Measurement of social-evaluative anxiety

Paranoia and Social Anxiety: Predicting Aggressive Behavior

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety.

Therapeutic potential of cannabidiol (CBD) in anxiety disorders: A systematic review and meta-analysis

Cannabidiol (CBD), as one of the phytocannabinoids, has a wide range of therapeutic properties for various neuropsychiatric disorders due to central nervous system effects. These therapeutic properties demonstrated by preclinical and clinical studies encompass more than just anticonvulsant, anti-arthritic, analgesic, anti-inflammatory, antioxidant, antitumor, antiemetic, antipsychotic and neuroprotective effects. It has been hypothesized that CBD holds potential in the treatment of various neuropsychiatric and anxiety disorders. Thus, PRISMA was used as a guide for our systematic review. Eight of the 1550 articles screened in June 2023 were eligible for meta-analysis. Based on the 316 participants included in these eight articles, this meta-analysis revealed a substantial significant impact of CBD on anxiety with a considerable effect size (Hedges' g = -0.92, 95% CI -1.80 to -0.04). In addition, this meta-analysis focuses on the efficacy of CBD in treating anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). However, caution should be exercised in interpreting our findings due to the limited size of the clinical sample, and additional trials ought to be carried out if deemed necessary.

The impact of physical activity on social anxiety among college students: the chain mediating effect of social support and psychological capital

Objective

As a topic of widespread concern in the fields of mental health and public health, social anxiety has many negative impacts on the physical and mental health of contemporary college students. Therefore, this study aims to provide new ideas for solving the problem of social anxiety among college students by exploring the potential mediating role of social support and psychological capital in the relationship between physical activity and social anxiety.

Methods

A cross-sectional survey was conducted on 874 college students from five universities in Shandong Province. Various self-report tools such as physical activity rating scale, social support scale, positive psychological capital scale, and social anxiety scale were used to collect information needed for this study. Related data. Use this to conduct descriptive statistical analysis, correlation analysis, and mediation effect analysis.

Results

The results showed that physical activity was significantly positively correlated with college students' social support (r = 0.354, p < 0.01) and psychological capital (r = 0.448, p < 0.01), and social support was significantly positively correlated with psychological capital (r = 0.556, p < 0.01), the above three are significantly negatively correlated with social anxiety (r = -0.326, -0.381, -0.432, p < 0.01); the mediation effect analysis shows that physical activity has a significant direct effect on college students' social anxiety The effect value is -0.136, accounting for 43.31% of the total effect; social support and psychological capital both play a separate mediating role between physical activity and social anxiety among college students, with effect values of -0.064 and -0.073 respectively, accounting for the total effect. 20.38, 23.25%, and also played a chain intermediary role, with an effect value of -0.041, accounting for 13.05% of the total effect.

Conclusion

Current research shows that physical activity can not only directly reduce social anxiety among college students, but also indirectly alleviate social anxiety among college students by increasing the level of social support and psychological capital. This has important reference significance for helping college students in China and even around the world overcome social anxiety.

Social anxiety and problematic social media use: A systematic review and meta-analysis

Some theories posit a close relationship between social anxiety and problematic social media use; however, empirical findings are inconsistent, and existing hypotheses are conflicting. Hence, we conducted a systematic review and meta-analysis to clarify the relationship between social anxiety and problematic social media use. After searching and screening the literature, we identified 53 studies, including 59,928 participants and 56 effect sizes, for analysis. A meta-analysis was subsequently performed using CMA software. Results showed that social anxiety and problematic social media use were highly positively correlated. The moderating effect results suggested that the relationship between social anxiety and problematic social media use was influenced by the measurement instrument, sex, publication year, and platform type; however, the relationship was not moderated by region and age. It is suggested to consider social anxiety in the treatment of problematic social media use.

The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis

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.

Association between physical activity and adolescent mental health in the post COVID-19: The chain mediating effect of self-esteem and social anxiety

BACKGROUND

In order to gain a deeper understanding of the relationship between physical activity and adolescent mental health in the post COVID-19 pandemic era, self-esteem and social anxiety were used as mediating variables to explore the potential mechanisms by which physical activity affects adolescent mental health.

METHODS

The study used the HELP-II Health Promoting Lifestyle Scale, the SPIN Social Phobia Scale, the Self-Esteem Scale, and the 10-item Kessler Psychological Distress Scale to administer questionnaires to 400 Chinese secondary school students, and SPSS 26.0 and PROCESS 3.3 were used to process the data.

RESULTS

The findings showed that (1) physical activity was significantly and positively associated with mental health; (2) self-esteem and social anxiety played a fully mediating role between physical activity and adolescent mental health respectively; (3) self-esteem and social anxiety played a chain mediating role between physical activity and adolescent mental health.

CONCLUSION

This study reveals the relationship and influencing mechanism between physical activity and adolescent mental health in the post COVID-19 pandemic era. Appropriate interventions for physical activity, self-esteem, and social anxiety may be beneficial to adolescent mental health. The protective role of self-esteem in adolescent mental health should be the focus of future studies, and further investigations into the association between the COVID-19 and adolescent mental health are warranted.

Changes of Solitude Behaviors among College Students: A Latent Transition Analysis

Solitude behaviors encompass four types: positive solitude, eccentricity, social avoidance, and loneliness. These four types of solitude behaviors are not entirely independent but can co-occur within individuals. Thus, the purpose of this study was to explore latent classes of solitude behaviors, their developmental patterns, and relevant influencing factors among college students. The Solitude Behavior Scale-Short Version was administered to a sample of college students. A total of 417 Chinese students completed a three-time longitudinal paper questionnaire. The data analysis was performed using Mplus 8.0 and SPSS 26.0. Harman's single-factor test, latent class analysis (LCA), and latent transition analysis (LTA) were employed for subsequent analysis. The results revealed three classes: low solitude, moderate solitude, and high solitude, which exhibited temporal changes. Social avoidance and loneliness could facilitate transitions between high solitude and moderate solitude. Females and first-grade students exhibited higher transition probabilities than males and students not in the first grade. The incidence of moderate solitude in the not-first-grade group was significantly higher than that in the first-grade group. Finally, this study offers new insights into the dynamics of solitude behaviors and their association with gender and age.

Post-event rumination and social anxiety: a systematic review and meta-analysis

Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting a correlation between post-event rumination and social anxiety symptomatology. Fisher's z correlation coefficients were calculated through random-effect meta-analyses. Results indicated a moderate association between post-event rumination and social anxiety symptomatology (r = 0.45, p < 0.001, 95%CI [0.40-0.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q = 44.36, df = 3, p < 0.001) and social anxiety (Q = 26.44, df = 8, p < 0.001), as well as the task conducted prior to assessing post-event rumination (Q = 14.31, df = 2, p < 0.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.

