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Villalongo Andino M, Garcia KM, Richey JA. Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review. Front Psychol 2024; 14:1331200. [PMID: 38259541 PMCID: PMC10800915 DOI: 10.3389/fpsyg.2023.1331200] [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: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of Dialectical Behavior Therapy-Skills Group (DBT-SG) for Social Anxiety Disorder (SAD) with suicidal ideation (SI) and to suggest further how DBT-based skills may be applied to cognitive maintenance factors of SAD. Accordingly, we first evaluate the relevance of DBT in treating SI in other disorders. Second, we evaluate the relationship between SI and SAD, providing considerations for the complexity of comorbid disorders and presentations. Finally, we extend this knowledge to discuss considerations for the use of DBT-SG skills to target specific etiological and maintenance elements of SAD, with a focus on four themes (interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance). Overall, we conclude that DBT-SG may prove beneficial in reducing SI and symptoms in SAD that impact social and emotional functioning.
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Yadlosky LB, Mowrey WB, Pimentel SS. Risky business: Considerations of emotion regulation and high-risk behaviors in anxious adolescents. J Anxiety Disord 2023; 99:102760. [PMID: 37672917 DOI: 10.1016/j.janxdis.2023.102760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
A growing body of empirical literature connects anxiety symptoms and high-risk suicidal and self-harming behaviors in youth. Emotion regulation (ER) processes and deficits have been identified as important factors in the etiology, maintenance, and treatment of both youth anxiety and high-risk behaviors. The present study assessed the association between these variables using an acute, socio-demographically diverse clinical sample of youth presenting to an outpatient mental health clinic. Ninety-nine youth aged 12-20 years old completed measures of anxiety symptoms, ER difficulties, and lifetime history of high-risk behaviors including non-suicidal self-injury (NSSI) and suicide attempts. Unadjusted analyses show that more severe anxiety symptoms were associated with more ER difficulties and history of risk behavior. Multivariate linear regression models considering age, sex, race/ethnicity, and risk history show that more severe anxiety symptoms remained significantly associated with more ER difficulties (p < 0.0001) and positive suicide attempt history (p < 0.01). Findings highlight the importance of integrating considerations of ER into the case conceptualization and treatment planning of high-risk, anxious youth to inform evidenced-based care with this population. The need for targeted, ongoing risk assessment with anxious youth to identify and mitigate risk is also demonstrated.
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Affiliation(s)
- Lauren B Yadlosky
- Montefiore Medical Center | Albert Einstein College of Medicine, USA.
| | - Wenzhu B Mowrey
- Montefiore Medical Center | Albert Einstein College of Medicine, USA
| | - Sandra S Pimentel
- Montefiore Medical Center | Albert Einstein College of Medicine, USA
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Leigh E, Chiu K, Ballard ED. Social Anxiety and Suicidality in Youth: A Systematic Review and Meta-analysis. Res Child Adolesc Psychopathol 2023; 51:441-454. [PMID: 36525228 PMCID: PMC10017648 DOI: 10.1007/s10802-022-00996-0] [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: 11/09/2022] [Indexed: 12/23/2022]
Abstract
Suicide is a leading cause of death among young people every year. Identifying risk factors provides opportunities to intervene, and social anxiety may represent one such factor. This systematic review and meta-analysis aimed to review the evidence of associations between social anxiety and suicidality in youth (10-25 years). Embase, PsycInfo, and Medline were searched to identify relevant articles. Meta-analysis was conducted to examine the mean effect sizes of concurrent and prospective associations between social anxiety and three indices of suicidality in adolescents aged 10-25 years. Meta-analyses of 16 studies showed that social anxiety was associated cross-sectionally with suicide attempt (r = 0.10, 95% CI: 0.04, 0.15), suicidal ideation (r = 0.22, 95% CI: 0.02, 0.41), and suicide risk (r = 0.24, 95% CI: 0.05, 0.41), and prospectively at trend level with suicidal ideation (r = 0.62, 95% CI: -0.03, 0.90). An examination of the prospective associations with suicide attempt and risk was not possible due to a lack of studies. Several studies suggested that results could not be solely attributed to depressive symptoms. A high level of heterogeneity was observed in each meta-analysis. Moderation analysis was possible for gender and publication year only; neither was significant. Findings provide further evidence of a link between social anxiety and suicidal thoughts and behaviors in youth but are limited by the small number of studies of mixed quality. This review supports future research into social anxiety symptoms as potential risk factors and treatment targets for suicidal youth.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Kenny Chiu
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, Norfolk, UK
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Chen C, Sun Y, Liu B, Zhang X, Song Y. The Latent Class Analysis of Adverse Childhood Experiences among Chinese Children and Early Adolescents in Rural Areas and Their Association with Depression and Suicidal Ideation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16031. [PMID: 36498106 PMCID: PMC9738574 DOI: 10.3390/ijerph192316031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Exposure to adverse childhood experiences (ACEs) is a global public health concern that is detrimental to the psychological outcomes of Chinese children in rural areas due to the lack of public awareness of ACEs and mental health resources. The objective of this study was to identify the patterns of ACEs and the impact of ACE patterns on depression and suicidal ideation among 4683 students (mean age = 10.08 years, SD = 0.99; 48.17% female students) from 63 elementary schools in rural areas in Guizhou Province, China. Latent class analysis was conducted to identify the best class pattern. A three-step approach was undertaken to explore the association between the class patterns and demographic covariates and depression and suicidal thoughts. An overall three-class pattern of ACEs was identified, which was: (1) high ACEs, (2) high verbal abuse and emotional neglect and low household dysfunction, and (3) low ACEs. The results also showed that children in the high ACEs class tended to show higher depression rates and more frequent suicidal ideation across the three groups. Being female and younger and having a lower socioeconomic status were risk factors. Our study identified a class pattern that was not found in previous research, which is high verbal abuse and emotional neglect and low household dysfunction.
