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Li Q, Song K, Feng T, Zhang J, Fang X. Machine learning identifies different related factors associated with depression and suicidal ideation in Chinese children and adolescents. J Affect Disord 2024; 361:24-35. [PMID: 38844165 DOI: 10.1016/j.jad.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/04/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Depression and suicidal ideation often co-occur in children and adolescents, yet they possess distinct characteristics. This study sought to identify the different related factors associated with depression and suicidal ideation. METHODS A nationwide cross-sectional survey collected data from Chinese children and adolescents aged 8 to 18 (N = 160,962; 48.91 % girls). The survey included inquiries about demographics, depression, suicidal ideation, anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, bullying, and being bullied. Fifteen machine learning algorithms were conducted to identify the different related factors associated with depression and suicidal ideation. Additionally, we conducted external validation on an independent sample of 1,812,889 children and adolescents. RESULTS Our findings revealed seven related factors linked to depression and six associated with suicidal ideation, with average accuracy rates of 86.86 % and 85.82 %, respectively. For depression, the most influential factors were anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, experience of bullying, and age. Similarly, anxiety, non-suicidal self-injury, perceived stress, internet addiction, academic burnout, and age emerged as paramount factors for suicidal ideation. Moreover, these related factors showed notable variations in their predictive capacities for depression and suicidal ideation across different subgroups. CONCLUSION Anxiety emerged as the predominant shared factor for both depression and suicidal ideation, whereas the other related factors displayed distinct predictive patterns for each condition. These findings highlight the critical need for tailored strategies from public mental health service providers and policymakers to address the pressing concerns of depression and suicidal ideation.
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Affiliation(s)
- Qingyin Li
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Kunru Song
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Tao Feng
- Beijing Mind Data & Analysis Technology Co. Ltd, Beijing, China
| | - Jintao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
| | - Xiaoyi Fang
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China; State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
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2
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Alnemr L, Salama AH, Abdelrazek S, Alfakeer H, Ali Alkhateeb M, Torun P. Prevalence of social anxiety disorder and its associated factors among foreign-born undergraduate students in Türkiye: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003184. [PMID: 39078858 PMCID: PMC11288422 DOI: 10.1371/journal.pgph.0003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024]
Abstract
Social anxiety disorder (SAD) is prevalent among university students, yet data on its severity among foreign-born international undergraduate students in Türkiye remains limited. This study aims to determine the prevalence of SAD and its associated factors within this population. A cross-sectional study was conducted using a Google Form survey distributed across various universities from September 17, 2023, to February 1, 2024. The survey comprised two sections: sociodemographic information and 17 items of the Social Phobia Inventory (SPIN), which measures the frequency and intensity of social anxiety symptoms. Data analysis included descriptive statistics and inferential analysis, multiple regression, and binomial logistic regression. Out of 506 participants, 455 were included in the study. Results revealed that 39.1% exhibited no or very mild symptoms of SAD, while 23.7% experienced mild symptoms, 21.3% faced moderate symptoms, and 11.6% and 4.2% presented with severe to very severe symptoms, respectively. Factors such as gender (p < 0.0001), previous academic failures (p = 0.013), family history of mental health issues (p = 0.009), exercise frequency (p < 0.0001), and perceptions of relationships with classmates (p < 0.0001) were significantly associated with SAD. Females showed a higher probability of SAD compared to males (OR = 1.976). Individuals engaging in over 90 minutes of exercise per week were less likely to have SAD (OR = 0.383), and occasional smokers had a lower risk of SAD compared to non-smokers (OR = 0.422). Our study uncovered a notably elevated prevalence of Social Anxiety Disorder (SAD) among foreign-born undergraduate students in Türkiye. Factors such as being female, having a family history of mental illnesses, studying in a stressful environment, experiencing academic failure, and engaging in less frequent exercise were associated with noticeable symptoms of SAD. These findings emphasize the urgent need for heightened efforts in recognizing and addressing SAD within this population.
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Affiliation(s)
- Lujain Alnemr
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
| | - Abdelaziz H. Salama
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Salma Abdelrazek
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
| | - Hussein Alfakeer
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
| | - Mohamed Ali Alkhateeb
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
| | - Perihan Torun
- Department of Public Health, Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Türkiye
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de Ponti N, Matbouriahi M, Franco P, Harrer M, Miguel C, Papola D, Sicimoğlu A, Cuijpers P, Karyotaki E. The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis. J Anxiety Disord 2024; 104:102881. [PMID: 38815481 DOI: 10.1016/j.janxdis.2024.102881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed. METHODS We selected studies from a database of randomized trials (RCTs) on psychotherapies for anxiety disorders (last updated search of PubMed, PsycINFO, Embase, and Cochrane (CENTRAL): 1 January 2024) We included RCTs comparing psychotherapy to a control condition for adults with SAD and conducted random effects meta-analyses to examine the efficacy of psychotherapy compared to control conditions at post-treatment. RESULTS Sixty-six RCTs were included with 5560 participants and 98 comparisons between psychotherapy and control groups. Psychotherapy was effective in reducing SAD symptoms, with a large effect size (g = 0.88; 95 % CI: 0.76 to 1.0; I2 = 74 %; 95 % CI: 69 to 79, NNT = 3.8). Effects remained robust across sensitivity analyses. However, there was evidence for significant risk of bias in the included trials. The multivariable meta-regression indicated significant differences in treatment delivery formats, type of recruitment strategy, target group, and number of sessions. CONCLUSION Psychotherapy is an effective treatment for SAD, with moderate to large effect sizes across all treatment types and formats. Future research is needed to determine the long-term effects.
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Affiliation(s)
- Nino de Ponti
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Minoo Matbouriahi
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ayşesu Sicimoğlu
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Babes,-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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4
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Baljé AE, Greeven A, Deen M, van Giezen AE, Arntz A, Spinhoven P. Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial. J Anxiety Disord 2024; 104:102860. [PMID: 38714138 DOI: 10.1016/j.janxdis.2024.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. METHODS We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). RESULTS Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. CONCLUSION GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.
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Affiliation(s)
- Astrid E Baljé
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Anja Greeven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Mathijs Deen
- Institute of Psychology/Leiden University, Leiden, the Netherlands; Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Anne E van Giezen
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands.
| | - Philip Spinhoven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
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Mou Q, Zhuang J, Wu Q, Zhong Y, Dai Q, Cao X, Gao Y, Lu Q, Zhao M. Social media addiction and academic engagement as serial mediators between social anxiety and academic performance among college students. BMC Psychol 2024; 12:190. [PMID: 38582933 PMCID: PMC10998323 DOI: 10.1186/s40359-024-01635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/29/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Social anxiety has been shown to affect college students' academic performance. However, the role of social media addiction and academic engagement in this association is unclear. METHODS A total 2661 college students completed a self-report questionnaire including Liebowitz Social Anxiety Scale, the Bergen Social Media Addiction Scale, the Utrecht Student Work Engagement Scale for Students, and the grade point average. Hayes' PROCESS macro for SPSS was employed to test the serial mediation effect. RESULTS Results indicated that social anxiety was negatively related to academic performance, only academic engagement played a single mediating role in the relationship between social anxiety and academic performance, meanwhile social media addiction and academic engagement acted as serial mediators between social anxiety on academic performance. CONCLUSIONS Social media addiction and academic engagement can explain the potential mechanisms of the association between social anxiety and academic performance, which have implications for devising intervention strategies to enhance the mental health and academic outcomes of college students.