Make No Apologies: Fear of Negative Evaluation, Depressive Symptoms, and the Mediating Role of Accounting for COVID-Safe Behavior Amongst People at High-Risk for Severe Illness

With the goal of understanding unique and important threats to the mental health of people who are especially vulnerable to severe illness as a result of COVID-19, this study investigated associations between such individuals' fear of negative evaluation, tendency to "account for" practicing COVID-safe behaviors, and depressive symptoms. Grounded in perspectives on self-presentation, normative influence, and cognitive dissonance, we hypothesized that fear of negative evaluation would relate positively to accounting for COVID-safe behaviors, which, in turn, would associate positively with increased depressive symptoms. The results showed that increased fear of negative evaluation predicted an increased use of apologies and excuses, which in turn were positively related to depressive symptoms. Justifications for COVID-safe behaviors were not significantly associated with either fear of evaluation or depressive symptoms. The practical and theoretical implications are discussed.

Internet-Based Versus Face-to-Face Cognitive-Behavioral Therapy for Social Anxiety Disorder: A Randomized Control Trial

During the COVID-19 epidemic, face-to-face mental health services faced obstacles. Using Internet-based interventions was a good solution and had the potential to overcome these treatment barriers. However, there is no strong research evidence about the effectiveness of these methods for social anxiety disorder in different cultures and developing countries. Therefore, the present study aimed to investigate the effectiveness and application of Internet-based cognitive-behavioral therapy for social anxiety disorder in Iran. The current study was a pretest-posttest follow-up experimental design. Fifty-four adolescents with social anxiety disorder were selected from Lorestan province (Iran) by cluster sampling method and randomly assigned to three groups: face-to-face, internet-based, and wait-list control. At the beginning and end of the study and 3-month follow-up, three groups were interviewed and answered questionnaires related to the primary and secondary symptoms of social anxiety disorder. Two experimental groups were treated with the same therapeutic intervention during 10 weekly sessions. ANCOVA analysis showed that both forms of intervention effectively reduced social phobia, fear of negative evaluation and social interaction anxiety and increased emotion regulation. Also, a significant decrease in secondary outcomes, including physical symptoms, insomnia, social dysfunction, and depression symptoms, was observed in both groups. The treatment effects were stable during a 3-month follow-up. Our findings showed that although Internet-based cognitive-behavioral therapy for adolescents with social anxiety disorder can be effective, several clinical, cultural, and implementation weaknesses should be considered.

Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes

Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.

The Relationship Between Overparenting and Social Avoidance Among Emerging Adults: Mediating Role of Peer Attachment and Gender Differences

Purpose

We aim to explore the relationship between overparenting and social avoidance among emerging adults, and the mediating effects of peer attachment and gender differences.

Participants and Methods

A total of 1161 Chinese college students completed the questionnaire. The structural equation model was established to validate the main effect model and the mediation model.

Results

The results found that both paternal and maternal overparenting positively predicted social avoidance among emerging adults. Both attachment avoidance and attachment anxiety played a significant mediating role in the relationship between paternal overparenting and social avoidance. Attachment anxiety played a significant mediating role in the relationship between maternal overparenting and social avoidance, while, the mediating effect of attachment avoidance was not significant. In addition, gender differences were found in the mediating effects of peer attachment. The mediating effect of attachment anxiety in males' families had an opposite-gender matching effect, while in females' families, the mediating effect of attachment avoidance had an opposite-gender matching effect.

Conclusion

This study contributes to the understanding of the effects of overparenting on emerging adults, enriching empirical research in related fields.

Personality and psychological profile for patients with and without halitosis: A case-control study

OBJECTIVE

To compare the personalities, social avoidance and distress, and anxiety status of Chinese patients with and without objective halitosis, and investigate the association among these psychological disorders.

METHODS

Patients who complained of bad breath and diagnosed with objective halitosis were enrolled into the halitosis group, while patients without objective halitosis were enrolled into the control group. The questionnaires included the sociodemographic profile of the participants, Eysenck Personality Questionnaire (EPQ), Social Avoidance and Distress Scale (SAD), and Beck Anxiety Inventory (BAI).

RESULTS

A total of 280 patients were assigned into objective halitosis group (n = 146) and control group (n = 134). The extraversion subscales (E) score of the EPQ in the halitosis group were significantly lower than that in the control group (p = 0.001). The total SAD score and proportion of patients with anxiety symptoms in the BAI scale in the objective halitosis was significantly higher than that in the control group (p < 0.05). There was a negative correlation between the extraversion subscale and the total SAD score, Social Avoidance and Social Distress subscales (p < 0.001).

CONCLUSION

Patients with objective halitosis have more introverted personality traits and are more likely to have social avoidance and distress than the nonhalitosis population.

Exploring the influence of appearance evaluation apprehension: How fear of negative evaluation affects quality of life in people with Vestibular Schwannoma

People diagnosed with Vestibular Schwannoma (VS) can experience several symptoms both pre and post-treatment. These, alongside the diagnosis experience, can significantly impact their daily life. The present research is a continuation of a larger study aiming to explore the impacts of symptomology and body image/fear of negative evaluation (FNAE) on the quality of life (QOL) for people with VS. The research design was exploratory and involved a nationwide survey with a total of 52 participants. FNAE was assessed using a measurement of the same name, and QOL was assessed using the Penn Acoustic Neuroma Quality of Life scale (PANQOL). Comparing management groups revealed a significant difference in FNAE with higher scores for surgery compared to radiation treatment. Regression analyses revealed that FNAE significantly accounted for 10.9% of the variance in QOL. However, no symptom was significantly predictive of FNAE. In conclusion, VS is associated with several symptoms that can persist post-treatment. Body satisfaction contributes to QOL and may differ between management types. However, due to inconclusive findings on the predictability of symptoms on FNAE, other moderator factors could influence these direct relationships. Future studies should evaluate the variables that could mitigate or protect from the impacts of FNAE for this population.

The Effect of Intervention for Improving Colonoscopy Quality Is Associated with the Personality Traits of Endoscopists

Background/Aims

This study investigated whether the personality traits of endoscopists are associated with the effect of interventions for the improvement of colonoscopy quality.

Methods

This prospective, multicenter, single-blind study was performed with 13 endoscopists in three health screening centers over a 12-month period. Quality indicators (QIs), including adenoma detection rate (ADR), polyp detection rate (PDR), and withdrawal time, were measured every 3 months. Consecutive interventions for the improvement of colonoscopy quality were conducted every 3 months, which included the personal notification of QIs, the in-group notification of QIs, and finally a targeted "quality education" session. The personality traits of each endoscopist were evaluated for perfectionism, fear of negative evaluation, and cognitive flexibility after the last QI assessment.

