Community sample evidence on the relations among behavioural inhibition system, anxiety sensitivity, experiential avoidance, and social anxiety in adolescents

Stuttering severity and social anxiety among adults who stutter: A multilevel analysis

PURPOSE

The purpose of this study is to further investigate the association between social anxiety and stuttering severity among adults who stutter (AWS) at both the between- and within-person levels of analysis.

METHOD

Sixty-two AWS (women = 27, men = 35; Mage = 39.5 years, SDage = 14.8) first completed a questionnaire (e.g., trait social anxiety and personality traits) and provided two speech samples (i.e., conversation, reading). Then, participants enrolled in up to 21 days of ecological momentary assessment (EMA) to self-report their momentary stuttering severity, social anxiety, and avoidance behaviors during social interactions. Correlational analyses and hierarchical regression analyses were conducted on between-person level measures. Multilevel mediation analysis was conducted on EMA data to disaggregate between- and within-person processes.

RESULTS

At the between-person level, percent syllables stuttered (%SS) and person mean Self-Reported Stuttering Severity (iSRSS) were both significantly correlated with trait social anxiety, but not above and beyond the effects of neuroticism, extraversion, the overall impact of stuttering, and avoidance behaviors. At the within-person level, when AWS self-reported to stutter more than they usually do on average, they also tended to exhibit higher levels of social anxiety than they usually did, regardless of the amount of avoidance behaviors exhibited at those moments. The within-person effect between stuttering severity and social anxiety was also significantly mediated by avoidance behaviors.

CONCLUSION

The associations between social anxiety and stuttering differed based on the analysis level (between vs within-person) and whether covariates are included.

Vulnerability Factors, Adjustment, and Opioid Misuse in Chronic Noncancer Pain Individuals

Several person variables predate injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of 2 diathesis variables (impulsiveness and anxiety sensitivity [AS]) in the adjustment of individuals with chronic noncancer pain and opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modeling analyses. The results show a significant association between impulsiveness and AS and all the maladjustment variables, and between impulsiveness and AS and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the structural equation modeling analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and AS are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including AS and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.

The relationship between urban greenspace perception and use within the adolescent population: A focused ethnography

INTRODUCTION

Greenspace is beneficial for improving adolescent mental health, yet healthcare professionals still do not understand the connection between the built environment and subjective mental well-being. We also need to understand how this population uses greenspace and how they feel when in it.

AIM

The aim of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace and to explore how they feel when they are in greenspace.

DESIGN

Focused ethnography.

METHODS

Data were collected between June 2022 and August 2022 using participant observation, photo elicitation and semi-structured interviews. Braun and Clarke's (2006) six phases of thematic analysis were used to guide data collection and analysis.

RESULTS

A total of 11 adolescents between ages 12 and 18 who resided in and around Newark, NJ, were recruited. Three themes were identified from the data: (1) A tranquil space in an unsafe place; (2) Park means family connection with burgeoning independence; and (3) My park: Sense of ownership and responsibility.

CONCLUSIONS

This study deepens the understanding between subjective mental well-being and urban greenspace exposure. Adolescents accepted responsibility for maintaining "my park", which strengthens community cohesion, detailing the importance of youth input during urban planning.

IMPLICATIONS FOR PRACTICE

Implications from this study suggest that environmental interventions may help ameliorate an ongoing mental health care crisis among adolescents. Healthcare providers should consider the built environment as another approach to promoting mental health.

PATIENT OR PUBLIC CONTRIBUTION

None other than research participants.

Experiential avoidance in participants with borderline personality disorder and other personality disorders

BACKGROUND

The present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament.

METHODS

The Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure).

RESULTS

Participants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD.

CONCLUSIONS

Taken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.

Lowered social motivation is associated with adolescent attention deficit hyperactivity disorder and social anxiety symptoms

BACKGROUND

Difficulties in social skills are highly prevalent in children and adolescents with attention deficit hyperactivity disorder (ADHD), however, the reasons for these social difficulties are poorly understood. This study aimed to understand social motivation in children (aged 5-8) and adolescents (aged 13-17) with and without ADHD, and the relationship between social anxiety and social motivation in youth with ADHD.