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Affiliation(s)
- Qiaoxing Mou
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Zhuang
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Qunhong Wu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
- Department of Group Health Care, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yaqin Zhong
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Qianqian Dai
- Department of Group Health Care, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xin Cao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Qingyun Lu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China.
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Konrad K, Gerloff C, Kohl SH, Mehler DMA, Mehlem L, Volbert EL, Komorek M, Henn AT, Boecker M, Weiss E, Reindl V. Interpersonal neural synchrony and mental disorders: unlocking potential pathways for clinical interventions. Front Neurosci 2024; 18:1286130. [PMID: 38529267 PMCID: PMC10962391 DOI: 10.3389/fnins.2024.1286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the "second-person" neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions. Methods To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction. Results Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups. Discussion Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.
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Affiliation(s)
- Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - Christian Gerloff
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
- Department of Applied Mathematics and Theoretical Physics, Cambridge Centre for Data-Driven Discovery, University of Cambridge, Cambridge, United Kingdom
| | - Simon H. Kohl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - David M. A. Mehler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- School of Psychology, Cardiff University Brain Research Imaging Center (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Lena Mehlem
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Emily L. Volbert
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maike Komorek
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Alina T. Henn
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maren Boecker
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Eileen Weiss
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Vanessa Reindl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Department of Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
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7
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Hansen B, Eide TO, Reiråskag MA, Tjelle KA, Solem S, Hagen K. The Bergen 4-day treatment for social anxiety disorder: a pilot study. BMC Psychiatry 2024; 24:145. [PMID: 38383324 PMCID: PMC10880199 DOI: 10.1186/s12888-024-05607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have examined the use of concentrated and intensified cognitive behaviour therapy for treating social anxiety disorder (SAD). The aim of this study was to examine the feasibility of the Bergen 4-Day Treatment (B4DT) for treating SAD. METHODS This study adopted an open trial design without a control group. Thirty consecutively referred patients who were diagnosed with SAD were treated and assessed at pre-treatment, at post-treatment, and at the 3-month follow-up. The Liebowitz Social Anxiety Scale was used to assess symptoms of SAD; the Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms; and the Patient Health Questionnaire-9 was used to assess symptoms of anxiety and depression. The Client Satisfaction Questionnaire-8 was administered posttreatment. RESULTS Overall, patients reported a high level of satisfaction with the B4DT. Large effect sizes were observed for symptoms of SAD (d = 1.94-2.66) and for the secondary outcomes, i.e., generalized anxiety (d = 0.86-0.99) and depression (d = 0.62-0.83). The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%. CONCLUSIONS The B4DT is a promising treatment approach for patients with SAD. In the future, controlled trials should be performed to compare the efficacy of this treatment approach with standard outpatient treatment. Practical consequences, policy implications, and suggestions for future research are discussed herein.
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Affiliation(s)
- Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Thorstein Olsen Eide
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
| | | | - Kristian August Tjelle
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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8
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Hamrick HC, Hager NM, Middlebrooks MS, Mach RJ, Abid A, Allan NP, Judah MR. Social concerns about anxious arousal explain the association between neural responses to anxious arousal pictures and social anxiety. Biol Psychol 2024; 185:108718. [PMID: 37951347 DOI: 10.1016/j.biopsycho.2023.108718] [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: 10/18/2022] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023]
Abstract
Cognitive theories propose that social anxiety disorder involves heightened attention to anxious arousal symptoms due to worries that they may evoke rejection from others. Supporting this, studies have shown that social anxiety is related to greater attention to representations of anxious arousal and to anxiety sensitivity social concerns, which refers to sensitivity to feelings of anxious arousal during social situations. However, this has not yet been tested using neural indices of attention to images depicting anxious arousal. To examine these associations, the current study examined early and sustained attentional bias to anxious arousal images using the P2 and the late positive potential (LPP), respectively. Electroencephalogram data were collected while a non-clinical sample of undergraduate students (N = 106) viewed images of people exhibiting anxious arousal in addition to blocks of negative and neutral images from the IAPS. The neural response to anxious arousal images was isolated using residual scores (e.g., using linear regression to predict the P2 elicited by anxious arousal images from the P2 elicited by neutral images (P2neutral→AA) or negative images (P2negative→AA), then saving the unstandardized residuals). There was an indirect effect of the P2neutral→AA and P2negative→AA waveforms that was explained by anxiety sensitivity social concerns. Additionally, there was an indirect effect of both LPP waveforms on social anxiety symptoms during the early time window of the LPP (400-700 ms). At the later time window of the LPP (700-1000 ms), there was an indirect effect of the LPPneutral→AA residual waveform, but not the LPPnegative→AA, on social anxiety symptoms.
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Affiliation(s)
- Hannah C Hamrick
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States.
| | - Nathan M Hager
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States; Old Dominion University, Department of Psychology, Norfolk, VA, United States
| | - Morgan S Middlebrooks
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | - Russell J Mach
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | - Arooj Abid
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | | | - Matt R Judah
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
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9
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Leigh LH, Doyle FL, Hudson JL. Increasing the Efficacy of Treatment for Socially Anxious Youth Through Theoretically Derived Improvements: A Pilot Study. Child Psychiatry Hum Dev 2023; 54:1653-1665. [PMID: 35507090 PMCID: PMC10582123 DOI: 10.1007/s10578-022-01351-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
Cognitive behavioural therapy is the first line of treatment for social anxiety disorder; however, children with social anxiety disorder do not respond as well to generic cognitive behavioural therapy programs, compared to children with other anxiety disorders. The aim of the study was to provide a preliminary examination of the efficacy and applicability of a new disorder specific intervention for children with social anxiety disorder. Five children aged 7-13 years, with a primary or secondary DSM-5 diagnosis of social anxiety disorder were provided with an adapted version of the Cool Kids anxiety program. Three out of the five children were in remission from social anxiety disorder at the end of the intervention and at 3-month follow-up. Statistically significant improvements were also noted in overall anxiety symptoms and functioning. Preliminary evidence was found for the efficacy of a social anxiety version of the Cool Kids program.
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Affiliation(s)
- Lynda H Leigh
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Frances L Doyle
- MARCS Institute for Brain, Behaviour and Development, School of Psychology, Western Sydney University, Penrith, Australia
| | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, Australia.
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10
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Koskela M, Ståhlberg T, Yunus WMAWM, Sourander A. Long-term outcomes of selective mutism: a systematic literature review. BMC Psychiatry 2023; 23:779. [PMID: 37875905 PMCID: PMC10598940 DOI: 10.1186/s12888-023-05279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Selective mutism (SM) is a childhood onset anxiety disorder, and the main symptom is not speaking in certain social situations. Knowledge about the duration and long-term outcomes of SM have been lacking and the aim of this systematic literature review was to address this gap in the literature. We investigated how long SM symptoms persisted as well as other psychiatric outcomes associated with SM in later life. METHODS The PubMed, PsycInfo, Web of Science, Cochrane Library and Embase databases were initially searched from inception to 11 September 2023. Studies were included if they were published in English and had followed up subjects with clinically diagnosed SM for at least two years. The review followed the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines and the protocol was registered with the Open Science Framework. The papers were assessed using the Quality Assessment with Diverse Studies tool. RESULTS This review screened 2,432 papers and assessed 18 studies. Seven case series studies were excluded from discussion because of the low number of subjects and the fact that their findings could not be generalized to wider populations. In the end, nine clinical cohorts and two case control studies were reviewed. These provided a total of 292 subjects and the sample sizes ranged from 11-49. The overall quality of the studies was moderate. The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. Other anxiety disorders were the most common psychiatric disorders later in life, although these results should be interpreted with caution. Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. CONCLUSIONS Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
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Affiliation(s)
- Miina Koskela
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.