Results

A total of 4,095 colonoscopies were evaluated to measure the QIs of the individual endoscopists for 12 months. The mean ADR, PDR, and withdrawal time of the 13 endoscopists were 32.3%, 47.7%, and 394 seconds at baseline and increased to 39.0%, 55.1%, and 430 seconds by the end of the study (p=0.003, p=0.006, and p=0.004, respectively). Among the three interventions, only quality education significantly improved QIs: ADR, 36.0% to 39.0% (odds ratio, 1.28; 95% confidence interval, 1.01 to 1.63). The improvement of ADR and PDR by education was significantly associated with perfectionism (r=0.617, p=0.033 and r=0.635, p=0.027, respectively) and fear of negative evaluation (r=0.704, p=0.011 and r=0.761, p=0.004, respectively).

Conclusions

Education can improve colonoscopy quality, and its effect size is associated with an endoscopist's personal traits such as perfectionism and fear of negative evaluation (Clinical-Trials.gov Registry NCT03796169).

Intersectional Stigma, Fear of Negative Evaluation, Depression, and ART Adherence Among Women Living with HIV Who Engage in Substance Use: A Latent Class Serial Mediation Analysis

Women Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma; (C2) moderate SU stigma; (C3) higher HIV and lower SU stigma; (C4) moderate HIV and high SU stigma; and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNE and depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV.

Low-intensity mindfulness and cognitive-behavioral therapy for social anxiety: a pilot randomized controlled trial

BACKGROUND

Cognitive-behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive-behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety.

METHODS

Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment.

RESULTS

A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51-1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention.

CONCLUSIONS

These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others.

TRIAL REGISTRATION

University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p = .006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed.

Patient-reported outcome measures more than fifteen years after treatment of sagittal or metopic craniosynostosis: a prospective cohort study

PURPOSE

To evaluate the long-term anthropometric measurements, cosmetic satisfaction, and other patient-reported outcome measures (PROMs) of patients who underwent surgical treatment or observation only of sagittal or metopic single-suture craniosynostosis (SSC).

METHODS

A prospective study was designed for all patients diagnosed with non-syndromic sagittal and metopic craniosynostosis at the British Columbia Children's Hospital, Vancouver, Canada, in the period July 1986 to July 2006. After a minimum of 15 years post-diagnosis, all eligible patients were invited to fill out the Craniofacial Surgery Outcomes Questionnaire (CSO-Q) and to attend a scheduled follow-up appointment for the collection of anthropometric measurements. A descriptive analysis of the cosmetic results was performed. Statistical analyses compared the differences in anthropometric measurements between treated and non-treated patients.

RESULTS

Of the 253 eligible patients, 52 participants were willing to share patient data for use in the study. Of those 52 former patients, 36 (69.2%) filled out and returned the CSO-Q and 23 (44.2%) attended the follow-up appointment. The mean follow-up period between surgical treatment and the CSO-Q was 20.2 ± 2.5 years and between surgical treatment and the follow-up appointment was 20.9 ± 2.7 years. In patients with sagittal SSC, the mean cephalic index (CI) was significantly larger in treated than in non-treated patients (74.6 versus 69.1, p = 0.04), while the mean pupillary distance and forehead to back index were significantly smaller (pupillary distance 6.0 cm versus 6.7 cm [p = 0.04] and forehead to back index 19.6 cm versus 21.1 cm [p = 0.03]). Focusing more on the patient reported outcome measures, overall cosmetic satisfaction was found to be high (80.6%) and no differences were found between sagittal and metopic synostosis patients, nor between treated or non-treated craniosynostosis patients. Overall outcomes regarding self-esteem (RSES) and fear of negative evaluation (FNE) were comparable with population based outcomes.

CONCLUSION

This is the first prospective study of sagittal and metopic craniosynostosis patients regarding long-term anthropometric outcome and patient reported outcome measures, including patients who were treated surgically and those who received observation only. Although study participation two decades after initial diagnosis was difficult to obtain, our data provide a platform from which one can develop an inclusive and uniform approach to assess patients' subjective cosmetic satisfaction using the CSO-Questionnaire and might be useful in preoperative counseling and psychosocial care for patients and their families.

Adverse competition-related cognitions questionnaire (ACCQ): Development and preliminary validation of a measure identifying different factors of athletes' cognitions related to competitions

This research project presents the development and preliminary validation of a German version of the Adverse Competition-related Cognitions Questionnaire (ACCQ) and comprises four studies. In Study 1, 101 athletes and 124 coaches from different team and individual sports generated a large pool of cognitions, which was reduced to an initial item pool of 54 cognitions through a multi-step procedure with different experts. In Study 2, the underlying factor structure of the questionnaire was examined by an exploratory factor analysis (N2 = 348), which revealed six factors (athletic comparison, coach devaluation, devaluation of one's own performance, appreciation by coach and family, inner resistance against competitions, and general exhaustion) with 26 items retained. Subsequently, in Study 3, the results were re-examined with a confirmatory factor analysis (CFA, N3 = 419; CFI = 0.91, RMSEA = 0.06, SRMR = 0.06). In addition, preliminary support for the construct validity (i.e., convergent, divergent, and concurrent validity) of the ACCQ was obtained by examining associations among the ACCQ subscales and theoretical correlates such as social comparison, cognitive interference, irrational performance beliefs, and fear of negative evaluation. In Study 4, a second CFA (N4 = 153; CFI = 0.89, RMSEA = 0.06, SRMR = 0.07) was conducted to test the identified 6-factor solution in a sample of high-performance competitive athletes. With its broad range of factors, the ACCQ provides a useful and valid measure for assessing different adverse competition-related cognitions, offering a wide range of potential applications in research and sport psychology practice.

Reliability (or lack thereof) of smartphone ecological momentary assessment of visual dot probe attention bias toward threat indices

BACKGROUND AND OBJECTIVES

Cognitive bias theories posit that generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are entwined with attention bias toward threats, commonly indexed by faster response time (RT) on threat-congruent (vs. threat-incongruent) trials on the visual dot probe. Moreover, although smartphone ecological momentary assessment (EMA) of the visual dot probe has been developed, their psychometric properties are understudied. This study thus aimed to assess the reliability of 8 smartphone-delivered visual dot probe attention bias and related indices in persons with and without GAD and SAD.

METHODS

Community-dwelling adults (n = 819; GAD: 64%; SAD: 49%; Mixed GAD and SAD: 37%; Non-GAD/SAD Controls: 24%) completed a five-trial smartphone-delivered visual dot probe for a median of 60 trials (12 sessions x 5 trials/session) and an average of 100 trials (20 sessions x 5 trials/session).

RESULTS

As hypothesized, Global Attention Bias Index, Disengagement Effect, and Facilitation Bias had low-reliability estimates. However, retest-reliability and internal reliability were good for Trial-Level Bias Scores (TLBS) (Bias Toward Treat: intra-class correlation coefficients (ICCs) = 0.626-0.644; split-half r = 0.640-0.670; Attention Bias Variability: ICCs = 0.507-0.567; split-half r = 0.520-0.580) and (In)congruent RTs. Poor retest-reliability and internal reliability estimates were consistently observed for all traditional attention bias and related indices but not TLBS.

