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Skumsnes T, Fjermestad KW, Wergeland GJ, Aalberg M, Heiervang ER, Kodal A, Ingul JM. Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Res Child Adolesc Psychopathol 2024; 52:1427-1439. [PMID: 38869750 PMCID: PMC11420389 DOI: 10.1007/s10802-024-01215-8] [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] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.
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Affiliation(s)
- Toril Skumsnes
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marianne Aalberg
- Department for Research and Development, Division of Mental Health and Substance Use, Akershus University Hospital, Oslo, Norway
| | - Einar R Heiervang
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway
| | - Arne Kodal
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jo Magne Ingul
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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2
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Mylett ML, Boucher TQ, Scheerer NE, Iarocci G. Examining the Relations Between Social Competence, Autistic Traits, Anxiety and Depression in Autistic and Non-Autistic Children. J Autism Dev Disord 2024; 54:3094-3106. [PMID: 37341858 DOI: 10.1007/s10803-023-06012-8] [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] [Accepted: 05/07/2023] [Indexed: 06/22/2023]
Abstract
The current study examined whether social competence and autistic traits are related to anxiety and depression in autistic and non-autistic children. Parents of 340 children aged 6 to 12 years old, including 186 autistic and 154 non-autistic children completed the Autism Spectrum Quotient (AQ) to assess their child's autistic traits, the Multidimensional Social Competence Scale (MSCS) to assess their child's social competence, and the Behaviour Assessment Scale for Children 2 (BASC-2) to assess their child's internalizing symptoms of depression and anxiety, and children were administered the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) to assess their intellectual abilities. Hierarchical multiple regression analyses were conducted to investigate the relations between social competence, autistic traits, anxiety, and depression. Social competence was related to anxiety and depression symptoms in autistic children, but only depression symptoms in non-autistic children, above and beyond the effects of autistic traits, IQ and age. Autistic children were also reported to experience more severe anxiety and depression symptoms, and more autistic traits were related to higher levels of anxiety and depression in both groups. These findings suggest that social competence and internalizing symptoms are intricately connected in autistic children and need to be jointly considered in both assessment and intervention. The social implications are discussed with an emphasis on acceptance of diverse social styles as a viable avenue to reduce children's internalizing symptoms.
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Affiliation(s)
- Marisa L Mylett
- Department of Psychology, Simon Fraser University, RCB 5213, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Troy Q Boucher
- Department of Psychology, Simon Fraser University, RCB 5213, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Nichole E Scheerer
- Psychology Department, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L3C5, Canada
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, RCB 5213, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Ong CW, Skolnik AM, Johnson HM, Krafft J, Loew S, Kurtz AJ, Lee EB. Sociodemographic representation in randomized controlled trials for anxiety-related disorders in the U.S.: A systematic review (1993-2023). Clin Psychol Rev 2024; 111:102446. [PMID: 38796946 DOI: 10.1016/j.cpr.2024.102446] [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: 10/14/2023] [Revised: 03/20/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Cognitive behavioral therapies have been identified as evidence-based treatments for anxiety-related disorders. However, data supporting the effectiveness of these treatments have been largely collected from participants with majoritized identities, potentially limiting the extent to which they can be considered "evidence-based" for clients from minoritized groups. The current review examined sociodemographic representation and quality of sociodemographic reporting in randomized controlled trials for anxiety-related disorders in the U.S. between 1993 and 2023. We conducted a systematic literature review of U.S.-based randomized controlled trials of cognitive behavioral therapies for anxiety-related disorders, extracted data on sociodemographic variables, and rated quality of reporting. Data from 55 eligible studies (N = 4492) indicated that white and female identities were overrepresented relative to the U.S. population, with variables like disability status, sexual orientation, and religious identification consistently ignored. In addition, quality of reporting was generally poor (mean = 3.6 out of 10), with many studies failing to account for demographic variables in their analyses or description of study limitations. Publication year, sample size, and NIH funding status did not significantly predict gender representation (% women), ethnoracial representation (% white), or quality of reporting. These findings underscore the importance of critically evaluating to whom "evidence-based" treatments apply and increasing diversity of clinical samples, to ensure that evidence-based treatments are inclusive. Recommendations for future research, clinical implications, and limitations are discussed.
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Affiliation(s)
| | | | | | | | - Sarah Loew
- Department of Psychology, Southern Illinois University, USA
| | | | - Eric B Lee
- Department of Psychology, Southern Illinois University, USA
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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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Sousa M, Cruz S, Inman R, Marchante M, Coelho VA. Bullying victimization and bullying perpetration, social anxiety, and social withdrawal in Portuguese adolescents: A reciprocal association model. Aggress Behav 2024; 50:e22170. [PMID: 39034466 DOI: 10.1002/ab.22170] [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: 09/27/2023] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Further research is needed to clarify the association of the different forms of bullying with social anxiety and social withdrawal over time in adolescents. This two-wave panel study with a 1-year time lag (October 2021-October 2022) examined the cross-lagged relationships between bullying victimization and bullying perpetration, social anxiety (i.e., fear or distress in social situations), and social withdrawal (i.e., consistent, and deliberate social solitude). Participants were 485 middle school students (234 girls) attending the seventh or eighth grade at Time 1 (T1) (Mage = 12.67 years, SD = 1.14 years). Social anxiety and social withdrawal were assessed using subscales of the Social and Emotional Competencies Evaluation Questionnaire. Bullying perpetration and bullying victimization were assessed using the Bullying and Cyberbullying Behavior Questionnaire-Short Form. The within-wave associations between the study variables were similar at T1 and Time 2 (T2), with the exception that the association between bullying perpetration and social anxiety was much weaker at T1 than at T2. The results of the path analysis showed that T1 bullying perpetration predicted T2 social anxiety, and that T1 bullying victimization predicted T2 social withdrawal. We also found a reciprocal relationship between social anxiety and social withdrawal. These findings highlight the importance of preventive and remediation interventions to reduce social anxiety in adolescents who engage in and experience bullying behavior.