- INVEST Research Flagship Center, University of Turku, Turku, Finland.
- Department of Child Neurology, Turku University Hospital, Varha, Turku, Finland.
| | - Tiia Ståhlberg
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Adolescent Psychiatry, Turku University Hospital, Varha, Turku, Finland
| | - Wan Mohd Azam Wan Mohd Yunus
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Andre Sourander
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Varha, Turku, Finland
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11
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Käll A, Olsson Lynch C, Sundling K, Furmark T, Carlbring P, Andersson G. Scheduled Support Versus Support on Demand in Internet-Delivered Cognitive Behavioral Therapy for Social Anxiety Disorder: Randomized Controlled Trial. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11379. [PMID: 38356895 PMCID: PMC10863636 DOI: 10.32872/cpe.11379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/01/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Clinician-supported internet-delivered cognitive behavioral therapy (ICBT) can be an effective treatment option when treating social anxiety disorder (SAD). Unguided ICBT is often found to be less effective. One possible solution to reduce the costs of clinician support is to provide support on demand. In this format of guidance, participants have the option to contact their clinician if needed. In a few studies, this mode of support has been compared favorably to scheduled support. Method Participants in a previously reported controlled trial on SAD who had been in a waitlist control group were randomly allocated to ICBT with either on-demand guidance or scheduled weekly therapist guidance. A total of 99 participants were included. Data were collected weekly on the primary outcome measure, the Liebowitz Social Anxiety Scale self-report (LSAS-SR), and at pre- and post-treatment for secondary measures. Data were analyzed in accordance with the intention-to-treat principle using mixed-effects models. Results Both groups improved significantly during the treatment according to the LSAS-SR ratings. The groups did not differ in their estimated change during the treatment period, with a between-group effect of d = 0.02, 95% CI [-0.37, 0.43]. Both groups experienced similar improvement also on the secondary outcome measures, with small between-group effect sizes on all outcomes. Conclusions The findings indicate that support on demand can be an effective way of providing guidance in ICBT for SAD, although more research on this topic is needed. A limitation of the study is that it was conducted in 2009, and the findings were in the file drawer. Subsequent published studies support our initial findings, but more research is needed.
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Affiliation(s)
- Anton Käll
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Kajsa Sundling
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Trent ES, Viana AG, Raines EM, Busch HEC, Silva K, Storch EA, Zvolensky MJ. Childhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress. J Clin Psychol 2023; 79:1984-2008. [PMID: 36971223 PMCID: PMC10440255 DOI: 10.1002/jclp.23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Although childhood exposure to parental threatening behaviors is associated with elevated anxiety in emerging adulthood, the underlying mechanisms remain unexplored. Perceived stress-a subjective experience comprised of feelings of helplessness (being unable to cope or exert control) and poor self-efficacy (confidence in one's ability to manage stressors)-is one candidate mechanism. The present investigation examined the underlying role of perceived stress in the association between childhood exposure to parental threatening behaviors and anxiety symptom severity in a sample of emerging adults. METHODS Participants (N = 855; Mage = 18.75 years, SD = 1.05, range 18-24; 70.8% female) were recruited from a large state university and administered a battery of self-report questionnaires assessing constructs of interest. RESULTS Structural equation modeling (SEM) analyses indicated that only greater childhood exposure to maternal threatening behaviors was directly associated with greater feelings of helplessness and lower self-efficacy. Furthermore, only childhood exposure to maternal threatening behaviors was indirectly associated with anxiety severity through greater feelings of helplessness and lower self-efficacy. In contrast, childhood exposure to paternal threatening behaviors was neither directly nor indirectly associated with anxiety severity. LIMITATIONS Limitations include a cross-sectional design, use of self-report measures, and a nonclinical sample. Replicating these findings in a clinical sample and testing the hypothesized model in a longitudinal design is necessary. CONCLUSIONS Findings underscore the need for intervention efforts that screen for and target perceived stress in emerging adults exposed to negative maternal parenting behaviors.
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Affiliation(s)
- Erika S. Trent
- Department of Psychology, University of Houston, Houston, TX
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX
- Texas Institute of Measurement, Evaluation, & Statistics, University of Houston, Houston, TX
| | | | | | - Karina Silva
- Department of Psychology, University of Houston, Houston, TX
| | - Eric A. Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Figueiredo DV, Alves F, Vagos P. Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample. CURRENT PSYCHOLOGY 2023:1-12. [PMID: 37359612 PMCID: PMC10117271 DOI: 10.1007/s12144-023-04650-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention – CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, 3000-115 Portugal
| | - Francisca Alves
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention – CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, 3000-115 Portugal
| | - Paula Vagos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention – CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, 3000-115 Portugal
- Institute of Human Development, Portucalense Infante D. Henrique University, Porto, 4200-072 Portugal
- William James Research Center, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
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14
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Carlton CN, Garcia KM, Honaker M, Richey JA, Ollendick TH. 5-year follow-up of adolescents with social anxiety disorder: Current functioning during COVID-19. Psychiatry Res 2023; 322:115118. [PMID: 36842399 PMCID: PMC9940468 DOI: 10.1016/j.psychres.2023.115118] [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: 03/16/2022] [Revised: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
The present study followed-up adolescents with social anxiety disorder (SAD) during the COVID-19 pandemic, approximately 5-years following their participation in an Attention Bias Modification Training (ABMT) program (Ollendick et al., 2019). The current study aimed to evaluate current functioning and quality of life (QoL) during the emerging adulthood period. Participants included 27 young adults who completed a randomized controlled trial of ABMT and were available for follow-up. Participants filled out self-report measures of QoL and functioning and underwent a clinical interview to assess current severity of social anxiety. Clinician-rated symptoms of SAD significantly decreased from post-treatment to 5-year follow-up. Additionally, results demonstrated that social anxiety severity was significantly related to poorer self-reported physical and psychological health as well as poorer functioning with regard to social distancing fears during COVID-19. Lastly, when evaluating change in symptoms over time, increases in social anxiety severity over a 5-year period significantly predicted worsened social distancing fears during COVID-19.
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Affiliation(s)
- Corinne N Carlton
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States.
| | - Katelyn M Garcia
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Makayla Honaker
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - John A Richey
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Thomas H Ollendick
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
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15
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Mordeno IG, Bigcas JD, Mordeno ER. Examining the Latent Dimensions of Social Anxiety Disorder. Psychol Rep 2023:332941231156815. [PMID: 36773037 DOI: 10.1177/00332941231156815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, College of Education, 69330Mindanao State University-Iligan Institute of Technology, Iligan City, Philippines
| | - Jimayma D Bigcas
- School of Graduate Studies, College of Education, 69330Mindanao State University-Iligan Institute of Technology, Iligan City, Philippines
| | - Emelyn R Mordeno
- Department of Psychology, College of Arts and Social Sciences, 69330Mindanao State University-Iligan Institute of Technology, Iligan City, Philippines
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16
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Internet-based cognitive behavioural therapy combined with attentional bias modification training in generalized anxiety disorder: a randomized, controlled multi-session experiment. Behav Cogn Psychother 2023; 51:32-45. [PMID: 36278480 DOI: 10.1017/s1352465822000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although attentional bias modification training (ABM) and cognitive behavioural therapy (CBT) are two effective methods to decrease the symptoms of generalized anxiety disorders (GAD), to date, no randomized controlled trials have yet evaluated the effectiveness of an intervention combining internet-based cognitive behavioural therapy (ICBT) and ABM for adults with GAD. AIMS This study aimed to investigate the effectiveness of an intervention combining ICBT and ABM for adults with GAD. METHOD Sixty-three participants diagnosed with GAD were randomly assigned to the treatment group (ICBT with ABM; 31 participants) or the control group (ICBT with ABM placebo; 32 participants), and received 8 weeks of treatment and three evaluations. The CBT, ABM and ABM-placebo training were conducted via the internet. The evaluations were conducted at baseline, 8 weeks later, and 1 month later, respectively. RESULTS Both the treatment and control groups reported significantly reduced anxiety symptoms and attentional bias, with no clear superiority of either intervention. However, the treatment group showed a greater reduction in negative automatic thoughts than the control group after treatment and at 1-month follow-up (η2 = 0.123). CONCLUSION The results suggest that although not differing in therapeutic efficacy, the intervention combining ICBT and ABM is superior to the intervention combining ICBT and ABM-placebo in the reduction of negative automatic thoughts. ABM may be a useful augmentation of ICBT on reducing anxiety symptoms.