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Affiliation(s)
- Chun Chen
- School of Humanities and Social Sciences, Chinese University of Hong Kong-Shenzhen, Shenzhen 518172, China
| | - Yu Sun
- Department of Education Policy Studies, Pennsylvania State University, State College, PA 16801, USA
| | - Boyuan Liu
- Department of Sociology, Tsinghua University, Beijing 100184, China
- China Development Research Foundation, Beijing 100011, China
| | - Xiao Zhang
- China Institute for Educational Finance Research, Peking University, Beijing 100871, China
| | - Yingquan Song
- China Institute for Educational Finance Research, Peking University, Beijing 100871, China
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Kirshenbaum JS, Chahal R, Ho TC, King LS, Gifuni AJ, Mastrovito D, Coury SM, Weisenburger RL, Gotlib IH. Correlates and predictors of the severity of suicidal ideation in adolescence: an examination of brain connectomics and psychosocial characteristics. J Child Psychol Psychiatry 2022; 63:701-714. [PMID: 34448494 PMCID: PMC8882198 DOI: 10.1111/jcpp.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidal ideation (SI) typically emerges during adolescence but is challenging to predict. Given the potentially lethal consequences of SI, it is important to identify neurobiological and psychosocial variables explaining the severity of SI in adolescents. METHODS In 106 participants (59 female) recruited from the community, we assessed psychosocial characteristics and obtained resting-state fMRI data in early adolescence (baseline: aged 9-13 years). Across 250 brain regions, we assessed local graph theory-based properties of interconnectedness: local efficiency, eigenvector centrality, nodal degree, within-module z-score, and participation coefficient. Four years later (follow-up: ages 13-19 years), participants self-reported their SI severity. We used least absolute shrinkage and selection operator (LASSO) regressions to identify a linear combination of psychosocial and brain-based variables that best explain the severity of SI symptoms at follow-up. Nested-cross-validation yielded model performance statistics for all LASSO models. RESULTS A combination of psychosocial and brain-based variables explained subsequent severity of SI (R2 = .55); the strongest was internalizing and externalizing symptom severity at follow-up. Follow-up LASSO regressions of psychosocial-only and brain-based-only variables indicated that psychosocial-only variables explained 55% of the variance in SI severity; in contrast, brain-based-only variables performed worse than the null model. CONCLUSIONS A linear combination of baseline and follow-up psychosocial variables best explained the severity of SI. Follow-up analyses indicated that graph theory resting-state metrics did not increase the prediction of the severity of SI in adolescents. Attending to internalizing and externalizing symptoms is important in early adolescence; resting-state connectivity properties other than local graph theory metrics might yield a stronger prediction of the severity of SI.
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Affiliation(s)
- Jaclyn S. Kirshenbaum
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
| | - Rajpreet Chahal
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
| | - Tiffany C. Ho
- Department of Psychiatry and Behavioral Sciences; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lucy S. King
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
| | - Anthony J. Gifuni
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA,Psychiatry Department and Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada
| | - Dana Mastrovito
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
| | - Saché M. Coury
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
| | | | - Ian H. Gotlib
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, USA
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Hermosillo-de-la-Torre AE, Arteaga-de-Luna SM, Acevedo-Rojas DL, Juárez-Loya A, Jiménez-Tapia JA, Pedroza-Cabrera FJ, González-Forteza C, Cano M, Wagner FA. Psychosocial Correlates of Suicidal Behavior among Adolescents under Confinement Due to the COVID-19 Pandemic in Aguascalientes, Mexico: A Cross-Sectional Population Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094977. [PMID: 34067094 PMCID: PMC8124170 DOI: 10.3390/ijerph18094977] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/13/2022]
Abstract
Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented.