METHOD

204 parents of children and adolescents with and without ADHD completed online questionnaires on social motivation, social anxiety, and ADHD symptoms.

RESULTS

Adolescents with ADHD had significantly lower social motivation than typically developing adolescents, and children with ADHD. Higher social anxiety significantly predicted lowered social motivation in participants with ADHD.

CONCLUSIONS

These findings indicate a unique pattern of social motivation in ADHD, specifically a reduction during adolescence, reflecting social intervention inefficacy. Additionally, these findings establish a link between social motivation and social anxiety, suggesting that they may act as barriers to social intervention.

Measures of Anxiety Disorder Symptoms in Adolescents

This study examines select psychometric properties (i.e., internal reliability, and factorial, convergent, discriminant, and criterion validity) of three commonly-used measures of anxiety disorder symptoms in adolescents in the context of multi-trait, multi-method matrix analyses. A sample of 331 adolescents (age M = 17.1; 75.3% white; 71.0% female) completed three self-report scales that assess symptoms of separation anxiety, social anxiety, panic, and generalized anxiety, as well as measures of depression, experiential avoidance, and intolerance of uncertainty. Measures of panic disorder symptoms showed poor factorial, convergent, and discriminant validity. A multi-trait, multi-method matrix model to understand the relationships among the measures of separation anxiety, social anxiety, and generalized anxiety symptoms provided a reasonable fit to the data. Measures of separation anxiety showed poor discriminant and criterion validity, suggesting limited relevance of separation anxiety in this adolescent sample. Measures of social anxiety generally showed evidence of adequate-to-good factorial, convergent, and discriminant validity. Measures of generalized anxiety showed adequate -to-good factorial and convergent validity, and poor-to-adequate discriminant validity. The associations of measures of social and generalized anxiety with measures of depression, experiential avoidance, and intolerance of uncertainty were at least partially independent of method variance. The findings of this study add to the growing literature that evaluates the strengths and limitations of these scales for clinical practice and research.

Development and effects of salutogenesis program for adolescents with moyamoya disease: A randomized controlled trial

BACKGROUND

Disease-specific interventions for management and health behavior implementation are needed to improve the health and quality of life of adolescents with moyamoya disease.

OBJECTIVE

This study aimed to develop a program for adolescents with moyamoya disease based on the salutogenesis theory, which focuses on the process of enhancing health through successful adaptation to external stressors, and to evaluate its effectiveness.

METHODS

A randomized controlled trial was performed according to the CONSORT guidelines. This preliminary research and experimental treatment were conducted at a Severance Hospital ward and outpatient clinic among 48 participants randomized into the intervention (seven sessions of salutogenesis program, n = 24) or the control group (one session of one-to-one moyamoya disease education program, n = 24) from September 6, 2018 to January 4, 2019. Changes in the following study outcomes were reported: "knowledge of moyamoya disease," "social support," "sense of coherence," "moyamoya disease health behavior," "stress," "depression," "subjective health status," "frequency of ischemic symptoms," and "quality of life".

RESULTS

The salutogenesis program improved the knowledge and social support of adolescents with illness-related problems and helped them attain healthy behaviors and stress reduction. It was confirmed to be effective in improving their quality of life.

CONCLUSIONS

The salutogenesis program for adolescents with moyamoya disease effectively improved the generalized resistance resources and sense of coherence in adolescents with moyamoya disease.

TRIAL REGISTRATION

Korean Clinical Research Information Service registry, KCT0006869.