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17
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Fadardi JS, Memarian S, Parkinson J, Cox WM, Stacy AW. Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety. J Psychiatr Res 2023; 157:141-151. [PMID: 36463629 DOI: 10.1016/j.jpsychires.2022.11.005] [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: 05/12/2022] [Revised: 10/20/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
UNLABELLED Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. OBJECTIVES The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. METHOD In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. RESULTS In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. CONCLUSIONS The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.
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Affiliation(s)
- Javad S Fadardi
- Claremont Graduate University, United States; Bangor University, UK; Ferdowsi University of Mashhad, Iran.
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18
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Kindred R, Bates GW, McBride NL. Long-term outcomes of cognitive behavioural therapy for social anxiety disorder: A meta-analysis of randomised controlled trials. J Anxiety Disord 2022; 92:102640. [PMID: 36265270 DOI: 10.1016/j.janxdis.2022.102640] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is effective in treating Social Anxiety Disorder (SAD). However, less is known about whether gains achieved in disorder-specific and secondary outcomes (e.g., depression, general anxiety, quality of life, and self-esteem) are maintained 12 months or longer. A systematic literature search yielded 25 relevant studies that administered CBT to participants with SAD. Multivariate meta-analyses of post-treatment assessments, found that CBT was superior to control conditions in reducing social anxiety (g =.74), depression (g =.52), general anxiety (g =.69) and improving quality of life (g =.39). The within-groups effect sizes revealed that 12 months or more after CBT treatment, symptoms continued to improve for social anxiety (gav =.23) and quality of life (gav =.17), and gains were maintained for depressive (gav =.06) and general anxiety symptoms (gav =.03). However, meta-analyses of long-term outcomes lack comparison groups. Moderation was non-significant for the treatment model, format, number of sessions, treatment duration, or inclusion of booster sessions. Future research may investigate what drives improvement after treatment cessation and how CBT affects other co-occurring symptomatology. Taken together, CBT produces many benefits for SAD and individuals with co-occurring symptoms can benefit from extant SAD-focused treatments.
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Affiliation(s)
- Reuben Kindred
- Department of Psychological Sciences, Swinburne University of Technology, John St, Hawthorn 3122, Australia
| | - Glen W Bates
- Department of Psychological Sciences, Swinburne University of Technology, John St, Hawthorn 3122, Australia.
| | - Nicholas L McBride
- Department of Psychological Sciences, Swinburne University of Technology, John St, Hawthorn 3122, Australia
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19
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Social anxiety in adolescents and young adults from the general population: an epidemiological characterization of fear and avoidance in different social situations. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractSocial Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.
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20
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Alves F, Figueiredo DV, Vagos P. The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12458. [PMID: 36231757 PMCID: PMC9566153 DOI: 10.3390/ijerph191912458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Francisca Alves
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal
| | - Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal
| | - Paula Vagos
- Institute of Human Development, Portucalense Infante D. Henrique University, 4200-072 Porto, Portugal
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21
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Aluh DO, Azeredo-Lopes S, Cardoso G, Pedrosa B, Grigaitė U, Dias M, Xavier M, Caldas-de-Almeida JM. Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative. Psychiatry Res 2022; 315:114734. [PMID: 35872402 DOI: 10.1016/j.psychres.2022.114734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Sofia Azeredo-Lopes
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Miguel Xavier
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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22
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McDonagh C, Lynch H, Hennessy E. Do stigma and level of social anxiety predict adolescents' help-seeking intentions for social anxiety disorder? Early Interv Psychiatry 2022; 16:456-460. [PMID: 34291581 DOI: 10.1111/eip.13197] [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: 10/30/2020] [Revised: 04/28/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many adolescents meeting diagnostic criteria for social anxiety disorder (SAD) do not seek help or access timely professional supports. The current study investigated two hypothesized barriers to adolescents' seeking help for SAD: stigma and SAD symptoms. METHOD Three hundred fifteen adolescents (52% female; mean age = 14.85 years) read a vignette describing a hypothetical peer with symptoms of SAD and completed measures of their own help-seeking intentions, SAD symptoms, stigma awareness and agreement. RESULTS The majority of adolescents reported that the vignette character needed help. Adolescents with more SAD symptoms, and those with greater stigma awareness, were less likely to indicate they would seek help from an adult they know (e.g., parent or teacher) for similar symptoms. CONCLUSIONS Both SAD symptoms and perceptions of societal stigma may act as barriers to help-seeking for young people indicating the importance of intervention with young people, and the adults with whom they interact regularly.
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Affiliation(s)
- Cal McDonagh
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Hannah Lynch
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Eilis Hennessy
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
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24
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Slivjak ET, Pedersen EJ, Arch JJ. Evaluating the efficacy of common humanity-enhanced exposure for socially anxious young adults. J Anxiety Disord 2022; 87:102542. [PMID: 35151021 DOI: 10.1016/j.janxdis.2022.102542] [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: 03/23/2021] [Revised: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Despite some evidence of the benefits of self-compassion training among socially anxious individuals, little is known about whether enhancing self-compassion prior to exposure therapy increases initial exposure engagement. Additionally, manipulations have relied on broad definitions of self-compassion, rendering it difficult to distinguish the impact of individual components. This study employed three experiential exercises designed to enhance one facet of self-compassion-common humanity. Socially anxious undergraduates (N = 63) were randomized in groups to 1) common humanity-enhanced exposure (n = 32) or 2) exposure alone (n = 31). In the common humanity condition, participants wrote self-compassionately, shared fears, and completed a common humanity-focused lovingkindness meditation. All participants then completed a speech exposure in front of live judges followed by an optional second exposure. Within the common humanity condition, positive self-responding to the speech exposure increased (b = 0.30, p = .026). Common humanity participants also remained in the first exposure longer, relative to exposure alone (b = -30.92, p = .002). Participants rated exercises as at least moderately helpful, with sharing fears rated most helpful. In sum, a brief group-based multi-modal common humanity induction represents a promising approach to improving initial engagement with feared contexts among socially anxious individuals.
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Affiliation(s)
- Elizabeth T Slivjak
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Eric J Pedersen
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Joanna J Arch
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA.