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Affiliation(s)
- Alicia Edith Hermosillo-de-la-Torre
- Psychology Department, Universidad Autónoma de Aguascalientes [Autonomous University of Aguascalientes], Aguascalientes 20131, Mexico; (A.E.H.-d.-l.-T.); (S.M.A.-d.-L.); (D.L.A.-R.); (F.J.P.-C.)
| | - Stephania Montserrat Arteaga-de-Luna
- Psychology Department, Universidad Autónoma de Aguascalientes [Autonomous University of Aguascalientes], Aguascalientes 20131, Mexico; (A.E.H.-d.-l.-T.); (S.M.A.-d.-L.); (D.L.A.-R.); (F.J.P.-C.)
| | - Denise Liliana Acevedo-Rojas
- Psychology Department, Universidad Autónoma de Aguascalientes [Autonomous University of Aguascalientes], Aguascalientes 20131, Mexico; (A.E.H.-d.-l.-T.); (S.M.A.-d.-L.); (D.L.A.-R.); (F.J.P.-C.)
| | - Angélica Juárez-Loya
- Clinical and Health Psychology Department, Psychology Faculty, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico;
| | - José Alberto Jiménez-Tapia
- Instituto Nacional de Psiquiatría [National Institute of Psychiatry], Tlalpan 14370, Mexico; (J.A.J.-T.); (C.G.-F.)
| | - Francisco Javier Pedroza-Cabrera
- Psychology Department, Universidad Autónoma de Aguascalientes [Autonomous University of Aguascalientes], Aguascalientes 20131, Mexico; (A.E.H.-d.-l.-T.); (S.M.A.-d.-L.); (D.L.A.-R.); (F.J.P.-C.)
| | - Catalina González-Forteza
- Instituto Nacional de Psiquiatría [National Institute of Psychiatry], Tlalpan 14370, Mexico; (J.A.J.-T.); (C.G.-F.)
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX 78207, USA;
| | - Fernando A. Wagner
- School of Social Work, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Correspondence: ; Tel.: +410-706-5696
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Montero ES, Morales-Rodríguez FM. Evaluation of Anxiety, Suicidal Risk, Daily Stress, Empathy, Perceived Emotional Intelligence, and Coping Strategies in a Sample of Spanish Undergraduates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1418. [PMID: 33546459 PMCID: PMC7913637 DOI: 10.3390/ijerph18041418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022]
Abstract
Anxiety disorders and suicide are commonly under-recognized issues that can be a public health problem. Adolescents are among the most affected population groups and studying them can prevent serious health problems. These two elements are related, but at the same time, they can only be understood from a multifactorial point of view, so other related variables such as emotional intelligence, empathy, or coping strategies are key to understand their effect on the population. In this study, a series of methods to measure the variables of interest were applied to a specific group of adolescents to determine their mental health levels, focusing on suicide and anxiety episodes. The results reflected average levels with a tendency to be high in the case of anxiety and nonalarming levels in terms of suicide risk, both parameters presenting more worrying values in women. In turn, the correlation between suicide and anxiety was demonstrated considering the other variables (coping strategies, empathy, emotional intelligence, and prosociality). This research has relevant implications for the diagnosis, orientation, and design of psychoeducational and clinical interventions that contribute to the improvement of their well-being and quality of life.
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Affiliation(s)
- Estefanía Solla Montero
- Department of Legal Medicine, Toxicology and Psychiatry, Faculty of Medicine, 18016 Granada, Spain;
| | - Francisco Manuel Morales-Rodríguez
- Department of Educational and Developmental Psychology, Faculty of Psychology, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain
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Kelly-Turner K, Radomsky AS. The Fear of Losing Control in Social Anxiety: An Experimental Approach. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10104-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Duffy ME, Mueller NE, Cougle JR, Joiner TE. Perceived burdensomeness uniquely accounts for suicidal ideation severity in social anxiety disorder. J Affect Disord 2020; 266:43-48. [PMID: 32056911 DOI: 10.1016/j.jad.2020.01.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND High rates of suicidal ideation in those with social anxiety disorder (SAD) have been attributed to feelings of thwarted belongingness and perceived burdensomeness, but most work has been in non-clinical samples. We assessed the contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation severity, over clinical covariates, in individuals diagnosed with SAD. METHODS Participants were 58 adult outpatients (mean age 25.62 years, 69% female) with SAD. Hierarchical linear regression assessed contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation, before and after covarying other potential explanatory variables (depression, agitation, brooding rumination). RESULTS Perceived burdensomeness was significantly positively related to suicidal ideation severity (p < .001) above thwarted belongingness, which was not incremental (p = .791). The same pattern was found after inclusion of additional covariates (perceived burdensomeness p = .006; thwarted belongingness p = .757). Greater agitation also uniquely accounted for more severe suicidal ideation (p = .001). LIMITATIONS This study was cross-sectional, did not assess all potential confounding variables, and utilized a treatment-seeking sample. CONCLUSIONS Results suggest perceived burdensomeness is independently related to suicidal ideation severity in SAD, over thwarted belongingness and other clinical features. Future work should seek to replicate these findings and evaluate causal, longitudinal relationships among perceived burdensomeness, agitation, and severity of suicidal ideation in those with SAD in order to determine whether these may be clinically-relevant mechanisms.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Nora E Mueller
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
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