Differences in anxiety sensitivity and experiential avoidance between subtypes of social anxiety disorder

Both anxiety sensitivity (AS) and experiential avoidance (EA) have been linked to social anxiety disorder (SAD). However, previous studies did not consider their joint variance and the heterogeneity of SAD. In this mixed methods cross-sectional survey, we examined 121 online participants (age range: 16-70 years) who self-reported as socially anxious. We compared AS and EA levels in individuals with a primary fear of noticeable anxiety symptoms vs. behaving ineptly. AS and EA were highly prevalent across the sample. Surprisingly, the noticeable symptoms subtype showed slightly lower AS and EA levels than the inept behavior subtype. The noticeable symptoms subtype scored notably lower on social anxiety measures (mean = 69.8) than the inept behavior subtype (mean = 89.3). EA was uniquely associated with social anxiety in both subtypes, while AS was uniquely associated with social anxiety only in the inept behavior subtype. The joint variance explained substantially more of the noticeable symptoms subtype's social anxiety (32.5%) compared to the inept behavior subtype's (9.4%). Qualitative themes aligned with these findings, indicating a self-reinforcing dynamic between high AS, high EA, and social anxiety symptoms. Potential clinical implications are discussed. Future research should examine causality in the AS-EA-SAD dynamic, considering the heterogeneity of SAD.

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

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

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

A number of studies to date examine dimensions of social phobia and anxiety in adolescents. A variety of tools has been developed, along with their abbreviated versions, that are used to assess Social Anxiety (SA) but little research has been devoted to the types of fears they each assess. Due to differences in the content of the multitude of instruments, different aspects of SA are addressed and this leads to confusion when the relationship between SA and other constructs is being investigated. The aim of the present study was to examine the psychometric properties of the abbreviated Social Phobia and Anxiety Inventory SPAI-23 in Greek-Cypriot community adolescents and describe dimensions of social fears at that age. Seven hundred twenty-one adolescent students from Cyprus, (Mean Age: 15.5, Range: 13-19, SD: 1.12, 64% female) participated in the study. Participants completed, among others, an abbreviated version of the Social Phobia and Anxiety Inventory (SPAI-23). Exploratory Factor Analysis on the SPAI-23 revealed a quite similar structure to the original questionnaire (SPAI). Three Social Phobia factors, describing distinct socially fearful situations, were identified (Performance, Interaction, and Presence in a social context) and one Agoraphobia factor after the evaluation of alternative solutions. Findings were verified by means of Confirmatory Factor Analysis, testing alternative models. Overall, findings were in line with recent evidence on youth samples, and contribute to significant insights towards more sophisticated and personalized assessments.

Avoidance Bias to Angry Faces Predicts the Development of Depressive Symptoms among Adolescent Girls

Interpersonal-motivational models posit that heightened avoidance of aversive social stimuli and diminished approach of appetitive social stimuli increases social withdrawal and reduces positive social interactions, thereby increasing risk for future social anxiety and depression. The current study examined if approach-avoidance biases toward angry and happy faces, measured during the Approach Avoidance Task (AAT), would be associated with the development of adolescent depressive and social anxiety symptoms. At baseline, participants included 129 never-depressed adolescent girls (ages 11-13), two-thirds of whom were at high-risk for internalizing problems due to shy/fearful temperament. Girls reported their depressive and social anxiety symptoms every 6 months for 24 months and completed the AAT at baseline and 24-mo follow-up. Heightened avoidance bias toward angry faces at baseline predicted increases in depressive symptoms across the follow-up, even after accounting for temperament and pubertal status. In contrast, girls with greater depression and social anxiety symptoms at 24-mo follow-up exhibited less avoidance bias for angry faces at the same time point. Findings suggest that avoidance behaviors (i.e., avoiding people or settings associated with angry faces, which are often perceived as hostile, critical, or rejecting) may be a risk factor for depression, above and beyond risk imparted by temperament or advances in puberty. However, with increasing internalizing symptoms, it may become more difficult for adolescents to maintain avoidance for aversive social stimuli, and without the introduction of more adaptive emotion regulation strategies, these biases may continue to increase and maintain risk for internalizing problems.

Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents

BACKGROUND AND OBJECTIVES

The potential mechanism by which rumination influences social anxiety through cognitive fusion and experiential avoidance proposed by the Acceptance and Commitment Therapy model has not been well-documented. This study, therefore, aimed to examine the sequential multiple mediation of the two processes.