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Affiliation(s)
- Mariana Sousa
- Psychology for Development Research Center, Lusíada University-Porto, Porto, Portugal
| | - Sara Cruz
- Psychology for Development Research Center, Lusíada University-Porto, Porto, Portugal
| | - Richard Inman
- Psychology for Development Research Center, Lusíada University-Porto, Porto, Portugal
| | - Marta Marchante
- Psychology for Development Research Center, Lusíada University-Porto, Porto, Portugal
- Académico de Torres Vedras, Torres Vedras, Portugal
| | - Vítor Alexandre Coelho
- Psychology for Development Research Center, Lusíada University-Porto, Porto, Portugal
- Académico de Torres Vedras, Torres Vedras, Portugal
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Scholten W, Seldenrijk A, Hoogendoorn A, Bosman R, Muntingh A, Karyotaki E, Andersson G, Berger T, Carlbring P, Furmark T, Bouchard S, Goldin P, Kampmann I, Morina N, Kocovski N, Leibing E, Leichsenring F, Stolz T, van Balkom A, Batelaan N. Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2023; 80:822-831. [PMID: 37256597 PMCID: PMC10233456 DOI: 10.1001/jamapsychiatry.2023.1291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/16/2023] [Indexed: 06/01/2023]
Abstract
Importance Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.
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Affiliation(s)
- Willemijn Scholten
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adrie Seldenrijk
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Renske Bosman
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Anna Muntingh
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, the Netherlands
| | - 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, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Stéphane Bouchard
- Departement de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
- Centre de Recherche, Centre Intégré de Santé et des Services Sociaux de l’Outaouais, Gatineau, Quebec, Canada
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Isabel Kampmann
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nancy Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine Goettingen, Georg-August-Universität Goettingen, Goettingen, Germany
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Timo Stolz
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton van Balkom
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Neeltje Batelaan
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
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Schwob JT, Newman MG. Brief imaginal exposure exercises for social anxiety disorder: A randomized controlled trial of a self-help momentary intervention app. J Anxiety Disord 2023; 98:102749. [PMID: 37542755 PMCID: PMC10493899 DOI: 10.1016/j.janxdis.2023.102749] [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: 12/19/2022] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Emerging technological interventions for psychological disorders are being developed continually. Offering imaginal exposure exercises as a self-help intervention presents the opportunity to acquire foundational skills to address social anxiety. The current study evaluates the feasibility and effectiveness of a novel smartphone application for social interaction anxiety. METHODS Participants (n = 82) were adults meeting criteria for social anxiety disorder. They were randomly assigned to imaginal exposure (IE; n = 39) or self-monitoring (n = 43) delivered multiple times daily via a smartphone application for a one-week trial. It was expected that participants using the IE exercises would demonstrate significantly greater declines in social anxiety in addition to increases in self-efficacy and that compliance would serve as a predictor of outcome. Mixed-effects models were utilized. RESULTS Participants using IE (vs. self-monitoring) evidenced significantly greater reductions in social anxiety from pre- to post-treatment and at 1-month follow-up. Similarly, IE (vs. self-monitoring) led to significantly greater increases in self-efficacy from pre- to post-treatment and 1-month follow-up. Further, more completed IE exercises predicted significantly greater changes in social anxiety and self-efficacy at subsequent timepoints compared with self-monitoring. CONCLUSIONS Findings suggest that a brief IE self-help intervention was effective in targeting social interaction anxiety.
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Benstead ML, Stones J, Gibson G, Moody LJ, Little K, Toumbourou JW. Program logic of a mental health outreach service for socially anxious youth. EVALUATION AND PROGRAM PLANNING 2023; 97:102250. [PMID: 36739745 DOI: 10.1016/j.evalprogplan.2023.102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/27/2022] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Youth mental health is a major concern both in Australia and internationally. Identifying at-risk young people is a core service priority. This report describes a "Youth Social Inclusion Program" developed in Australia to assist young people identified as having social difficulties that prevent them linking into formal mental health services. This report describes the Australian service context and uses the "program explication" methodology to document: the program activities, therapeutic processes, and underpinning evidence for the benefits of this service. Program explication is a consulting method designed to assist services to identify and review implicit program logic assumptions against evaluation literature. We demonstrate the application of this method in exploring the assumptions and evidence for the Youth Social Inclusion Program, targeting outreach to socially anxious young people in Australia. The Youth Social Inclusion Program involved seven logically consistent activities. Our literature search revealed moderate evidence for the expected benefits of the activities. This practice-based design drew on several theoretical perspectives. Given that the program logic has been established, we outline a proposal for further evaluation.