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25
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Lorenzo NE, Novick DR, Seddio K, Degnan KA, Henderson HA, Almas AN, Chronis-Tuscano A, Fox N. Bidirectional and interactive effects of child temperament and parenting in early childhood on the trajectory of social anxiety in adolescence. Depress Anxiety 2022; 39:192-200. [PMID: 34762343 PMCID: PMC8901539 DOI: 10.1002/da.23224] [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: 12/01/2020] [Revised: 10/05/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Research suggests that certain parenting behaviors are best suited to promote optimal child development, depending on a child's distinctive temperamental presentation. This multimethod, longitudinal study examines the interactive effect of parenting and temperament in early childhood on the developmental trajectory of social anxiety in adolescence. METHODS Longitudinal growth modeling was used to examine the developmental trajectory of child social anxiety from age 9-15 and the interactive effect of parenting and child temperament at 36 months on the developmental trajectory of child social anxiety from age 9-15. RESULTS The slope of social anxiety from age 9-15 suggested a decrease in social anxiety throughout early adolescence. Furthermore, 36-month behavioral inhibition (BI) predicted the trajectory of child social anxiety from age 9-15 when parents displayed low and high levels of dismissive and supportive parenting (at 36 months). CONCLUSIONS Results support an interactive effect of infant temperament and parenting in early childhood (at 36 months) on the developmental trajectory of child social anxiety from age 9-15. Specifically, results suggest that engaging highly inhibited children with high supportive and low dismissive parenting may help reduce social anxiety over time in adolescence. Furthermore, parenting needs may differ for children high or low in BI to impact the developmental trajectory of social anxiety in adolescence, such that children who are high BI seem to benefit from low dismissive and high supportive parenting, and children who are low in BI seem to benefit more from high dismissive parenting.
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Affiliation(s)
- Nicole E. Lorenzo
- University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States,Correspondence Nicole E. Lorenzo, University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States,
| | - Danielle R. Novick
- University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States
| | | | - Kathryn A. Degnan
- Catholic University, Washington, District of Columbia, United States
| | - Heather A. Henderson
- University of Waterloo, Department of Psychology, Waterloo, Ontario, United States
| | - Alisa N. Almas
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Chronis-Tuscano
- University of Maryland, Psychology, Biology/Psychology Bldg, College Park, Maryland, United States
| | - Nathan Fox
- University of Maryland, Human Development, 3304 Benjamin Bldg, College Park, Maryland, United States
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26
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Furer P, Alcolado G, Reynolds K, Hebert EA. Group cognitive-behavioural therapy for perinatal anxiety disorders: Treatment development, content, and pilot results. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Although autism spectrum disorder (ASD) is the prototypical psychiatric disorder of social impairment, several if not most psychiatric disorders are characterized by prominent impairments in social functioning. A challenge in clinically assessing and describing social impairment is that it has been variably defined and can be difficult to measure. In this article we consider the psychiatric differential diagnosis of social impairment within the DSM-5 framework. We describe the features of social impairment in 13 DSM-5 disorders from a developmental perspective and highlight diagnostic factors that differentiate among the disorders, including the main features of social impairment, verbal communication, nonverbal communication, course of social impairment, social cognition, and key features of accompanying neuropsychiatric symptoms. We conclude by describing an approach for assessing social impairment across the lifespan.
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Luoma J, Lear MK. MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder. Front Psychiatry 2021; 12:733893. [PMID: 34646176 PMCID: PMC8502812 DOI: 10.3389/fpsyt.2021.733893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.
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Affiliation(s)
- Jason Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
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29
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Mahon CP, Lombard-Vance R, Kiernan G, Pachankis JE, Gallagher P. Social Anxiety Among Sexual Minority Individuals: A Systematic Review. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1936140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Conor P Mahon
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology and Assisting Living & Learning Institute, Maynooth University, Ireland
| | - Gemma Kiernan
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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30
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Sarfan LD, Magee JC, Clerkin EM. Evaluating Mechanisms: Mapping Weekly Dynamics between Experiential Avoidance and SAD Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractWidely-used, empirically-supported treatments focus on reducing experiential avoidance (EA) as a mechanism of social anxiety disorder (SAD) symptom change. However, little is known about how EA and SAD symptoms bidirectionally interrelate from session to session, or throughout the course of an intervention—a gap that raises significant theoretical and clinical questions about the mechanistic role of EA. Participants (N = 78) with elevated EA and SAD symptoms completed a 3-session pilot intervention (Approach-Avoidance Task training plus psychoeducation) designed to target EA. Bivariate latent change score modeling was then used to map the bidirectional, temporal interrelationships between EA and SAD symptoms from session to session. Analyses accounted for the overall trajectory of change in both variables (i.e., EA and SAD) and both variables’ preceding measurement. Findings suggested that changes in SAD symptoms preceded and predicted changes in EA from session to session. Contrary to hypotheses, this effect was not bidirectional, as changes in EA did not precede and predict changes in SAD symptoms from session to session. The use of a relatively small analogue sample limit the external validity of the present findings. Nevertheless, these novel findings advance our understanding of the dynamic interrelationships between EA and SAD symptoms throughout treatment. Moreover, given that many leading treatments target EA, this study highlights a need for future work to continue evaluating whether EA is indeed a mechanism of SAD symptom change.
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31
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Herpers PCM, Neumann JEC, Staal WG. Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence. Child Psychiatry Hum Dev 2021; 52:515-532. [PMID: 32748274 PMCID: PMC8113221 DOI: 10.1007/s10578-020-01036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.
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Affiliation(s)
- Pierre C M Herpers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands.
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands.
| | - Josephine E C Neumann
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525 GA, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
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32
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Ten Have M, Tuithof M, van Dorsselaer S, Kleinjan M, Penninx BWJH, Batelaan NM, de Graaf R. Duration of anxiety disorder and its associated risk indicators: Results of a longitudinal study of the general population. Depress Anxiety 2021; 38:328-336. [PMID: 33107675 DOI: 10.1002/da.23103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Data on episode duration of anxiety disorders are required for informing patients and for disease management, but such data from population studies are lacking. METHODS Three-year longitudinal data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the general adult population (N = 6646). Respondents with a new (first or recurrent) anxiety disorder were selected (n = 158). DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview; the Life Chart Interview assessed episode duration and recovery rates. RESULTS Among those with anxiety disorder, median episode duration was 7.5 months and mean duration was 15.2 months. 38.8% had not recovered at 12 months and 30.1% not at 36 months. Longer duration was associated with older age, not having a paid job, higher neuroticism, more physical disorders, and worse physical functioning. CONCLUSIONS Also, in the general population, anxiety disorder has a rather chronic course. After 12 months the cumulative recovery rate flattened. To prevent and manage chronicity, timely treatment, and chronic disease management are required. The risk indicators found may help to identify individuals with an anxiety disorder at risk for chronicity.
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Affiliation(s)
- Margreet Ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marloes Kleinjan
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Department of Interdisciplinary Social Sciences, Youth Studies, Utrecht University, Utrecht, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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33
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Knapstad M, Smith ORF. Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6- and 12-month follow-up: Secondary analysis from a randomized controlled trial. Depress Anxiety 2021; 38:351-360. [PMID: 33393688 PMCID: PMC7986705 DOI: 10.1002/da.23132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prompt Mental Health Care (PMHC, Norwegian adaption of Improving Access to Psychological Therapies) has shown effects on symptoms of anxiety and depression compared to treatment as usual (TAU). In this secondary analysis, we examine the effectiveness of PMHC among clients presenting with symptoms of social anxiety disorder (SAD) and/or agoraphobia on core symptoms at 6- and 12-month follow-up. METHODS Randomized controlled trial in two PMHC sites (70:30 ratio PMHC:TAU). Of participants, 61.3% (n = 472) scored at caseness for SAD and 47.7% (n = 367) for agoraphobia (40% both). Effects on SAD avoidance and physiological discomfort (SPIN-9), SAD cognitions (ATQ-SA), agoraphobic avoidance (MIA-8), and agoraphobic cognitions (ATQ-AP) were examined in piecewise growth models. RESULTS The PMHC group showed substantially greater symptom reduction than the TAU group for all outcomes: At 6-month follow-up, the between-group effect sizes were d -0.60 (95% CI: -0.94 to -0.26) for SPIN-9, -0.45 (95% CI: -0.70 to -0.20) for ATQ-SA, -0.50 (95% CI: -0.87 to -0.13) for MIA-8, and -0.61 (95% CI: -0.92 to -0.31) for ATQ-AP. All effects were sustained at similar level at a 12-month follow-up. CONCLUSION PMHC effectively alleviated SAD and agoraphobia symptoms, and individuals struggling with such symptoms constituted a large proportion of clients. Although results should be interpreted with caution due to risk of attrition bias, they lend further support for a scale-up of PMHC and similar initiatives. Individuals struggling with SAD and/or agoraphobia stood out as relatively high burdened, whereas only one of five had sought help the last 12 months, underscoring the need for the PMHC service.