LIMITATIONS

Our visual dot probe EMA should have administered ≥320 trials to match best-practice guidelines based on similar laboratory studies.

CONCLUSIONS

Future research should strive to examine attention bias paradigms beyond the dot-probe task that evidenced meaningful test-retest reliability properties in laboratory and real-world naturalistic settings.

Social anxiety and loneliness among older adults: a moderated mediation model

BACKGROUND

Few studies have clarified the mechanisms linking social anxiety and loneliness in older populations. The study aimed to explore how social network mediate the relationship between social anxiety and loneliness in older adults, with perceived social support playing a moderating role.

METHODS

A total of 454 older patients completed the Social Avoidance and Distress Scale, Lubben Social Network Scale-6, Chinese version of the Short Loneliness Scale and Perceived Social Support Scale. Bootstrap and simple slope methods were used to test the moderated mediation model.

RESULTS

Social anxiety had a significant positive predictive effect on loneliness and social network partially mediated this relationship. The relationship between social anxiety and social network, as well as the relationship between social network and loneliness, was moderated by perceived social support. Specifically, perceived social support buffered the effects of social anxiety on social network, but the buffering effect diminished with increasing levels of social anxiety. On the social network and loneliness pathway, the social network of older persons with higher perceived social support has a stronger prediction of loneliness.

CONCLUSIONS

The study found that social anxiety can contribute to loneliness by narrowing older adults' social network. High perceived social support can buffer this process, but do not overstate its protective effects. Thus, interventions to reduce social anxiety and improve social network and social support may help prevent and alleviate loneliness in older adults.

Unveiling a novel clinical risk assessment model for identifying non-suicidal self-injury risks in depressed Chinese adolescents amidst the COVID-19 pandemic: insights from low self-esteem, internet use, and sleep disturbance

Background

Non-suicidal self-injury (NSSI) is a highly prevalent behavioral problem among depression adolescent patients that can result in numerous adverse outcomes. This study endeavors to bridge this knowledge gap by creating a comprehensive model that incorporates multiple aspects of NSSI to accurately evaluate its risk in adolescents with depression, thereby enhancing our ability to prevent and address this challenging issue.

Method

Using a cross-sectional design, we recruited 302 adolescents with depressive disorders who visited or were hospitalized at Shandong Mental Health Center from December 2021 to June 2022. The participants completed several self-report questionnaires, including the Chinese version of the Internet Addiction Test, the Pittsburgh Sleep Quality Index questionnaire, the Defeat Scale, the Social Avoidance and Distress Scale and the Children's Depression Inventory. Logistic regression analysis was performed to identify the diagnostic factors, which were further used to establish clinical risk assessment models. A receiver operating characteristic curve (ROC) to identify the best model. An external validating team was introduced to verify the assessing efficiency.

Results

Based on a logistic regression analysis, three variables have been identified as significant risk factors. Specifically, adolescents with depression who experience low self-esteem, internet use, or suffer from sleep disturbance face an increased risk of NSSI. An integrated risk index for NSSI exhibits excellent accuracy in identifying depressed adolescents at risk of NSSI (area under the curve = 0.86, sensitivity = 0.88, specificity = 0.69). In the validation cohort, the identification performance remains strong (area under the curve = 0.84, sensitivity = 0.72, specificity = 0.81).

Conclusion

This study highlighted the role of self-esteem, internet use and sleep disturbance in the development of NSSI. The risk index diagnosing NSSI onset may help to guide the design and application of novel interventions to minimize this risky behavior in future depressed adolescents.

Effects of smartphone-based hypnotic intervention for undergraduate students' shyness during the COVID-19 pandemic: A randomized controlled trial

BACKGROUND

Since the outbreak of the COVID-19 pandemic, university students have been exposed to a heightened vulnerability towards developing psychological issues, such as psychological distress and shyness. Internet-based interventions offer a convenient avenue for scalability, thus prompting the development of a smartphone-based hypnotic intervention aimed at addressing shyness among university students.

OBJECTIVE

We devised an innovative smartphone-based hypnotic intervention called mHypnosis to examine its impact on shyness among undergraduate students. Furthermore, we aimed to investigate whether the apprehension of negative evaluations before treatment could serve as a predictor for the effectiveness of the intervention on shyness.

METHODS

Eighty students with high shyness scores were randomly assigned to the experimental group and the control group. Another 40 participants with low shyness score were selected as the baseline group. The Shyness Scale (SS), Fear of Negative evaluation scale (FNE), Self-Acceptance Questionnaire (SAQ), and Self-Esteem Scale (SES) were used to evaluate the effect of hypnotic intervention.

RESULTS

Before the intervention, the scores of the experimental and control groups on the SS, FNE, SAQ, and SES were higher than those in the baseline group (p < 0.05). There was no significant difference in scores between the experimental and control group (p > 0.05). After the intervention, the scores of the SS, FNE, SAQ, and SES were significantly lower in the experimental group than those in the control group (p < 0.05). The pretest score of FNE could predict the shyness score after hypnotic intervention (B = 0.35, p < 0.05).

CONCLUSION

Smartphone-based hypnotic intervention had a significant effect on ameliorating shyness during the COVID-19 pandemic; fear of negative evaluation can be a target for treating shyness.

Exploring the Nexus between Moderate-to-Vigorous Physical Activity, Self-Disclosure, Social Anxiety, and Adolescent Social Avoidance: Insights from a Cross-Sectional Study in Central China

Objectives: Psychological issues among adolescents represent a prevalent challenge in today's society. The purpose of this study is to explore the associations among moderate-to-vigorous physical activity, self-disclosure, social anxiety, and social avoidance in adolescents. Methods: This study collected cross-sectional data from 427 students in eight provincial key junior and senior high schools in the central China region of three provinces using snowball sampling and convenience sampling from July to August 2023. A structural equation model was employed to investigate the relationship between moderate-to-vigorous physical activity and social avoidance among adolescents. Results: The findings indicate that moderate-to-vigorous physical activity is negatively correlated with social anxiety (standardized coefficient = -0.219, p < 0.001) and positively correlated with self-disclosure (standardized coefficient = 0.454, p < 0.001). Social anxiety is negatively correlated with self-disclosure (standardized coefficient = -0.220, p < 0.001). Social avoidance is positively correlated with social anxiety (standardized coefficient = 0.461, p < 0.001) and negatively correlated with self-disclosure (standardized coefficient = -0.331, p < 0.001). Conclusions: The chain-mediated dual-path model between moderate-to-vigorous physical activity and social avoidance is facilitated by social anxiety and self-disclosure. In other words, adolescents who engage in more moderate to high-intensity physical activities exhibit lower levels of social anxiety, and those who have a stronger inclination for self-disclosure tend to demonstrate lower levels of social avoidance. In light of these findings, it is recommended that the government, society, schools, and families collaborate synergistically to promote the holistic well-being of adolescents and advance the development of a healthier China.