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Affiliation(s)
- M L Benstead
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, Australia.
| | - J Stones
- Headspace Geelong, 105 Yarra Street, Geelong 3220, Australia; Barwon Child, Youth & Family, 222 Malop Street, Geelong 3220, Australia
| | - G Gibson
- Headspace Geelong, 105 Yarra Street, Geelong 3220, Australia; Barwon Child, Youth & Family, 222 Malop Street, Geelong 3220, Australia
| | - L J Moody
- Barwon Child, Youth & Family, 222 Malop Street, Geelong 3220, Australia; School of Medicine, Deakin University, Waurn Ponds 3216, Australia
| | - K Little
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, Australia; Barwon Child, Youth & Family, 222 Malop Street, Geelong 3220, Australia
| | - J W Toumbourou
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, Australia
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Metts AV, LeBeau RT, Craske MG, Himle JA. Perceived interpersonal competence as a predictor of clinical outcomes in a randomized controlled trial for social anxiety and employment. Cogn Behav Ther 2023; 52:146-162. [PMID: 36409226 PMCID: PMC9839579 DOI: 10.1080/16506073.2022.2137578] [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: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
This study explored relationships among perceived interpersonal competence and demographic and work history variables in a randomized control trial for social anxiety disorder (SAD) that compared work-related group cognitive behavioral therapy plus vocational services (WCBT+VSAU) to vocational services only (VSAU-alone). Intervention effects of perceived interpersonal competence on treatment outcomes over 12 weeks were also examined. Data from 250 job seekers with SAD (59.2% Female; 40.8% Black/African American; 82.4% Non-Hispanic/non-Latino/a) were analyzed. We predicted negative relationships between perceived interpersonal competence and symptoms/impairment and that individuals with lower perceived interpersonal competence would benefit more quickly in WCBT+VSAU relative to VSAU-alone. Results indicated that perceived interpersonal competence did not vary by gender, race, ethnicity, homeless status, or employment history. There were no intervention effects of perceived interpersonal competence regarding social anxiety or overall functional impairment, but results supported negative relationships between perceived interpersonal competence and lower social anxiety and overall functional impairment in both conditions. Separately, perceived interpersonal competence moderated effects in the depression model such that there were faster declines in depression at lower perceived interpersonal competence levels in WCBT+VSAU, but not in VSAU-alone. Results indicate the value of attending to perceived interpersonal competence in interventions, which may result in mood benefits.
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Affiliation(s)
- Allison V. Metts
- Department of Psychology, University of California, Los Angeles, USA
| | - Richard T. LeBeau
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Joseph A. Himle
- School of Social Work University of Michigan, USA
- Department of Psychiatry, University of Michigan, USA
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Muacevic A, Adler JR, Ghasib AM, Kabbarah AJ, Alnefaie SA, Hariri N, Altammar MA, Fadhel AM, Altowairqi FM. Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches. Cureus 2022; 14:e32687. [PMID: 36660516 PMCID: PMC9847330 DOI: 10.7759/cureus.32687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Social anxiety disorder (SAD) is a highly distressing chronic psychiatric disorder characterized by persistent fear of social situations in anticipation of being judged negatively by others. As shyness mimics some of the symptoms of SAD, people suffering from this debilitating disease are often underdiagnosed. It can have a devastating impact on all areas of life including academic performance, social growth, relationship status, and work performance. In recent years, research on anxiety and related disorders has proliferated due to the increased use of cognitive-behavioral models. The understanding of SAD has evolved greatly from distinguishing it from shyness to implementing modalities to comprehend the sophisticated underlying mechanism of disease prevalence and progression as well as methods to treat it. This review summarizes the concept of SAD, its epidemiology, symptoms, and diagnostic tools. Frequent comorbidities including other psychiatric disorders are also discussed. Additionally, we examine the latest evidence related to treatment options including psychotherapy and pharmacotherapy as well as recommendations for managing SAD.
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The double-edged sword effect of social networking use intensity on problematic social networking use among college students: The role of social skills and social anxiety. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Fear, psychophysiological arousal, and cognitions during a Virtual Social Skills Training in Social Anxiety Disorder while manipulating gaze duration. Biol Psychol 2022; 175:108432. [DOI: 10.1016/j.biopsycho.2022.108432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022]
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Alvi T, Kumar D, Tabak BA. Social anxiety and behavioral assessments of social cognition: A systematic review. J Affect Disord 2022; 311:17-30. [PMID: 35490878 PMCID: PMC9754122 DOI: 10.1016/j.jad.2022.04.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning, identifying aspects of social cognition that may be impaired can increase our understanding of the development and maintenance of social anxiety disorder. However, to date, studies examining associations between social anxiety and social cognition have resulted in mixed findings. METHODS The aim of this systematic review was to summarize the literature on the association between social anxiety and social cognition, while also considering several potential moderators and covariates that may influence findings. RESULTS A systematic search identified 52 studies. Results showed mixed evidence for the association between social anxiety and lower-level social cognitive processes (emotion recognition and affect sharing) and a trend for a negative association with higher-level social cognitive processes (theory of mind and empathic accuracy). Most studies examining valence-specific effects found a significant negative association for positive and neutral stimuli. LIMITATIONS Not all aspects of social cognition were included (e.g., attributional bias) and we focused on adults and not children, limiting the scope of the review. CONCLUSIONS Future studies would benefit from the inclusion of relevant moderators and covariates, multiple well-validated measures within the same domain of social cognition, and assessments of interpersonal functioning outside of the laboratory. Additional research examining the moderating role of attention or interpretation biases on social cognitive performance, and the potential benefit of social cognitive skills training for social anxiety, could inform and improve existing cognitive behavioral interventions.
