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Ginat-Frolich R, Gilboa-Schechtman E, Huppert JD, Aderka IM, Alden LE, Bar-Haim Y, Becker ES, Bernstein A, Geva R, Heimberg RG, Hofmann SG, Kashdan TB, Koster EHW, Lipsitz J, Maner JK, Moscovitch DA, Philippot P, Rapee RM, Roelofs K, Rodebaugh TL, Schneier FR, Schultheiss OC, Shahar B, Stangier U, Stein MB, Stopa L, Taylor CT, Weeks JW, Wieser MJ. Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives. Clin Psychol Rev 2024; 109:102415. [PMID: 38493675 DOI: 10.1016/j.cpr.2024.102415] [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: 06/10/2022] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.
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Affiliation(s)
| | | | | | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel
| | - Lynn E Alden
- Department of Psychology, University of British Columbia, Canada
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, Netherlands
| | - Amit Bernstein
- School of Psychological Sciences, University of Haifa, Israel
| | - Ronny Geva
- Department of Psychology, Bar Ilan University, Israel
| | - Richard G Heimberg
- Department of Psychology, Temple University, Philadelphia, United States of America
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany; Department of Psychological and Brain Sciences, Boston University, Boston, United States of America
| | - Todd B Kashdan
- Department of Psychology, George Mason University, Virginia, United States of America
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | | | - Jon K Maner
- Department of Psychology, Florida State University, Florida, United States of America
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research & Treatment, University of Waterloo, Canada
| | - Pierre Philippot
- Department of Psychology, Université Catholique de Louvain, Belgium
| | - Ronald M Rapee
- Centre for Emotional Health and School of Psychological Sciences, Macquarie University, Australia
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University Nijmegen, Netherlands; Donders Institute, Radboud University Nijmegen, Netherlands
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Missouri, United States of America
| | - Franklin R Schneier
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, United States of America
| | | | - Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Ulrich Stangier
- Department of Psychology, Goethe University Frankfurt, Germany
| | - Murray B Stein
- Department of Psychiatry and School of Public Health, University of California San Diego, United States of America
| | - Lusia Stopa
- Department of Psychology, University of Southampton, United Kingdom
| | - Charles T Taylor
- Department of Psychiatry and School of Public Health, University of California San Diego, United States of America
| | - Justin W Weeks
- Department of Psychology, Nebraska Medicine, Omaha, Nebraska, United States of America; Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Matthias J Wieser
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Netherlands
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Mobach L, Rapee RM, Klein AM. The Role of Distorted Cognitions in Mediating Treatment Outcome in Children with Social Anxiety Disorder: A Preliminary Study. Child Psychiatry Hum Dev 2023; 54:558-569. [PMID: 34674074 PMCID: PMC9977708 DOI: 10.1007/s10578-021-01268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7-12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment.
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Affiliation(s)
- Lynn Mobach
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia
| | - Anke M Klein
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands
- Unit Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
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Dapprich AL, Becker ES, Derks LM, Legenbauer T, Lange WG. Specific interpretation biases as a function of social anxiety and callous-unemotional traits in a community and a clinical adolescent sample. Child Adolesc Psychiatry Ment Health 2023; 17:46. [PMID: 37004075 PMCID: PMC10064950 DOI: 10.1186/s13034-023-00585-z] [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: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Threatening and hostile interpretation biases are seen as causal and maintaining mechanisms of childhood anxiety and aggression, respectively. However, it is unclear whether these interpretation biases are specific to distinct problems or whether they are general psychopathological phenomena. The specificity versus pervasiveness of interpretation biases could also differ depending on mental health status. Therefore, in the current study, we investigated whether social anxiety and callous-unemotional (CU) traits were uniquely related to threatening and hostile interpretation biases, respectively, in both a community and a clinical sample of adolescents. METHODS A total of 161 adolescents between 10 to 15 years of age participated. The community sample consisted of 88 participants and the clinical sample consisted of 73 inpatients with a variety of psychological disorders. Social anxiety and CU-traits were assessed with self-report questionnaires. The Ambiguous Social Scenario Task was used to measure both threatening and hostile interpretations in response to written vignettes. RESULTS Results showed that social anxiety was uniquely related to more threatening interpretations, while CU-traits were uniquely related to more hostile interpretations. These relationships were replicated for the community sample. For the clinical sample, only the link between social anxiety and threatening interpretations was significant. Explorative analyses showed that adolescents with externalizing disorders scored higher on hostile interpretations than adolescents with internalizing disorders. CONCLUSIONS Overall, these results support the content-specificity of threatening interpretation biases in social anxiety and of hostile interpretation biases in CU-traits. Better understanding the roles of interpretation biases in different psychopathologies might open avenues for tailored prevention and intervention paradigms.
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Affiliation(s)
- Anna L Dapprich
- Behavioural Science Institute, Radboud University, 500 HB, Nijmegen, The Netherlands.
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, 500 HB, Nijmegen, The Netherlands
| | - Laura M Derks
- Behavioural Science Institute, Radboud University, 500 HB, Nijmegen, The Netherlands
- LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr-University Bochum, Bochum, Germany
| | - Tanja Legenbauer
- LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr-University Bochum, Bochum, Germany
| | - Wolf-Gero Lange
- Behavioural Science Institute, Radboud University, 500 HB, Nijmegen, The Netherlands
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Subar AR, Humphrey K, Rozenman M. Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2022; 31:1341-1352. [PMID: 33616762 DOI: 10.1007/s00787-021-01740-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen's d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.