Gender differences in vitiligo: psychological symptoms and quality of life assessment description

Objective

Assuming that the difference exist in the manifestation of psychological suffering among genders, the purpose of this review is to summarize the current knowledge on gender differences in vitiligo quality of life and psychological assessment.

Methods

We searched in PubMed, Scopus, and Web of Science databases for original articles in English language. Results were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist).

Results

The study yielded 107 results; 12 articles have been evaluated as eligible. Each eligible study has been screened and analyzed. The study's qualitative evaluation revealed that 8 papers were classifiable as satisfactory, 4 were classifiable as unsatisfactory. The agreement between the coders was high (% agreement = 84.6%; Cohen's kappa = 0.79). All considered researches (100%) were cross-sectional studies, based on self-report questionnaires. From our analysis, women with vitiligo had a higher risk to experience lower quality of life, and worse mental health in a wide range of psychopathology symptoms than men. A wide heterogeneity of tools is used to investigate the quality of life and psychological symptoms among these patients.

Conclusion

Unfortunately, there are few explanatory models proposed in the literature to rationalize these findings. It will be important to investigate in further researches the specific influence of known risk factors for psychopathology in this population to better explore these phenomena.

Autistic traits predict social avoidance and distress: The chain mediating role of perceived stress and interpersonal alienation

Social avoidance and distress are the primary aspects of social anxiety. Nonautistic people with high levels of autistic traits are more likely to exhibit social avoidance and distress. However, research has yet to reveal how autistic traits induce social avoidance and distress. To fill this gap, the present study recruited 708 participants to complete the 25-item Autism Spectrum Quotient, Social Avoidance and Distress Scale, Chinese Perceived Stress Scale, and Interpersonal Alienation Subscale. The results indicated that autistic traits significantly predicted social avoidance and distress in nonautistic people. In addition, autistic traits induced social avoidance and distress through perceived stress and interpersonal alienation, respectively. Importantly, perceived stress and interpersonal alienation (including the subdimensions of interpersonal alienation: sense of loneliness, sense of social isolation, and alienation between family members) partially mediated the relationships between autistic traits and social avoidance and distress. Overall, autistic traits predict social avoidance and distress via perceived stress and interpersonal alienation. This finding extends the hypothetical model of clinical anxiety in autism spectrum disorders. Furthermore, reducing perceived stress and interpersonal alienation in nonautistic people with high levels of autistic traits may be a valid intervention method to prevent and eliminate their social avoidance and distress.

Metacognitive beliefs predict interpersonal problems in patients with social anxiety disorder

Patients with Social Anxiety Disorder (SAD) typically report interpersonal problems, and these are important targets in treatment beyond social anxiety symptoms as they impair quality of life, maintain emotion symptoms and effect on social functioning. What factors contribute to interpersonal problems? In the current study we set out to explore the role of metacognitive beliefs as correlates of interpersonal problems in patients treated for SAD when controlling for the effect of social phobic cognitions and symptoms. The sample consisted of 52 patients with a primary diagnosis of SAD participating in a randomized controlled trial comparing cognitive therapy, paroxetine, pill placebo, or the combination of cognitive therapy and paroxetine in treating SAD. Two hierarchical multiple linear regression analyses were conducted to explore change in metacognitions as predictors of change in interpersonal problems when controlling for change in social phobic cognitions and social anxiety. Change in metacognitions accounted for unique variance in interpersonal problems improvement beyond change in cognitions. Furthermore, change in cognitions overlapped with change in social anxiety symptoms, and when controlling the overlap between these three predictors, only change in metacognitions was uniquely associated with improvement in interpersonal problems. This finding indicates that metacognitions are linked to interpersonal problems in patients with SAD with the implication that treatment should aim to modify metacognitive beliefs to alleviate interpersonal dysfunction.

An Initial examination of fear of negative and positive evaluation in youth

Fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are both core features of social anxiety. The majority of research with these constructs has been done with older adolescents and adults, with only one previous study examining FNE and FPE in childhood. However, this previous work relied exclusively on parent-report of youth FNE and FPE. Here, we examined the factor structure of FNE and FPE using youth self-reports. Moreover, we examined the associations with dimensions of internalizing and externalizing problems. We found that two-factor structure of FNE and FPE was a marginal fit to the data. Exploratory models identified three items that showed significant cross-loadings on non-target factors. Overall, we found that FNE was associated with dimensions of internalizing problems reported by youth and their mothers. FPE was associated with internalizing problems reported by youth, but not parents. Associations between FNE and clinical outcomes were stronger than those for FPE. This study demonstrates promise of FNE and FPE in youth and highlights important directions for future research.

A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial

BACKGROUND

Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student's sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors.

OBJECTIVE

This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way.

METHODS

To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus.

RESULTS

In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of -2 to +2) and had a high completion rate (>97%).

CONCLUSIONS

This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class.

TRIAL REGISTRATION

OSF Registries osf.io/4ca68 http://osf.io/4ca68.

Induced interpretation bias affects free recall and episodic memory bias in social anxiety

The combined effect of each cognitive bias, interpretation, attention, and memory bias, is known to play a causal role in the etiology and maintenance of social anxiety. However, little is known about how each type of bias (i.e., interpretation, memory bias) acts during social anxiety. The present study aimed to investigate whether experimentally induced interpretation bias using the cognitive bias modification (CBM) paradigm would influence free recall and episodic memory biases in a Korean sample. A total of 61 participants were randomly assigned to either a positive (n = 30) or negative (n = 31) CBM group. The study used CBM scenarios that were auditory-specific and focused on social anxiety symptoms. The results showed that interpretation biases could be induced, and they resulted in training congruent state mood and memory biases on both free-recall memory and autobiographical memory, which partly confirmed the combined cognitive biases hypothesis proposed by Hirsch, Clark (1).

Relationship between types of anxiety and the ability to recognize facial expressions

This study examined whether three subtypes of anxiety (trait anxiety, state anxiety, and social anxiety) have different effects on recognition of facial expressions. One hundred and thirty-eight participants matched facial expressions of three intensity levels (20 %, 40 %, 100 %) with one of the six emotion labels ("happy", "sad", "fear", "angry", "disgust", and "surprise"). While using a conventional method of analysis we were able to replicate some significant correlations between each anxiety type and recognition performance found in the literature. However, when we used partial correlation to isolate the effect of each anxiety type, most of these correlations were no longer significant, apart from the negative correlations between Beck Anxiety Inventory and reaction time to fearful faces displayed at 40 % intensity level, and the correlations between anxiety and categorisation errors. Specifically, social anxiety was positively correlated with misidentifying a happy face as a disgust face at 40 % intensity level, and state anxiety negatively correlated with misidentifying a happy face as a sad face at 20 % intensity level. However, these partial correlation analyses became non-significant after p value adjustment for multiple comparisons. Our eye tracking data also showed that state anxiety may be associated with reduced fixations on the eye regions of low-intensity sad or fearful faces. These analyses cast doubts on some effects reported in the previous studies because they are likely to reflect a mixture of influences from highly correlated anxiety subtypes.