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Affiliation(s)
- Talha Alvi
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, USA
| | - Divya Kumar
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, USA
| | - Benjamin A Tabak
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, USA.
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14
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Etkin RG, Marin CE, Silverman WK, Lebowitz ER. Youth social functioning interacts with treatment arm, diagnosis, and gender to predict anxiety treatment outcome. Behav Res Ther 2022; 156:104160. [PMID: 35870327 DOI: 10.1016/j.brat.2022.104160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
Research has uncovered a wide range of predictors of youth anxiety treatment outcome (i.e., symptom severity and diagnostic remission). Youth's social functioning is one predictor that has been rarely studied, however, which is a significant gap given its importance to development and clinical functioning. We address this gap by examining two aspects of youth's social functioning as predictors of anxiety treatment outcome: (1) positive social interactions and (2) social skills. We further examined the moderating roles of treatment arm (child- or parent-based treatment), diagnosis (presence or absence of social anxiety disorder), and youth gender, between each of the two predictors and treatment response and remission. Participants were 96 youths with anxiety disorders (6-16 years; 54% girls) and their mothers, who completed diagnostic interviews and questionnaires at baseline and posttreatment. Multiple regression models revealed that higher baseline parent-reports of their child's social skills predicted lower posttreatment anxiety symptom severity for youth with social anxiety disorder. Modified linear probability models revealed that baseline youth-reports of their social skills predicted remission from anxiety diagnoses for youths assigned to the parent-based treatment. Baseline youth-reports of their positive social interactions and parent-reports of youth social skills predicted remission from anxiety diagnoses for girls. Results contribute to the predictor literature by highlighting the importance of youth social functioning to anxiety treatment outcome.
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Affiliation(s)
- Rebecca G Etkin
- Yale Child Study Center, Yale University School of Medicine, 350 George St, New Haven, CT, USA.
| | - Carla E Marin
- Yale Child Study Center, Yale University School of Medicine, 350 George St, New Haven, CT, USA
| | - Wendy K Silverman
- Yale Child Study Center, Yale University School of Medicine, 350 George St, New Haven, CT, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine, 350 George St, New Haven, CT, USA
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15
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Shechter T, Asher M, Aderka IM. Man vs. machine: A comparison of human and computer assessment of nonverbal behavior in social anxiety disorder. J Anxiety Disord 2022; 89:102587. [PMID: 35661576 DOI: 10.1016/j.janxdis.2022.102587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/02/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
Social anxiety disorder (SAD) is a common psychological disorder associated with broad interpersonal impairment. Most previous studies have examined nonverbal behavior in SAD using human coders. However, one recent study utilized a machine-based analysis of nonverbal behavior and dyadic synchrony in SAD (Asher, Kauffmann, & Aderka, 2020). In the present study, we compared human and computer assessments of nonverbal behavior in social anxiety to enhance our knowledge about their commonalities and unique differences in capturing nonverbal behavior in the context of SAD. Specifically, the present study included 152 individuals: 38 individuals diagnosed with SAD and 114 individuals without SAD. Participants formed 76 opposite-sex interaction dyads comprising either two individuals without SAD (n = 39 control dyads) or one individual with SAD and one individual without SAD (n = 37 SAD dyads). All participants underwent a getting-acquainted task and were videotaped during the conversation. Half of the interactions were small talk interactions and half were closeness-generating interactions that required significant self-disclosure. We found that both types of coding were associated with self-reported social anxiety but that machine-based coding was superior in capturing social anxiety in closeness-generating contexts. Implications for research on nonverbal behavior in SAD are discussed.
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Affiliation(s)
- Talia Shechter
- School of Psychological Sciences, University of Haifa, Israel
| | - Maya Asher
- School of Psychological Sciences, University of Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel.
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16
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Lyubomirsky S. Toward a New Science of Psychedelic Social Psychology: The Effects of MDMA (Ecstasy) on Social Connection. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1234-1257. [PMID: 35536567 DOI: 10.1177/17456916211055369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychedelic science has generated hundreds of compelling published studies yet with relatively little impact on mainstream psychology. I propose that social psychologists have much to gain by incorporating psychoactive substances into their research programs. Here I use (±)-3,4-methylenedioxymethamphetamine (MDMA) as an example because of its documented ability in experiments and clinical trials to promote bonding, love, and warmth. Social connection is a fundamental human need, yet researchers still possess few tools to effectively and durably boost it. MDMA allows investigators to isolate the psychological mechanisms-as well as brain pathways-underlying felt social connection and thus reveal what should be targeted in future (nondrug) studies. Accordingly, I introduce a conceptual model that presents the proximal psychological mechanisms stimulated by MDMA (lowered fear, increased sociability, more chemistry), as well as its potential long-term impacts (improved relationships, reduced loneliness, stronger therapeutic alliances). Finally, I discuss further questions (e.g., whether using MDMA for enhancing connection can backfire) and promising research areas for building a new science of psychedelic social psychology. In sum, psychopharmacological methods can be a useful approach to illuminate commonly studied social-psychological processes, such as connectedness, prejudice, or self, as well as inform interventions to directly improve people's lives.