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Affiliation(s)
- Marit Knapstad
- Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Department of Clinical PsychologyUniversity of BergenBergenNorway
| | - Otto R. F. Smith
- Department of Health PromotionNorwegian Institute of Public HealthBergenNorway
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Welsh J, Banks E, Joshy G, Butterworth P, Strazdins L, Korda RJ. Does psychological distress directly increase risk of incident cardiovascular disease? Evidence from a prospective cohort study using a longer-term measure of distress. BMJ Open 2021; 11:e039628. [PMID: 33593764 PMCID: PMC7888372 DOI: 10.1136/bmjopen-2020-039628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study. DESIGN We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations. RESULTS Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26). CONCLUSION Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.
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Affiliation(s)
- Jennifer Welsh
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Sax Institute, Sydney, New South Wales, Australia
| | - Grace Joshy
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter Butterworth
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyndall Strazdins
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary J Korda
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Raes F, Bastin M, Pede T, Belmans E, Goossens L, Vanhalst J. Repetitive Negative Thinking outperforms loneliness and lack of social connectedness as a predictor of prospective depressive symptoms in adolescents. Scand J Child Adolesc Psychiatr Psychol 2021; 8:149-156. [PMID: 33564631 PMCID: PMC7863726 DOI: 10.21307/sjcapp-2020-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Repetitive Negative Thinking (RNT) is a well-established predictor in adolescents of emotional problems, such as depression. Surprisingly little research, however, has looked at the relative importance of RNT vs. more interpersonally relevant variables in the context of depression, such as loneliness and lack of social connectedness. Objective: The present study, therefore, set out to examine whether RNT is a significant predictor when taking into account the contribution of loneliness and social connectedness. Methods: A sample of 135 typically developing adolescents (N = 135; 79.3% girls; Mage = 17.5; range 16-21) completed measures of depressive symptoms, RNT, loneliness and social connectedness at two time points with a 3-month interval. Results: Results showed that above and beyond baseline depressive symptoms, RNT was the only other significant predictor of prospective depressive symptoms. Conclusions: According to these results, RNT seems a relatively more important factor to consider in the context of adolescent depression than factors in the interpersonal or social context. Consequently, targeting RNT might be expected to yield more significant gains in reducing or preventing depressive symptoms in adolescents compared to focusing on feelings of loneliness or social connectedness – a hypothesis that remains to be tested.
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Affiliation(s)
- Filip Raes
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Margot Bastin
- Research Unit School Psychology and Development in Context, KU Leuven, Belgium
| | - Tina Pede
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Eline Belmans
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Luc Goossens
- Research Unit School Psychology and Development in Context, KU Leuven, Belgium
| | - Janne Vanhalst
- Department of Developmental, Personality and Social Psychology, Ghent University, Belgium
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Roelofs EF, Bas-Hoogendam JM, van Ewijk H, Ganjgahi H, van der Werff SJA, Barendse MEA, Westenberg PM, Vermeiren RRJM, van der Wee NJA. Investigating microstructure of white matter tracts as candidate endophenotypes of Social Anxiety Disorder - Findings from the Leiden Family Lab study on Social Anxiety Disorder (LFLSAD). NEUROIMAGE-CLINICAL 2020; 28:102493. [PMID: 33395984 PMCID: PMC7691726 DOI: 10.1016/j.nicl.2020.102493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a mental illness with a complex, partially genetic background. Differences in characteristics of white matter (WM) microstructure have been reported in patients with SAD compared to healthy controls. Also, WM characteristics are moderately to highly heritable. Endophenotypes are measurable characteristics on the road from genotype to phenotype, putatively reflective of genetically based disease mechanisms. In search of candidate endophenotypes of SAD we used a unique sample of SAD patients and their family members of two generations to explore microstructure of WM tracts as candidate endophenotypes. We focused on two endophenotype criteria: co-segregation with social anxiety within the families, and heritability. METHODS Participants (n = 94 from 8 families genetically vulnerable for SAD) took part in the Leiden Family Lab Study on Social Anxiety Disorder (LFLSAD). We employed tract-based spatial statistics to examine structural WM characteristics, being fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD), in three a-priori defined tracts of interest: uncinate fasciculus (UF), superior longitudinal fasciculus (SLF) and inferior longitudinal fasciculus (ILF). Associations with social anxiety symptoms and heritability were estimated. RESULTS Increased FA in the left and right SLF co-segregated with symptoms of social anxiety. These findings were coupled with decreased RD and MD. All characteristics of WM microstructure were estimated to be at least moderately heritable. CONCLUSION These findings suggest that alterations in WM microstructure in the SLF could be candidate endophenotypes of SAD, as they co-segregated within families genetically vulnerable for SAD and are heritable. These findings further elucidate the genetic susceptibility to SAD and improve our understanding of the overall etiology.
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Affiliation(s)
- Eline F Roelofs
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Janna Marie Bas-Hoogendam
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands; Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.
| | - Hanneke van Ewijk
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Habib Ganjgahi
- Department of Statistics, University of Oxford, Oxford, United Kingdom.
| | - Steven J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | | | - P Michiel Westenberg
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands; Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.
| | - Robert R J M Vermeiren
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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Zhang S, Zhang S, Zhu D, Jiao Z, Zhao X, Sun M, Che Y, Feng X. Effects of 17β-trenbolone exposure on sex hormone synthesis and social behaviours in adolescent mice. CHEMOSPHERE 2020; 245:125679. [PMID: 31869672 DOI: 10.1016/j.chemosphere.2019.125679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Abstract
17β-Trenbolone (17β-TBOH) is an endocrine disruptor that has been widely reported in aquatic organisms. However, little is known about the effect of 17β-TBOH on mammals, particularly on the development of adolescents. Through a series of behavioural experiments, exposure to at 80 μg kg -1 d -1 and 800 μg kg -1 d -1 17β-TBOH during puberty (from PND 28 to 56, male mice) increased anxiety-like behaviours. Exposure to the low dose of 80 μg kg -1 d -1 resulted in a clear social avoidance behaviour in mice. The two doses affected testicular development and endogenous androgen synthesis in male mice. In addition, 17β-TBOH exposure altered the differentiation of oligodendrocytes and the formation of the myelin sheath in the medial prefrontal cortex (mPFC). These results reveal the effects of 17β-TBOH on the behaviours, gonadal and neurodevelopment of adolescent mammals. In addition, the inhibition of the secretion of endogenous hormones and decrease in the formation of the myelin sheath in mPFC may be associated with the 17β-TBOH-induced behavioural changes in mice.