The role of personality traits in mediating the relation between fear of negative evaluation and social interaction anxiety

Introduction

Social interaction anxiety and fear of negative evaluation have many maladaptive outcomes and, in order to counteract their effects, it is essential to identify those psychological or social factors that make people vulnerable to them. One of these factors is the individual's personality structure: some personality traits increase the individuals' vulnerability to symptoms of social anxiety, while others protect them.

Methods

The aim of this paper is to analyse the role of HEXACO personality traits in mediating the relationship between fear of negative evaluation and social anxiety, in a sample of 352 cadets from the Land Forces Academy of Sibiu. The relationships between these concepts were analysed using structural equation modeling (SEM) in several hypothetical models, two of which were ultimately validated.

Results

In the first model, the fear of negative evaluation has an indirect effect on social interaction anxiety through the mediation of extraversion, conscientiousness, and altruism, separately. Furthermore, extraversion, conscientiousness, and altruism play a serial mediating role in the association between the fear of negative evaluation and social interaction anxiety. In the second model, the fear of negative evaluation has an indirect effect on social interaction anxiety through the mediation of social boldness, liveliness, and organization, separately, but not through altruism. Social boldness, liveliness, and organization played a serial mediating role in the relationship between the two constructs, while altruism moderated the relationship between liveliness, organization, and social interaction anxiety.

Discussion

Analysing the relationship between the individuals' personality traits, social anxiety, and fear of negative evaluation facilitated the identification of ways to cultivate desirable behaviours in social environments typified by compliance, discipline, uniformity, and rigor.

Association between bullying victimization and post-traumatic stress disorders among Chinese adolescents: a multiple mediation model

BACKGROUND

Research that focused on the mechanisms underlying the relation between school bullying victimization and PTSD ignored the simultaneous effect of emotional and cognitive factors, which may limit our comprehensive understanding of their roles. Besides, most researchers included non-bullying victims in data analysis, and this may mask the true effect among bullying victims. The present study aimed to explore the relation between bullying victimization and PTSD, and the mediating roles of social anxiety, loneliness, and rumination, after filtering out non-bullying victims.

MATERIALS AND METHODS

In April 2019, we used convenience sampling to recruit 5013 students from Grade 10 and 11 in two high schools in Anhui Province, China. The mean age of these students was 16.77 (SD = 0.92) years. They completed five self-report questionnaires including the Delaware Bullying Victimization Scale-Student Chinese Revision (DBVS-S), the modified PTSD Checklist, the Social Anxiety Scale, the Adolescent Loneliness Scale, and the Rumination Scale. Further, a total of 443 bullying victims were screened out for this study according to the critical score of the DBVS-S.

RESULTS

The results showed that bullying victimization had a direct and positive association with PTSD among adolescents (β = 0.16, 95%CI: 0.046-0.252). Bullying victimization was positively associated with PTSD through increasing adolescents' social anxiety (β = 0.06, 95%CI: 0.017-0.105), as well as through increasing their loneliness (β = 0.16, 95%CI: 0.109-0.215). In addition, bullying victimization was positively associated with PTSD through social anxiety via loneliness (β = 0.04, 95%CI: 0.013-0.067), as well as through loneliness via rumination (β = 0.02, 95%CI: 0.003-0.033). Bullying victimization was also positively associated with PTSD through a three-step path from social anxiety to rumination via loneliness (β = 0.004, 95%CI: 0.001-0.009).

CONCLUSIONS

Social anxiety, loneliness, and rumination have important mediating effects in the relation between bullying victimization and adolescents' PTSD, in which emotional factors (e.g., social anxiety, loneliness) are more crucial than cognitive factors (e.g., rumination). Intervention should pay more attention to timely alleviate victims' emotional problems to reduce the risk of developing PTSD.

A scoping review of emotions and related constructs in simulation-based education research articles

BACKGROUND

While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows.

METHODS

The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses.

RESULTS

A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence.

CONCLUSIONS

Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.

Efficacy of social cognition and interaction training in outpatients with schizophrenia spectrum disorders: randomized controlled trial

Given the relationship between social cognition and functional outcome in schizophrenia, a number of social cognitive interventions have been developed, including Social Cognition Interaction Training (SCIT), a group-based, comprehensive, manualized intervention. In the current trial, we examined SCIT efficacy as well as potential moderators of treatment effects. Fifty-one outpatients were randomized to SCIT or a wait-list-control (WLC), with assessments of social cognition, neurocognition, self-report, symptoms, and functioning conducted at baseline and end of the active phase. Relative to WLC, we did not find significant improvements for SCIT on neurocognition, social cognition, self-report, or symptoms, though there was a trend-level, medium effect favoring the SCIT condition on interpersonal and instrumental role function. Post-hoc analyses indicated that baseline neurocognition did not impact degree of social cognitive or functional change. Shorter duration of illness was significantly associated with better post-training neurocognition and self-esteem and, at trend-level with better symptoms and social functioning. We discuss the importance of outcome measure selection and the need for continued evaluation of potential treatment moderators in order to better match people to existing treatments. Clinical trial registration: Clinicaltrials.gov, Identifier NCT00587561.

Neuronal signatures of anger and fear in patients with psychosis

The present study investigated the functional neuroanatomy in response to sentence stimuli related to anger-provoking situations and fear of negative evaluation in patients with psychosis. The tasks consisted of four active conditions, Self-Anger (SA), Self-Fear, Other-Anger (OA), and Other-Fear (OF), and two neutral conditions, Neutral-Anger (NA) and Neutral-Fear (NF). Several relevant clinical measures were obtained. Under all contrasts, significantly higher activation in the left inferior parietal gyrus or superior parietal gyrus and the left middle occipital gyrus or superior occipital gyrus was observed in patients compared to healthy controls (HCs). However, we observed significantly lower activation in the left angular gyrus (AG) and left middle temporal gyrus (MTG) under the OA vs. NA contrast, as well as in the left precuneus and left posterior cingulate gyrus (PCG) under the OF vs. NF contrast in patients. The mean beta values for the significant regions under the SA vs. NA and OF vs. NF contrasts were significantly associated with the total PI and PANSS scores, respectively. These findings indicate that patients with psychosis exhibit hypoactivation in the AG, MTG, precuneus, and PCG compared to HCs. The findings suggest that patients with psychosis are less efficient at recruiting neural responses in those regions for semantic processing and social evaluation.