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17
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Siddique RF, Ahmed O, Hossain KN. Relationship between the fear of COVID-19 disease and sleep quality: the mediating role of stress. Heliyon 2021; 7:e07033. [PMID: 34027200 PMCID: PMC8123159 DOI: 10.1016/j.heliyon.2021.e07033] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/30/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
The whole world almost came to a standstill due to the COVID-19 pandemic. In response to this pandemic, most psychological responses have been at a higher prevalence such as stress, anxiety, depression, lower mental well-being, poor sleep quality, along with the fear of contracting the COVID-19 disease. Related to these psychological responses, previous studies have suggested an association between COVID-19 fear and stress as well as stress and sleep quality. The present study aimed to assess the association between COVID-19 fear and sleep quality and investigate the possible mediating effect of perceived stress during this pandemic. The data were collected, utilizing a self-report online questionnaire, from a sample of 521 Bangladeshi adults. Results showed significant gender differences in COVID-19 fear, stress, and sleep quality and also a significant association between these variables. Mediation results revealed that stress fully mediated the association between COVID-19 fear and sleep quality for males and partially mediated it for females. These results suggest that women are in a more vulnerable position in this pandemic. These findings would be helpful to mental health professionals and policy makers to address the psychological problems induced by the current pandemic.
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Affiliation(s)
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Kazi Nur Hossain
- Department of Psychology, Jagannath University, Dhaka, 1100, Bangladesh
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18
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Lei J, Russell A. I Have a Fear of Negative Evaluation, Get Me Out of Here! Examining Latent Constructs of Social Anxiety and Autistic Traits in Neurotypical and Autistic Young People. J Autism Dev Disord 2021; 51:1729-1747. [PMID: 32808152 PMCID: PMC8084828 DOI: 10.1007/s10803-020-04657-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Understanding shared and unique constructs underlying social communication difficulties in autism spectrum disorder (ASD) and social anxiety disorder (SAD) can address potential diagnostic overshadowing when evaluating SAD in the context of autism. Using self-report measures, factor analyses examined constructs underlying autistic traits, social anxiety, internalising symptoms and wellbeing amongst 267 neurotypical (17-19 years) and 145 autistic (15-22 years) students in the UK. Shared constructs across measures assessed general social communication competency (e.g., social distress in new situations and peer relationships). Fear of Negative Evaluation (FNE) was identified in both samples as a stable construct unique to social anxiety. Adapting interventions targeting SAD in autism should target FNE during adolescence which marks a period of heightened peer interaction and social vulnerability.
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Affiliation(s)
- Jiedi Lei
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK
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19
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Jeong HS, Lee JH, Kim HE, Kim JJ. Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder. J Clin Med 2021; 10:jcm10050915. [PMID: 33652739 PMCID: PMC7956456 DOI: 10.3390/jcm10050915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 01/15/2023] Open
Abstract
Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.
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Affiliation(s)
- Hyu Seok Jeong
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jee Hyun Lee
- Department of Social Work and Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jae-Jin Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence:
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20
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Lipton MF, Qasmieh N, Racz SJ, Weeks JW, Reyes ADL. The Fears of Evaluation About Performance (FEAP) Task: Inducing Anxiety-Related Responses to Direct Exposure to Negative and Positive Evaluations. Behav Ther 2020; 51:843-855. [PMID: 33051028 DOI: 10.1016/j.beth.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
Fears of negative and positive evaluation (i.e., evaluative fears) manifest within performance-based situations (e.g., public speaking, group presentations), particularly among those experiencing social anxiety. Within these performance-based situations, individuals experiencing such evaluative fears frequently display a variety of impairments (e.g., avoidance, nervousness) that might manifest within and across various settings (e.g., employment, school). How do those who experience these fears react to in-the-moment feedback about their performance? We constructed the Fear of Evaluation About Performance (FEAP) task to examine ecologically valid experiences with anxiety when reacting to positive and negative feedback. During the task, participants gave a speech, and subsequent to this and in counterbalanced order, received positive and negative feedback about their speech, with continued assessment of anxiety-related arousal throughout the task. We tested the FEAP task among 127 adults, who provided self-reports of fears of positive and negative evaluation before completing the task. Fears of positive evaluation uniquely predicted arousal following receipt of positive feedback, whereas fears of negative evaluation uniquely predicted arousal following receipt of negative feedback. Relative to participants receiving positive feedback first, those receiving negative feedback first experienced elevated post-feedback arousal, followed by a steep decline in arousal post-positive feedback. Conversely, participants receiving positive feedback first experienced a buffer effect whereby arousal post-negative feedback remained low, relative to the arousal experienced post-negative feedback among those who received negative feedback first. We expect the FEAP task to inform basic science on fears of negative and positive evaluation, as well as treatment planning in applied clinical settings.