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Affiliation(s)
- Shaozhi Zhang
- College of Life Science, The Key Laboratory of Bioactive Materials, Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, 300071, China
| | - Shuyu Zhang
- The Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin, 300071, China
| | - Dashuai Zhu
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zihao Jiao
- The Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin, 300071, China
| | - Xin Zhao
- The Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin, 300071, China
| | - Mingzhu Sun
- The Institute of Robotics and Automatic Information Systems, Nankai University, Tianjin, 300071, China.
| | - Yongzhe Che
- School of Medicine, Nankai University, Tianjin, 300071, China.
| | - Xizeng Feng
- College of Life Science, The Key Laboratory of Bioactive Materials, Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, 300071, China.
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Belmans E, Bastin M, Raes F, Bijttebier P. Temporal associations between social anxiety and depressive symptoms and the role of interpersonal stress in adolescents. Depress Anxiety 2019; 36:960-967. [PMID: 31437332 DOI: 10.1002/da.22939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 05/02/2019] [Accepted: 06/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence is characterized by an increased vulnerability for internalizing psychopathologies such as depression and anxiety. A positive association between anxiety and depression has consistently been found in research. However, the specific direction of this association is less clear. In this study, we investigated the temporal associations between (social) anxiety and depressive symptoms. Furthermore, the role of dependent interpersonal stress as a potential mediating factor in these temporal associations was examined. METHODS Data were part of a larger longitudinal study on the emotional development of adolescents, which was initiated in February 2013. The total sample consisted of 2011 adolescents between the ages of 11 and 19. Data were analyzed using cross-lagged models. RESULTS Bidirectional positive associations were found between social anxiety symptoms and depressive symptoms. However, dependent interpersonal stress was not a mediator in the link between social anxiety and depression. Our results indicate that dependent interpersonal stress seems to be particularly related to depressive symptoms and not to social anxiety symptoms. CONCLUSIONS Findings suggest that bidirectional associations between social anxiety and depressive symptoms exist. This implies that clinicians should be specifically vigilant for the development of depressive symptoms in socially anxious adolescents and the development of social anxiety symptoms in depressed adolescents. Our findings further highlight the importance of targeting dependent interpersonal stress in the context of depression.
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Affiliation(s)
- Eline Belmans
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Margot Bastin
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Filip Raes
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patricia Bijttebier
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: where are we now? Expert Rev Neurother 2019; 19:1179-1189. [PMID: 31502896 DOI: 10.1080/14737175.2019.1666713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.
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Affiliation(s)
- Antoine Pelissolo
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Faculté de médecine, Créteil, France
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Psychiatry Department, Lebanese University, Beirut, Lebanon
| | - Lauriane Delhay
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Créteil, France
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Peters L, Romano M, Byrow Y, Gregory B, McLellan LF, Brockveld K, Baillie A, Gaston J, Rapee RM. Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial. J Affect Disord 2019; 256:70-78. [PMID: 31158718 DOI: 10.1016/j.jad.2019.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/28/2019] [Accepted: 05/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND We examined whether providing three sessions of treatment based on motivational interviewing (MI) prior to Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder (SAD) improved outcomes. METHODS Participants diagnosed with SAD (N = 186) were randomly allocated to receive three sessions of MI (MI+CBT; n = 85) or supportive counselling (SC+CBT; n = 101) prior to a 12-week group CBT program. Assessments occurred at baseline, after preparatory treatment, after CBT, and at 6-months follow-up. Outcomes were expectations for change, number of CBT sessions attended, self- and clinician-rated CBT homework completion, and self- and clinician-rated social anxiety severity. RESULTS Conditions did not differ significantly on expectations for change, number of CBT sessions attended, or clinician-rated homework completion. Self-rated homework completion was greater in MI+CBT than in SC+CBT. Change over time in social anxiety severity did not differ between conditions overall, however, this outcome was significantly moderated by two variables; those in MI+CBT, as compared to SC+CBT, showed significantly poorer outcomes on self-reported social anxiety severity if they were higher in change readiness and significantly better outcomes on clinician-rated social anxiety severity if they were higher in functional impairment. LIMITATIONS Although therapists in MI sessions were rated as behaving more consistently with MI than therapists in SC sessions, some MI consistent behaviors occurred in the SC sessions. CONCLUSIONS Addition of a MI-based discussion prior to evidence-based CBT appears to benefit people with SAD who have high functional impairment but may interfere with outcomes for those higher in readiness for change.
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Affiliation(s)
- Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
| | - Mia Romano
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Yulisha Byrow
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Keila Brockveld
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Andrew Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Jonathan Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
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Abstract
PURPOSE OF REVIEW This article provides a synopsis of the current understanding of the pathophysiology of anxiety disorders, the biological and environmental risk factors that contribute to their development and maintenance, a review of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, and a practical approach to the treatment of anxiety disorders in adults. RECENT FINDINGS Despite the ubiquity of anxiety, the evidence is that most individuals with an anxiety disorder are not identified and do not receive guideline-level care. In part, this may be because of the manifold clinical presentations of anxiety disorders and clinicians' lack of confidence in accurately diagnosing and treating these conditions, especially in nonpsychiatric settings. Anxiety disorders represent the complex interplay between biological, psychological, temperamental, and environmental factors. Converging lines of evidence point to dysfunction in regulating activity in the "threat circuit" in the brain as a putative common pathophysiology underlying anxiety disorders. Evidence-based treatments for anxiety disorders, such as cognitive-behavioral therapy and antidepressant medications, have been shown to regulate activity in this circuit, which consists of reciprocal connections between the dorsomedial prefrontal cortex, insula, and amygdala. SUMMARY Anxiety disorders are the most common class of emotional disorders and a leading cause of disability worldwide. A variety of effective treatment strategies are available, which may exert their therapeutic benefits from top-down or bottom-up modulation of the dysfunctional brain activity associated with anxiety disorders.
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McDougall J, DeWit DJ, Wright FV. Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors. Disabil Rehabil 2019; 42:3293-3305. [PMID: 30950664 DOI: 10.1080/09638288.2019.1590742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: This study explored three-year trajectories of social anxiety symptoms among youth with chronic health conditions and investigated factors influencing those trajectories.Methods: Participants (N = 439) were recruited from eight pediatric rehabilitation centers. The Social Anxiety Scale for Children-Revised measured social anxiety across four time points. Latent Class Growth Analysis was used to study trajectories and logistic regression to identify related factors.Results: A three-class solution was supported: a "high anxiety and stable" group (17.1%), a "moderate anxiety and stable" group (44.4%), and a "low anxiety and stable" group (38.5%). Youth in the "moderate and stable" group were less likely to be male compared to the "low and stable" group. Youth in the "high and stable" group were more likely to have greater cognitive symptoms and less likely to have higher levels of social participation compared to the "low and stable" group. Youth in both the "high and stable" and "moderate and stable" groups were less likely to have high support from classmates or close friends compared to the "low and stable" group. Moreover, both the "high and stable" and "moderate and stable" groups were less likely to have positive family functioning.Conclusion: Youth with chronic conditions belonging to "high and stable" and "moderate and stable" social anxiety trajectories can be distinguished from those in a "low and stable" trajectory using personal, functional, and environmental level variables.Implications for RehabilitationYouth with chronic health conditions are at risk of developing and maintaining moderate to high levels of social anxiety symptoms as they move through adolescence.Compared to youth with "low and stable" social anxiety, those with "moderate and stable" social anxiety are less likely to be male, have high peer support or high family functioning.Compared to youth with "low and stable" social anxiety, those with "high and stable" social anxiety are more likely to have greater cognitive symptoms, and less likely to have high social participation, high peer support, or high family functioning.Rehabilitation and other professionals should not only consider factors that are functional in nature; they should also consider personal and environmental level factors when supporting youth with chronic health conditions who experience social anxiety symptoms.