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Affiliation(s)
- Anni R Subar
- Behavioral Research for Anxiety InterVention Efficiency (BRAVE) Lab, Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA.
| | - Kaeli Humphrey
- Behavioral Research for Anxiety InterVention Efficiency (BRAVE) Lab, Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA
| | - Michelle Rozenman
- Behavioral Research for Anxiety InterVention Efficiency (BRAVE) Lab, Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA
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Emerging Domain-Based Treatments for Pediatric Anxiety Disorders. Biol Psychiatry 2021; 89:716-725. [PMID: 33451677 DOI: 10.1016/j.biopsych.2020.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/25/2022]
Abstract
Domain-specific cognitive training treatments for pediatric anxiety disorders rely on accurate and reliable identification of specific underlying deficits and biases in neurocognitive functions. Once identified, such biases can serve as specific targets for therapeutic intervention. Clinical translations typically reflect mechanized training protocols designed to rectify the identified biases. Here, we review and synthesize research on key neurocognitive processes that emerge as potential targets for specialized cognitive training interventions in pediatric anxiety disorders in the domains of attention, interpretation, error monitoring, working memory, and fear learning. For each domain, we describe the current status of target establishment (i.e., an association between pediatric anxiety and a specific neurocognitive process), and then review extant translational efforts regarding these targets and the evidence supporting their clinical utility in youths. We then localize each of the domains within the path leading to efficacious, evidence-supported treatments for pediatric anxiety, providing a roadmap for future research. The review indicates that specific cognitive targets in pediatric anxiety have been established in all the reviewed domains except for fear learning, where a clear target is yet to be elucidated. In contrast, evidence for clinical efficacy emerged only in the threat-related attention domain, with some preliminary findings in the domains of interpretation and working memory. The path to clinical translation in the domain of error monitoring is yet unclear. Implications and potential avenues for future research and translation are discussed.
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Gober CD, Lazarov A, Bar-Haim Y. From cognitive targets to symptom reduction: overview of attention and interpretation bias modification research. EVIDENCE-BASED MENTAL HEALTH 2021; 24:42-46. [PMID: 33246935 PMCID: PMC10231632 DOI: 10.1136/ebmental-2020-300216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
Cognitive bias modification (CBM) is a class of mechanised psychological interventions designed to target specific aberrant cognitive processes considered key in the aetiology and/or maintenance of specific psychiatric disorders. In this review, we outline a multistage translational process that allows tracking progress in CBM research. This process involves four steps: (1) the identification of reliable cognitive targets and establishing their association with specific disorders; (2) clinical translations designed to rectify the identified cognitive targets; (3) verification of effective target engagement and (4) testing of clinical utility in randomised controlled trials. Through the prism of this multistage process, we review progress in clinical CBM research in two cognitive domains: attention and interpretation; in six psychiatric conditions: anxiety disorders, major depressive disorder, post-traumatic stress disorder, addictive disorders, eating disorders and obsessive-compulsive disorder. The review highlights achievement as well as shortcomings of the CBM approach en route to becoming a recognised evidence-supported therapy for these disorders.
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Affiliation(s)
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Calleja RL, Rapee RM. Social threat sensitivity and its relationships with peer victimisation and internalising symptoms among adolescent girls. Behav Res Ther 2020; 133:103710. [PMID: 32836111 DOI: 10.1016/j.brat.2020.103710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/12/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
Consistent associations have been shown between self-reported peer victimisation and internalising symptoms. In distinct literature, anxious and depressed youth have been shown to interpret ambiguous social stimuli in a manner consistent with social threat and rejection. The aim of the current study was to determine whether this sensitivity to social threat among anxious/depressed youth explains significant variance in the relationship between self-reports of peer victimisation and internalising symptoms. Two hundred and sixty-seven students in grades seven and eight (M age = 12.62, SD = 0.65) completed measures of their own symptoms of anxiety and depression as well as their experiences of being physically or relationally victimised by their peers. They also read descriptions of 10 hypothetical ambiguous social interactions and provided responses indicating whether they interpreted each scenario as indicating social threat (rejection/negative evaluation) and the extent to which they perceived it as victimisation. As expected, anxiety and depression were positively correlated with self-reported peer victimisation and with interpretations consistent with social threat and victimisation (social threat sensitivity). In turn, social threat sensitivity was positively correlated with both self-reported relational and physical victimisation, but moreso with the former. However, the relationship between anxiety and depression and victimisation remained significant, even after controlling for social threat sensitivity. Results suggest that a sensitivity toward social threat can influence self-reports of peer victimisation among anxious and depressed youth, but that the relationship between internalising and victimisation goes beyond this sensitivity.
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Affiliation(s)
- Rachel L Calleja
- 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.
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Mobach L, Klein AM, Schniering CA, Hudson JL. Specificity of Dysfunctional Beliefs in Children with Social Anxiety Disorder: Effects of Comorbidity. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:389-396. [DOI: 10.1080/15374416.2019.1697930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lynn Mobach
- Centre for Emotional Health, Department of Psychology, Macquarie University
- Behavioural Science Institute, Radboud University
| | - Anke M. Klein
- Behavioural Science Institute, Radboud University
- Developmental Psychology, University of Amsterdam
| | | | - Jennifer L. Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University
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