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21
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Shaw PV, Wilson GA, Antony MM. Examination of emotional contagion and social anxiety using novel video stimuli. ANXIETY STRESS AND COPING 2020; 34:215-227. [PMID: 33124470 DOI: 10.1080/10615806.2020.1839729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Socially anxious individuals often exhibit signs of anxiety that might elicit discomfort in others and negatively influence their interactions, due in part to emotional contagion. However, there is limited research examining the phenomenon of emotional contagion in social anxiety, which is the topic of the current study. DESIGN AND METHODS An experimental design was used in which undergraduate psychology students (N = 128) were assigned to either an experimental condition (watching a video of a socially anxious presenter) or a control condition (watching a video of a nonanxious presenter). Various measures were administered to assess social anxiety, emotional contagion, state anxiety, and related constructs. RESULTS After controlling for baseline anxiety levels, participants in the experimental condition reported significantly higher levels of anxiety during and immediately after watching the video compared to individuals in the control condition (multivariate analysis of covariance, analysis of variance). Similar results were found across both conditions in participants with higher levels of trait social anxiety and higher public speaking anxiety (moderated regression analyses). CONCLUSIONS The findings suggest that social anxiety may be emotionally contagious, and provides insight into the role that emotional contagion may play in the association between social anxiety and interpersonal functioning.
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Affiliation(s)
- Pam V Shaw
- Department of Psychology, Ryerson University, Toronto, Canada
| | | | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, Canada
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22
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23
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Exploratory and Confirmatory Factor Analysis of the Social Skills Scale for Young Immigrants. SUSTAINABILITY 2020. [DOI: 10.3390/su12176897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The integration of young immigrants in the societies that host them highlights the need for the intervention of social workers to facilitate their adaptation and inclusion from an individualized diagnosis of their needs. The development of social skills in the immigrants is one of the main ways to make that integration happen, and therefore its diagnosis is fundamental. However, at present, there are no valid and reliable instruments that take into account the sociocultural factors that surround young immigrants for the evaluation of their social skills. It is for this reason that the purpose of this study was to adapt and validate a current and useful instrument for the diagnosis of such social skills to young immigrants welcomed in Spain. To do this, it was started on the choice and adaptation of The Social Skills Scale (Escala de Habilidades Sociales). Subsequently, the questionnaire was submitted to concurrent, predictive, and nomological validation processes. The construct validity was carried out by factor analysis first and second order to confirm the hierarchical structure of the scale. After validation with Exploratory Factor Analysis (n = 330), the structure was checked, and the model was later adjusted with Confirmatory Factor Analysis (n = 568) by means of structural equations. The reliability and internal consistency of the instrument was also tested with values in all dimensions above 0.8. It is concluded that this new instrument has 29 items and 6 dimensions, has acceptable validity and reliability, and can be used for the diagnosis of Social Skills in Young Immigrants.
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24
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Mehl A, Reif M, Zerm R, Pranga D, Friemel D, Berger B, Brinkhaus B, Gutenbrunner C, Büssing A, Kröz M. Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study. Integr Cancer Ther 2020; 19:1534735420935618. [PMID: 32618207 PMCID: PMC7491213 DOI: 10.1177/1534735420935618] [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: 11/16/2022] Open
Abstract
Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.
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Affiliation(s)
| | - Marcus Reif
- Society for Clinical Research, Berlin, Germany
| | - Roland Zerm
- Research Institute Havelhöhe, Berlin, Germany.,Havelhöhe Hospital, Berlin, Germany
| | | | | | | | | | | | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Witten/Herdecke University, Witten, Germany
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25
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McCarthy SA, Ford TC, Lomas JE, Stough C. Subclinical autistic traits mediate the relationship between emotional intelligence and resiliency in adolescents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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26
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Cannon CJ, Makol BA, Keeley LM, Qasmieh N, Okuno H, Racz SJ, De Los Reyes A. A Paradigm for Understanding Adolescent Social Anxiety with Unfamiliar Peers: Conceptual Foundations and Directions for Future Research. Clin Child Fam Psychol Rev 2020; 23:338-364. [DOI: 10.1007/s10567-020-00314-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Romano M, Moscovitch DA, Huppert JD, Reimer SG, Moscovitch M. The effects of imagery rescripting on memory outcomes in social anxiety disorder. J Anxiety Disord 2020; 69:102169. [PMID: 31862574 DOI: 10.1016/j.janxdis.2019.102169] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/27/2023]
Abstract
Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets negative autobiographical memories. IR has been theorized to work through various memory mechanisms, including modifying the content of negative memory representations, changing memory appraisals, and improving negative schema or core beliefs about self and others. However, no prior studies have investigated the unique effects of rescripting itself relative to other IR intervention components on these proposed mechanisms. In this preliminary study, 33 individuals with SAD were randomized to receive a single session of IR, imaginal exposure (IE), or supportive counselling (SC). Memory outcomes were assessed at 1- and 2-weeks post-intervention and at 3-months follow-up. Results demonstrated that the content of participants' autobiographical memory representations changed in distinct ways across the three conditions. Whereas IR facilitated increases only in positive/neutral memory details, IE facilitated increases in both positive/neutral and negative memory details and SC facilitated no changes in memory details. Although memory appraisals did not differ across conditions, participants who received IR were more likely to update their negative memory-derived core beliefs. These unique effects of rescripting on memory representations and core beliefs enhance our understanding of the memory-based mechanisms of IR within the context of exposure-based learning for people with SAD.