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Affiliation(s)
- Janette McDougall
- Thames Valley Children's Centre, Research Program, London, ON, Canada.,School of Occupational Therapy, Western University, London, ON, Canada
| | - David J DeWit
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study. J Affect Disord 2019; 247:81-87. [PMID: 30658244 DOI: 10.1016/j.jad.2018.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/04/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment. METHOD We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score. RESULTS BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75). CONCLUSIONS A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.
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Social anxiety and drinking game behaviors among Australian university students. Addict Behav 2019; 88:43-47. [PMID: 30138776 DOI: 10.1016/j.addbeh.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The relationship of social anxiety with alcohol use/problems has been examined among college student samples, but the relevance of findings to drinking game (DG) consumption/gaming consequences is not well understood due to a paucity of research. METHODS A cross-sectional sample of 224 Australian university students aged 18-25 years (Mage = 20.7 years; 63% female) was utilized for analysis. Participants completed an online questionnaire which included measures of social anxiety, DG consumption, DG consequences, and motives for playing drinking games. RESULTS Social anxiety was positively associated with DG consequences, but not DG consumption. However, after controlling for DG motives, social anxiety was no longer associated with DG consequences. Rather, an indirect effect of social anxiety on DG consequences via conformity DG motives was identified. CONCLUSIONS Our findings highlight the vulnerability of socially anxious students to experiencing greater drinking game consequences, but the importance of considering motives specific to playing DGs when examining these relationships.
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Fernández-Álvarez J, Díaz-García A, Vara MD, Molinari G, Colombo D, Riva G, Baños RM, Botella C. Clients' Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies. JMIR Res Protoc 2018; 7:e183. [PMID: 30463837 PMCID: PMC6282014 DOI: 10.2196/resprot.9722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/02/2018] [Accepted: 05/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients' experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients' perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. OBJECTIVE The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. METHODS Elliot and Timulak's metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. RESULTS The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. CONCLUSIONS We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. TRIAL REGISTRATION PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/9722.
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Affiliation(s)
| | | | | | | | | | - Giuseppe Riva
- Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Instituto Auxologico Italiano, Milan, Italy
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47
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Bas-Hoogendam JM, Harrewijn A, Tissier RLM, van der Molen MJW, van Steenbergen H, van Vliet IM, Reichart CG, Houwing-Duistermaat JJ, Slagboom PE, van der Wee NJA, Westenberg PM. The Leiden Family Lab study on Social Anxiety Disorder: A multiplex, multigenerational family study on neurocognitive endophenotypes. Int J Methods Psychiatr Res 2018; 27:e1616. [PMID: 29700902 PMCID: PMC6001802 DOI: 10.1002/mpr.1616] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition, with a heritable component. However, little is known about the characteristics that are associated with the genetic component of SAD, the so-called "endophenotypes". These endophenotypes could advance our insight in the genetic susceptibility to SAD, as they are on the pathway from genotype to phenotype. The Leiden Family Lab study on Social Anxiety Disorder (LFLSAD) is the first multiplex, multigenerational study aimed to identify neurocognitive endophenotypes of social anxiety. METHODS The LFLSAD is characterized by a multidisciplinary approach and encompasses a variety of measurements, including a clinical interview, functional and structural magnetic resonance imaging and an electroencephalography experiment. Participants are family members from 2 generations, from families genetically enriched for SAD. RESULTS The sample (n = 132 participants, from 9 families) was characterized by a high prevalence of SAD, in both generations (prevalence (sub)clinical SAD: 38.3%). Furthermore, (sub)clinical SAD was positively related to self-reported social anxiety, fear of negative evaluation, trait anxiety, behavioral inhibition, negative affect, and the level of depressive symptoms. CONCLUSIONS By the multidimensional character of the measurements and thorough characterization of the sample, the LFLSAD offers unique opportunities to investigate candidate neurocognitive endophenotypes of SAD.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anita Harrewijn
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Renaud L M Tissier
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Melle J W van der Molen
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Henk van Steenbergen
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.,Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - P Eline Slagboom
- Section of Molecular Epidemiology, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - P Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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48
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Wang X, Cheng B, Luo Q, Qiu L, Wang S. Gray Matter Structural Alterations in Social Anxiety Disorder: A Voxel-Based Meta-Analysis. Front Psychiatry 2018; 9:449. [PMID: 30298028 PMCID: PMC6160565 DOI: 10.3389/fpsyt.2018.00449] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
The current insight into the neurobiological pathogenesis underlying social anxiety disorder (SAD) is still rather limited. We implemented a meta-analysis to explore the neuroanatomical basis of SAD. We undertook a systematic search of studies comparing gray matter volume (GMV) differences between SAD patients and healthy controls (HC) using a whole-brain voxel-based morphometry (VBM) approach. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of SAD patients compared with HC. We included eleven studies with 470 SAD patients and 522 HC in the current meta-analysis. In the main meta-analysis, relative to HC, SAD patients showed larger GMVs in the left precuneus, right middle occipital gyrus (MOG) and supplementary motor area (SMA), as well as smaller GMV in the left putamen. In the subgroup analyses, compared with controls, adult patients (age ≥ 18 years) with SAD exhibited larger GMVs in the left precuneus, right superior frontal gyrus (SFG), angular gyrus, middle temporal gyrus (MTG), MOG and SMA, as well as a smaller GMV in the left thalamus; SAD patients without comorbid depressive disorder exhibited larger GMVs in the left superior parietal gyrus and precuneus, right inferior temporal gyrus, fusiform gyrus, MTG and superior temporal gyrus (STG), as well as a smaller GMV in the bilateral thalami; and currently drug-free patients with SAD exhibited a smaller GMV in the left thalamus compared with HC while no larger GMVs were found. For SAD patients with different clinical features, our study revealed directionally consistent larger cortical GMVs and smaller subcortical GMVs, including locationally consistent larger precuneus and thalamic deficits in the left brain. Age, comorbid depressive disorder and concomitant medication use of the patients might be potential confounders of SAD at the neuroanatomical level.
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Affiliation(s)
- Xiuli Wang
- Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Qiang Luo
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lihua Qiu
- Department of Radiology, the Second People's Hospital of Yibin, Yibin, China
| | - Song Wang
- Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China.,Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
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Affiliation(s)
- Falk Leichsenring
- From the Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Frank Leweke
- From the Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
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50
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Kinney KL, Boffa JW, Amir N. Gender Difference in Attentional Bias Toward Negative and Positive Stimuli in Generalized Anxiety Disorder. Behav Ther 2017; 48:277-284. [PMID: 28390492 DOI: 10.1016/j.beth.2016.06.002] [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: 06/09/2015] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022]
Abstract
Females are two times as likely as males to develop generalized anxiety disorder (GAD; Steiner et al., 2005; Vesga-López et al., 2008). Moreover, the clinical presentation of GAD is different across genders. One explanation for these differences may be the role of cognitive biases involved in GAD between genders. In the present study, we used an exogenous spatial cueing task to examine gender differences in attentional bias for negative and positive information in 118 individuals with a primary diagnosis of GAD. Males and females did not differ in their attentional bias for idiographically selected negative or neutral words. However, women showed a significantly larger attentional bias for positive words than did men. Results suggest that developing gender-specific treatments for GAD could improve treatment response rates.
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Affiliation(s)
| | | | - Nader Amir
- San Diego State University; University of California San Diego.
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