotional working memory training on emotional and cognitive outcomes in individuals with elevated social anxiety. J Affect Disord 2020; 261:76-83. [PMID: 31605835 DOI: 10.1016/j.jad.2019.09.085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/18/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although cognitive-behavioural therapy is the gold standard psychological treatment for individuals with social anxiety disorder (SAD), it does not benefit everyone. Emotional working memory training (eWMT) is a promising alternative intervention. This study examined the effects of eWMT versus control training (CT) on emotional and cognitive outcomes in individuals with elevated social anxiety. METHODS Forty participants with elevated social anxiety were randomly allocated to eWMT (n = 21) or CT (n = 19), each consisting of six training sessions. At pre- and post-training, participants completed: a working memory task, an impromptu speech, and self-reported measures of emotional and cognitive outcomes (anticipatory processing, peak anxiety and attentional focus during the speech, post-event processing). RESULTS Participants in both training conditions exhibited performance improvements on their respective training tasks. As expected, there was a Time x Condition interaction for peak anxiety, reflecting a decrease in peak anxiety for the eWMT condition but not the CT condition. Exploratory analyses also indicated a Time x Condition interaction for an aspect of post-event processing, reflecting a decrease in thinking about the past for the eWMT condition but not the CT condition. LIMITATIONS Although the level of social anxiety of the current sample is comparable to that of samples of individuals diagnosed with SAD in the literature, participant diagnoses were not assessed in this study. CONCLUSIONS The findings suggest that eWMT has potential as an alternative intervention for individuals with elevated social anxiety.
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Affiliation(s)
- Simone A du Toit
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Saif A Kade
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Craig T Danielson
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jin Han
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Quincy J J Wong
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia.
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Wong QJJ, Chen J, Gregory B, Baillie AJ, Nagata T, Furukawa TA, Kaiya H, Peters L, Rapee RM. Measurement equivalence of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) across individuals with social anxiety disorder from Japanese and Australian sociocultural contexts. J Affect Disord 2019; 243:165-174. [PMID: 30243196 DOI: 10.1016/j.jad.2018.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan. METHODS Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework. RESULTS The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants. LIMITATIONS We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture. CONCLUSIONS When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.
| | - Junwen Chen
- School of Psychology, Flinders University, Adelaide, Australia
| | - Bree Gregory
- School of Psychology, University of Sydney, Sydney, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | | | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Hisanobu Kaiya
- Akasaka Clinic for Psychosomatic Medicine and Psychiatry, Medical Corporation Warakukai, Tokyo, Japan
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Sunderland M, Batterham P, Calear A, Carragher N, Baillie A, Slade T. High agreement was obtained across scores from multiple equated scales for social anxiety disorder using item response theory. J Clin Epidemiol 2018; 99:132-143. [DOI: 10.1016/j.jclinepi.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 03/16/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
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Zsido AN, Arato N, Inhof O, Janszky J, Darnai G. Short versions of two specific phobia measures: The snake and the spider questionnaires. J Anxiety Disord 2018; 54:11-16. [PMID: 29306023 DOI: 10.1016/j.janxdis.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/27/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
Zoophobias are the most prevalent form of specific phobia worldwide. Two of the most widely used measures, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ) are good indicators of specific fears, but researchers have recognised that shorter, yet nevertheless reliable measures are needed. Hence the aims of this research were to develop short forms of the SNAQ and SPQ using item response theory and to use receiver operating characteristic (ROC) curve analyses to determine cut-offs for use in future research. Twelve-item versions of both scales (SNAQ-12 and SPQ-12) demonstrated excellent discrimination along the latent continuum in a sample of 1354 people. The SNAQ-12 and SPQ-12 showed excellent reliability and were highly correlated with the corresponding full-length scale. The scales discriminated between participants who reported snake (3.25%) or spider (8.05%) phobia and those who did not. Further analyses revealed that non-phobic women report higher fear of both snakes and spiders than do men, but this difference was not present in phobics. These findings suggest that the SNAQ-12 and SPQ-12 have considerable strengths, including shorter assessment and scoring times, whilst retaining high reliability and potential utility as a clinical screening tool.
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Affiliation(s)
- Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
| | - Nikolett Arato
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Orsolya Inhof
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Jozsef Janszky
- Department of Neurology, University of Pécs, Medical School, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Gergely Darnai
- Institute of Psychology, University of Pécs, Pécs, Hungary; Department of Neurology, University of Pécs, Medical School, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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18
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Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, McEvoy PM, Peters L, Rapee RM. Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder. Behav Ther 2017; 48:651-663. [PMID: 28711115 DOI: 10.1016/j.beth.2017.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.
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Iverach L, Rapee RM, Wong QJJ, Lowe R. Maintenance of Social Anxiety in Stuttering: A Cognitive-Behavioral Model. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:540-556. [PMID: 28334398 DOI: 10.1044/2016_ajslp-16-0033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Stuttering is a speech disorder frequently accompanied by anxiety in social-evaluative situations. A growing body of research has confirmed a significant rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a chronic and disabling anxiety disorder associated with substantial life impairment. Several influential models have described cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering populations. The purpose of the present article is to apply these leading models to the experience of social anxiety for people who stutter. METHOD Components from existing models were applied to stuttering in order to determine cognitive-behavioral processes that occur before, during, and after social-evaluative situations, which may increase the likelihood of stuttering-related social fears persisting. RESULTS Maintenance of social anxiety in stuttering may be influenced by a host of interrelated factors, including fear of negative evaluation, negative social-evaluative cognitions, attentional biases, self-focused attention, safety behaviors, and anticipatory and postevent processing. CONCLUSION Given the chronic nature of social anxiety disorder, identifying factors that contribute to the persistence of stuttering-related social fears has the potential to inform clinical practice and the development of psychological treatment programs to address the speech and psychological needs of people who stutter with social anxiety.
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Affiliation(s)
- Lisa Iverach
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, AustraliaAustralian Stuttering Research Centre, The University of Sydney
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Robyn Lowe
- Australian Stuttering Research Centre, The University of Sydney
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Wong QJJ, Gregory B, Gaston JE, Rapee RM, Wilson JK, Abbott MJ. Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder. J Affect Disord 2017; 207:121-127. [PMID: 27721185 DOI: 10.1016/j.jad.2016.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prominent cognitive models of social anxiety have consistently emphasised the importance of beliefs about the self in the aetiology and maintenance of social anxiety. The present study sought to develop and validate a new measure of core beliefs about the self for SAD, the Core Beliefs Questionnaire (CBQ). METHODS Three versions of the CBQ were developed: a Trait version (fundamental absolute statements about the self), a Contingent version (statements about the self related to a specific social-evaluative situation), and an Other version (statements about how others view the self in social-evaluative situations generally). The psychometric features of the scales were examined in clinical (n=269) and non-clinical (n=67) samples. RESULTS Exploratory factor analysis yielded a one factor model for all three versions of the questionnaire. Total scores differentiated individuals with SAD from individuals without a psychiatric condition, and demonstrated excellent internal consistency. The three CBQ versions had positive associations with social anxiety while controlling for depression, although zero-order correlations indicated the Trait version was more strongly related to depression than social anxiety, the Contingent version was similarly related to depression and social anxiety, and the Other version was more strongly related to social anxiety than depression. Scores on all three versions of the CBQ reduced from pre- to post-treatment and this change predicted treatment outcome. LIMITATIONS This is the first validation study of the CBQ. CONCLUSIONS This study provides initial support for the reliability and validity of the CBQ.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Jonathan E Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Judith K Wilson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Maree J Abbott
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
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