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Affiliation(s)
- Mia Romano
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada.
| | | | - Susanna G Reimer
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada
| | - Morris Moscovitch
- University of Toronto and the Rotman Research Institute and Department of Psychology, Baycrest Centre for Geriatric Care, Canada
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28
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Reddy YCJ, Sudhir PM, Manjula M, Arumugham SS, Narayanaswamy JC. Clinical Practice Guidelines for Cognitive-Behavioral Therapies in Anxiety Disorders and Obsessive-Compulsive and Related Disorders. Indian J Psychiatry 2020; 62:S230-S250. [PMID: 32055066 PMCID: PMC7001348 DOI: 10.4103/psychiatry.indianjpsychiatry_773_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - M Manjula
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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29
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Richey JA, Brewer JA, Sullivan-Toole H, Strege MV, Kim-Spoon J, White SW, Ollendick TH. Sensitivity shift theory: A developmental model of positive affect and motivational deficits in social anxiety disorder. Clin Psychol Rev 2019; 72:101756. [DOI: 10.1016/j.cpr.2019.101756] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/21/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023]
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30
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Walczak M, Breinholst S, Ollendick T, Esbjørn BH. Cognitive Behavior Therapy and Metacognitive Therapy: Moderators of Treatment Outcomes for Children with Generalized Anxiety Disorder. Child Psychiatry Hum Dev 2019; 50:449-458. [PMID: 30406900 DOI: 10.1007/s10578-018-0853-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7-14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD.
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Affiliation(s)
- Monika Walczak
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.
| | - Sonja Breinholst
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | | | - Barbara Hoff Esbjørn
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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31
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Read DL, Clark GI, Rock AJ, Coventry WL. Adult attachment and social anxiety: The mediating role of emotion regulation strategies. PLoS One 2018; 13:e0207514. [PMID: 30592712 PMCID: PMC6310265 DOI: 10.1371/journal.pone.0207514] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 11/01/2018] [Indexed: 12/23/2022] Open
Abstract
Despite extensive evidence relating attachment dimensions to maladaptive interpersonal behaviours and dysfunctional emotion regulation strategies, few studies have explored social anxiety in the context of adult attachment dimensions. The aim of the present study was to investigate whether attachment-related anxiety and avoidance are associated with symptoms of social anxiety and whether cognitive emotion regulation strategies (reappraisal and suppression) play a role in the relationship between adult attachment and social anxiety. A sample of 253 adults (male n = 47, 18.6%; female n = 202, 79.8%; gender not disclosed n = 4, 1.6%) ranging in age from 18 to 74 years (M = 33.12, SD = 11.56) completed an online questionnaire that consisted of the Experience in Close Relationships–Revised Questionnaire (ECR-R); The Inventory of Interpersonal Situations Discomfort scale (IIS-D); and The Emotion Regulation Questionnaire (ERQ). Results indicated that both attachment anxiety and attachment avoidance have a direct effect on indices of social anxiety symptomology. Reappraisal partially mediated the relationship between attachment anxiety and social anxiety. However, the relationship between attachment avoidance and social anxiety was not mediated by the use of reappraisal and suppression. Findings of the study have implications for the development of clinical interventions targeting mediators of psychological distress associated with social anxiety.
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Affiliation(s)
- Darryl L. Read
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, NSW, Australia
| | - Gavin I. Clark
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, NSW, Australia
| | - Adam J. Rock
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, NSW, Australia
- * E-mail:
| | - William L. Coventry
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, NSW, Australia
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Olivares-Olivares PJ, Ortiz-González PF, Olivares J. Role of social skills training in adolescents with social anxiety disorder. Int J Clin Health Psychol 2018; 19:41-48. [PMID: 30619496 PMCID: PMC6300857 DOI: 10.1016/j.ijchp.2018.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background/Objective: Social skills training (SST) is frequently included in the treatment of social anxiety disorder (SAD) in both children and adolescents, although there is no empirical evidence to support it. Consequently, our objective is to study the role and effects of SST in the treatment of a sample of adolescents with SAD. Method: A total of 108 adolescents diagnosed with generalized social phobia were randomly assigned to two treatment conditions (with and without SST) and a control group waiting list (WLCG). The evaluation included self-report measures, observational tests and blind evaluators. Results: Both interventions significantly reduced the number of social situations feared/avoided with respect to the WLCG, which worsened. Likewise, both interventions were effective but the group with SST obtained better results in the post-test and follow-ups, as well as a lower dropout rate (6:1). Conclusions: The use of SST reduces the dropout rate of treated adolescents and increases the effectiveness of the Intervention Program for Adolescents with Social Phobia.
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Bernik M, Corregiari F, Savoia MG, de Barros Neto TP, Pinheiro C, Neto FL. Concomitant treatment with sertraline and social skills training improves social skills acquisition in social anxiety disorder: A double-blind, randomized controlled trial. PLoS One 2018; 13:e0205809. [PMID: 30372482 PMCID: PMC6205595 DOI: 10.1371/journal.pone.0205809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives To examine whether: (1) sertraline (SER) + psychotherapy is superior to psychotherapy alone; (2) group cognitive-behavioural therapy (GCBT) is superior to group psychodynamic therapy (GPT) and (3) SER+GCBT or SER+GPT is superior to Placebo (PLA)+GCBT or PLA+GPT in social anxiety disorder (SAD). Methods A double-blind randomized controlled trial. Participants were assigned either to: SER+GCBT (n = 34); SER+GPT (n = 36); PLA+GCBT (n = 36) or PLA+GPT (n = 41) for 20 weeks. SER (or PLA) was administered at doses from 50 to 200 mg/d. Primary measures were both categorial: remission (CGI score≤2), response of social symptoms (≥50% reduction in Scale of Avoidance and Social Discomfort (SASD)); and continuous: reduction of SASD and Multidimensional Scale of Social Expression(M-MSSE). Results SER exhibited better improvement of social anxiety symptoms rate than PLA (25.73% vs. 9.46%, P < .05). Neither GCBT differed from GPT (12.33% vs. 22.54%, P = .11) nor SER+GCBT from PLA+GCBT (17.65% vs. 7.69%, P = .20). However, SER+GPT was superior to PLA+GPT (33.33%, vs. 11.43%, P < .05). M-MSSE had superior improvement for SER+GCBT vs PLA+GCBT (P < .01) but not for SER+GPT vs. PLA+GPT (P = .80). SASD scores improvement were greater for SER than PLA (P < .01) and for SER+GCBT vs. PLA+GCBT (P < .05), but neither GCBT differed from GPT(P = .60) nor SER+GPT differed from PLA+GPT (P = .09). Conclusions In overall, SER+psychotherapy was superior to psychotherapy alone. SER potentiated GCBT by enhancing social skills acquisition. Trial registration ISRCTN 57551461.