DESIGN

A cross-sectional survey was conducted.

METHOD

A total of 233 Chinese adolescents (42.06% girls) completed a set of printed self-report questionnaires measuring rumination, cognitive fusion, experiential avoidance, and social anxiety. The SPSS macro PROCESS (model 6) was used to test a sequential mediating model. A 95% confidence interval (CI) was calculated with 5000 bootstrapping re-samples.

RESULTS

Bootstrap analyses indicated that there were indirect effects of rumination on social anxiety mediated by cognitive fusion together with experiential avoidance (B = 0.098, BootSE = 0.032, CI = 0.045 to 0.170), or solely by experiential avoidance (B = 0.048, BootSE = 0.020, CI = 0.014 to 0.093). The mediation of cognitive fusion alone was not significant (B = 0.065, BootSE = 0.038, CI = -0.006 to 0.144).

CONCLUSIONS

The results indicated the sequential mediating role of cognitive fusion and experiential avoidance, and the relative prominence of the latter in the association between rumination and social anxiety.

Familial Factors in the Development of Social Anxiety Disorder

The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].

Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis

The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I² statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.

I'm Not Feeling It: Momentary Experiential Avoidance and Social Anxiety Among Individuals With Social Anxiety Disorder

Previous studies have found that social anxiety and experiential avoidance (EA) are significantly associated, but the directionality of this relationship has not been firmly established. The present study examined momentary EA and social anxiety using repeated measurements during an opposite-sex interaction. Participants were 164 individuals (50% female): 42 were diagnosed with social anxiety disorder (SAD) and the remaining 122 were non-socially-anxious individuals (NSAs). Participants formed 42 experimental dyads including 1 individual with SAD and 1 NSA individual, and 40 control dyads including 2 NSA individuals. Lower-level mediational modeling indicated that for individuals with SAD, a reciprocal relationship was observed in which changes in both EA and social anxiety mediated changes in each other. However, changes in EA explained approximately 89% of changes in social anxiety whereas changes in social anxiety explained approximately 52% of changes in EA throughout the interaction. For NSA individuals, only social anxiety predicted EA. These findings point to a deleterious cycle driven mostly by EA among individuals with SAD, but not NSA individuals. Findings are discussed within the context of previous empirical findings as well as acceptance and commitment therapy (ACT) and cognitive-behavioral models of psychopathology.

Behavioral Inhibition in Childhood as A Risk Factor for Development of Social Anxiety Disorder: A Longitudinal Study

Previous research has suggested the association between behavioral inhibition (BI) and the development of social anxiety disorder in childhood. However, there is scarce research using longitudinal methodology in Spanish-speaking populations. To cover this gap, the sample comprised 73 children ranging from six to eight years who had been examined for BI two years earlier in home and school settings. Children and their parents were administered the Anxiety Disorders Interview Schedule for DSM-5-Child and Parent Versions to assess the presence of possible anxiety disorders. The results revealed the stability of BI symptomatology over time. Data also showed that BI children were almost ten times more likely to develop social anxiety disorder two years later, compared to no-BI children. As a result, findings suggest behavioral inhibition strongly predicts social anxiety disorder, making BI a logical focus for selective preventive interventions. Therefore, screening for behavioral inhibition holds promise for primary prevention.

Emotional responding: Integration of multiple constructs and association with psychological health

OBJECTIVE

Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs (mindfulness, emotional nonacceptance, experiential avoidance, and anxiety sensitivity) of individuals' responses to their affective experience, hypothesizing that a bifactor model would fit the data best.

METHOD

We used exploratory structural equation modeling, a novel latent variable modeling framework, to compare five measurement models of emotional responding in an online community sample (N = 307).

RESULTS

A bifactor model including a general emotional responding factor had substantial factor loadings from nearly all items, with mixed results for specific factors. Exploratory analyses supported the significant association of avoidant emotional responding and psychopathology/well-being.

CONCLUSION

The general avoidant emotional responding factor appears to overlap most directly with experiential avoidance and may be a transtheoretical construct relevant to mental health.