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Affiliation(s)
- Marcio Bernik
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Fabio Corregiari
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Mariangela Gentil Savoia
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Tito Paes de Barros Neto
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Cristiane Pinheiro
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Francisco Lotufo Neto
- Anxiety Disorders Program, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
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Harley J. The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1139-1151. [PMID: 30347059 DOI: 10.1044/2018_ajslp-odc11-17-0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
METHOD This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being. CONCLUSIONS Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.
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Affiliation(s)
- Jane Harley
- The Michael Palin Centre for Stammering, London, United Kingdom
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Barry TJ, Yeung SP, Lau JY. Meta-analysis of the influence of age on symptom change following cognitive-behavioural treatment for anxiety disorders. J Adolesc 2018; 68:232-241. [DOI: 10.1016/j.adolescence.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/19/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022]
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Hopwood CJ. A framework for treating DSM-5 alternative model for personality disorder features. Personal Ment Health 2018; 12:107-125. [PMID: 29656545 DOI: 10.1002/pmh.1414] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022]
Abstract
Despite its demonstrated empirical superiority over the DSM-5 Section 2 categorical model of personality disorders for organizing the features of personality pathology, limitations remain with regard to the translation of the DSM-5 Section 3 alternative model of personality disorders (AMPD) to clinical practice. The goal of this paper is to outline a general and preliminary framework for approaching treatment from the perspective of the AMPD. Specific techniques are discussed for the assessment and treatment of both Criterion A personality dysfunction and Criterion B maladaptive traits. A concise and step-by-step model is presented for clinical decision making with the AMPD, in the hopes of offering clinicians a framework for treating personality pathology and promoting further research on the clinical utility of the AMPD. Copyright © 2018 John Wiley & Sons, Ltd.
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Trained Observers’ Ratings of Adolescents’ Social Anxiety and Social Skills within Controlled, Cross-Contextual Social Interactions with Unfamiliar Peer Confederates. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9676-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cheng J, Craske MG, Niles AN. Exposure reduces negative bias in self-rated performance in public speaking fearful participants. J Behav Ther Exp Psychiatry 2017; 54:101-107. [PMID: 27459691 DOI: 10.1016/j.jbtep.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Individuals with public speaking anxiety (PSA) under-rate their performance compared to objective observers. The present study examined whether exposure reduces the discrepancy between self and observer performance ratings and improved observer-rated performance in individuals with PSA. METHODS PSA participants gave a speech in front of a small audience and rated their performance using a questionnaire before and after completing repeated exposures to public speaking. Non-anxious control participants gave a speech and completed the questionnaire one time only. Objective observers watched videos of the speeches and rated performance using the same questionnaire. RESULTS PSA participants underrated their performance to a greater degree than did controls prior to exposure, but also performed significantly more poorly than did controls when rated objectively. Bias significantly decreased and objective-rated performance significantly increased following completion of exposure in PSA participants, and on one performance measure, anxious participants no longer showed a greater discrepancy between self and observer performance ratings compared to controls. LIMITATIONS The study employed non-clinical student sample, but the results should be replicated in clinical anxiety samples. CONCLUSIONS These findings indicate that exposure alone significantly reduces negative performance bias among PSA individuals, but additional exposure or additional interventions may be necessary to fully correct bias and performance deficits.
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Affiliation(s)
- Joyce Cheng
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
| | - Michelle G Craske
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
| | - Andrea N Niles
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
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Cuijpers P, Gentili C, Banos RM, Garcia-Campayo J, Botella C, Cristea IA. Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis. J Anxiety Disord 2016; 43:79-89. [PMID: 27637075 DOI: 10.1016/j.janxdis.2016.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
Abstract
Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands.
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy
| | - Rosa M Banos
- Department of Personality, Assessment and Psychological Treatments, Valencia, Spain; Ciber Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Javier Garcia-Campayo
- Department of Psychatry, Miguel Servet Hospital & University of Zaragoza, Red Investigación en Atención Primaria (REDIAPP), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Cristina Botella
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain; Department of Psicología Básica, Clínica y Psicobiología, Castellón, Spain
| | - Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy; Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
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Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016; 15:245-258. [PMID: 27717254 PMCID: PMC5032489 DOI: 10.1002/wps.20346] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g=0.75 for MDD to g=0.80 for GAD, g=0.81 for PAD, and g=0.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g=0.59) and MDD (adjusted g=0.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g=0.61) and SAD (g=0.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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