More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder

BACKGROUND

Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time.

METHODS

102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test.

RESULTS

CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test.

CONCLUSIONS

When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.

Specific facial signals associate with categories of social actions conveyed through questions

The early recognition of fundamental social actions, like questions, is crucial for understanding the speaker's intended message and planning a timely response in conversation. Questions themselves may express more than one social action category (e.g., an information request "What time is it?", an invitation "Will you come to my party?" or a criticism "Are you crazy?"). Although human language use occurs predominantly in a multimodal context, prior research on social actions has mainly focused on the verbal modality. This study breaks new ground by investigating how conversational facial signals may map onto the expression of different types of social actions conveyed through questions. The distribution, timing, and temporal organization of facial signals across social actions was analysed in a rich corpus of naturalistic, dyadic face-to-face Dutch conversations. These social actions were: Information Requests, Understanding Checks, Self-Directed questions, Stance or Sentiment questions, Other-Initiated Repairs, Active Participation questions, questions for Structuring, Initiating or Maintaining Conversation, and Plans and Actions questions. This is the first study to reveal differences in distribution and timing of facial signals across different types of social actions. The findings raise the possibility that facial signals may facilitate social action recognition during language processing in multimodal face-to-face interaction.

Comparison of Cognitive Behavioral Therapy and Cognitive Behavioral Group Therapy in the Treatment of Avoidant Personality Disorder

The primary aim of this study is to compile studies on cognitive behavioral therapy method in the treatment of avoidant personality disorder and present their data. Another aim is to discuss with the reasons, cognitive behavior group therapies may be more effective on this disorder than cognitive behavioral individual therapies, since the main problem in avoidant personality disorder stems from interpersonal communication and because the cognitive behavioral therapies applied as a group were found to be quite effective when the avoidant personality disorder was first defined. The aim of this study is to present recommendations together and to compile studies in which cognitive behavioral group therapies were applied on avoidant personality disorder. In this study, studies in domestic and foreign sources, which were conducted with a sample group with avoidant personality disorder and social anxiety disorder, were examined and the study was prepared by reviewing the literature, which is one of the secondary data collection techniques. Since there are not many studies on avoidant personality disorder in the literature, considering the high similarity and comorbidity of avoidant personality disorder with social anxiety disorder, studies on cognitive behavioral group therapies related to social anxiety disorder have also been compiled. As a result of the studies examined, it has been found that the symptoms of avoidant personality disorder are related to the distorted cognition of individuals and cognitive behavioral therapies are a very effective approach because they increase the awareness of the automatic thoughts in the minds of the clients, question their correctness and provide alternative thoughts to replace them.

Problem Solving and Emotion Coping Styles for Social Anxiety: A Meta-analysis of Chinese Mainland Students

Studies of how positive and negative coping styles affect social anxiety show mixed results. Hence, our two meta-analyses determined the overall effect sizes of problem solving-focused coping (PSC) styles and emotion-focused coping (EFC) styles on social anxiety in mainland China (PSC: k = 49 studies, N = 34,669; EFC: k = 52, N = 36,531). PSC was negatively linked to social anxiety (- .198), and EFC was positively linked to social anxiety (.223). In years with more national income, PSC's and EFC's effect sizes were larger. PSC's effect sizes were smaller among rural students (vs. urban students), larger among older students (university, high school, middle school), and larger in cross-sectional (vs. longitudinal) studies. When using SAD (vs. others) social anxiety measures, PSC effect sizes were larger, but EFC effect sizes were smaller. EFC effect sizes were larger in studies with convenience (vs. representative) samples. Gender, single child status, and coping style measurement showed no moderation effects. These findings suggest that using problem solving-focused coping styles rather than emotion-focused may reduce social anxiety, so future experimental studies can test this idea more rigorously.

Cosmetic satisfaction and patient-reported outcome measures following cranioplasty after craniectomy - A prospective cohort study

Introduction

Evaluating patient-reported outcomes (PROMs) helps optimize preoperative counseling and psychosocial care for patients who underwent cranioplasty.

Research question

This study aimed to evaluate cosmetic satisfaction, level of self-esteem, and fear of negative evaluation (FNE) of patients who underwent cranioplasty.

Material and methods

Patients who underwent cranioplasty from 1 January 2014 to 31 December 2020 ​at University Medical Center Utrecht and a control group consisting of our center' employees were invited to fill out the Craniofacial Surgery Outcomes Questionnaire (CSO-Q), consisting of an assessment of cosmetic satisfaction, the Rosenberg Self-Esteem Scale (RSES), and the FNE scale. To test for differences in results, chi-square tests and T-tests were performed. Logistic regression was used to study the effect of cranioplasty-related variables on cosmetic satisfaction.

Results

Cosmetic satisfaction was seen in 44/80 patients (55.0%) and 52/70 controls (74.3%) (p ​= ​0.247). Thirteen patients (16.3%) and 8 controls (11.4%) had high self-esteem (p ​= ​0.362), 51 patients (63.8%) and 59 controls (84.3%) had normal self-esteem (p ​= ​0.114), and 7 patients (8.8%) and 3 controls (4.3%) had low self-esteem (p ​= ​0.337). Forty-nine patients (61.3%) and 39 controls (55.7%) had low FNE (p ​= ​0.012), 8 patients (10.0%) and 18 controls (25.7%) had average FNE (p ​= ​0.095), and 6 patients (7.5%) and 13 controls (18.6%) had high FNE (p ​= ​0.215). Cosmetic satisfaction was associated with glass fiber-reinforced composite implants (OR 8.20, p-value ​= ​0.04).

Discussion and conclusion

This study prospectively evaluated PROMs following cranioplasty, for which we found favorable results.

The Aspects of Active-Learning Science Courses That Exacerbate and Alleviate Depression in Undergraduates

College science courses continue to transition from traditional lecture to active learning, which has been shown to have both alleviating and exacerbating effects on undergraduate mental health. Notably, existing studies have primarily examined the relationship between active learning and anxiety, and no studies have specifically assessed the relationship between active learning and depression. To address this gap, we conducted hourlong exploratory interviews with 29 undergraduates from six institutions who identify as having depression and who had been enrolled in at least one active-learning college science course. We probed how undergraduates' depression affects their experiences in active learning, and in turn, what aspects of active-learning practices exacerbate or alleviate students' depressive symptoms. Students described that their depression negatively impacted their cognitive domains, which could make learning and social interactions challenging. Additionally, we found that the underlying aspects of active-learning practices that impact students' depression fall into four overarching categories: opportunities to compare oneself with others, socializing with others while learning, frequent formative evaluation, and engagement in learning. Each of these aspects of active learning could alleviate and/or exacerbate depressive symptoms. This work supports recommendations to create more inclusive active-learning courses for students with depression.

Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis

PURPOSE

The goal of this study is to investigate the social isolation (SI) subtypes of patients with breast cancer (BC) and to explore its influencing factors.

METHODS

A sample of 303 BC patients participated in the study from September to December, 2021. Latent profile analysis (LPA) was performed to identify SI clusters based on the three sub-scales of the Chinese version of the Social Anxiety Scale, the Chinese version of the Social Avoidance and Distress Scale, and the Chinese version of the Loneliness Scale.

RESULTS

We found that SI can be divided into three categories: high-level (Class 1), middle-level (Class 2), and low-level (Class 3), accounting for 20.46%, 33.00%, and 46.54%, respectively. Compared to Class 3, Class 1, which had the lower average monthly income per family member (RMB) (< 3000: OR = 5.298, P = .021; 3000 ~ 5000: OR = 5.320, P = .018), was more likely to suffer from SI due to occupation (Laborer: OR = 12.023, P = .009). Surgery (OR = 14.138, P < .001; OR = 2.777, P = .020), chemotherapy (OR = 10.224, P = .001; OR = 3.545, P = .001); poorer family functioning (OR = .671, P < .001; OR = .801, P = .002), and lower levels of self-transcendence (OR = .806, P < .001; OR = .911, P < .001) were important influencing factors for SI in Class 1 and Class 2 compared to Class 3.

CONCLUSION

SI is classifiably heterogeneous among patients with BC. Strategies that identify characteristics of SI and give targeted intervention focusing on family functioning and improving self-transcendence levels contribute to the prevention of SI among patients with BC.

Social distance of bystanders affects people's embarrassment via changing fear of negative evaluation and feelings of attachment security

BACKGROUND

Embarrassment is a self-conscious emotion with important social functions, but it is not well understood. The perception of bystanders is considered a precondition for embarrassment, which makes it unique from other self-conscious emotions. Studies have shown that socially close bystanders can reduce individuals' embarrassment. However, whether and how the embarrassment of individuals varies with the changes in social distance between them and their bystanders remained unclear, which indicates the key characteristics of embarrassment.

METHODS

The current research consists of two studies. Study 1 tested whether participants' embarrassment systematically varied with social distance by setting up three levels of social distance: close friends (i.e., short), casual friends (i.e., medium), and strangers (i.e., long), based on 159 participants. With two full mediation models, study 2 investigated whether and how the fear of negative evaluation and state attachment security mediated the influence of social distance on embarrassment based on 155 participants.

CONCLUSIONS

The current findings revealed that the social distance between bystanders and protagonists systematically influenced the embarrassment of protagonists and this effect occurred via two parallel pathways, i.e., by increasing the fear of negative evaluation and by reducing state attachment security. The findings not only showed the unique role of bystander characteristics on embarrassment, but also two cognitive processes behind this unique self-conscious emotion: fearing negative evaluation and seeking attachment for security.

Parental phubbing and academic burnout in adolescents: the role of social anxiety and self-control

Based on the limited resource model of self-control, we construct a chain mediation model to examine the relationship between parental phubbing and adolescents' academic burnout, and whether social anxiety and self-control play a mediating role in it. We used 4 questionnaires to investigate parental phubbing, social anxiety, self-control, and adolescents' academic burnout among 828 high school students in Wuhu and Huangshan City, Anhui Province, China. The findings indicated that: (1) parental phubbing, social anxiety, and self-control all significantly predict adolescents' academic burnout directly and (2) parental phubbing could indirectly influence adolescents' academic burnout through three pathways: the separate mediating effect of social anxiety and self-control, and the chain mediating effect on both. The results of this study help parents understand how their phubbing actions affect adolescents' academic burnout and the mechanism of action.

Modification of the therapist's facial expressions using virtual reality technology during the treatment of social anxiety disorder: a case series

Exposure therapy is a mainstream of treatment for social anxiety disorder (SAD). However, effort and time are required to recreate interpersonal situations that produce moderate anxiety. On the other hand, virtual reality exposure therapy can easily control anxiety-inducing conditions and allow for graduated exposure. However, artificial intelligence and animations that speak as naturally as actual humans are not yet practical, adding to the limitations of these treatments. The authors propose the use of a virtual reality technology that can transform facial expressions into smiling or sad faces in real time and display them on a monitor, potentially solving the above-mentioned problems associated with virtual reality animations. This feasibility study was conducted to determine whether this system can be safely applied to the treatment of SAD patients. A total of four SAD patients received 16 exposure therapy sessions led by an experienced therapist over a monitor; throughout the sessions, the facial expressions of the therapist were modified using software to display expressions ranging from smiling to sad on the monitor that was being viewed by the patient. Client satisfaction, treatment alliance, and symptom assessments were then conducted. Although one patient dropped out of the study, treatment satisfaction and treatment alliance were scored high in all the cases. In two of the four cases, the improvement in symptoms was sustained over time. Exposure therapy in which the interviewer's facial expressions are modified to induce appropriate levels of anxiety in the patient can be safely used for the treatment of SAD patients and may be effective for some patients.

The current state-of-the-art in pharmacotherapy for pediatric generalized anxiety disorder

INTRODUCTION

Anxiety disorders are the most prevalent psychiatric disorders among youth. Among the various anxiety disorders, generalized anxiety disorder is particularly prevalent. Youth with GAD appear at elevated risk of developing other anxiety disorders, mood disorder, and substance use disorders. Functional outcomes of youth with GAD can be improved through early recognition and treatment, thus promoting better longer-term outcomes.

AREAS COVERED

The current article summarizes evidence-based state-of-the-art pharmacotherapy for pediatric GAD based on open-label, randomized, and controlled trials. Two electronic databases (PubMed and Scopus) were systematically searched in April 2022 for relevant publications.

EXPERT OPINION

The literature supports a combination of psychotherapy and pharmacotherapy as being associated with better outcomes when compared to mono-therapies. While longer-term follow-ups are limited, one such study does challenge this notion. Both selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) have been found across studies to have moderate effect sizes in the treatment of pediatric anxiety disorders. SSRIs continue to be a first-line intervention, whereas SNRIs may be considered a second-line treatment. While more evidence is needed, there are emerging data indicating that SSRIs are associated with a more rapid and greater reduction in anxiety symptoms when compared to SNRIs.

A boost in self-esteem after positive social evaluation predicts social and non-social learning

Fluctuations in self-esteem resulting from social acceptance and rejection could guide social behaviour by putting us in a state that is more or less open to social experiences. However, it remains unclear whether social acceptance and rejection may shape learning from social information depending on individual differences in self-esteem changes. Here we used a social feedback paradigm to manipulate social acceptance and rejection in a between-subjects design. Subsequently, we administered a behavioural task that enables the assessment of how well individuals learn on the basis of own experiences versus social information. Participants receiving positive (N = 43) versus negative (N = 44) social evaluation demonstrated an increase in subjective self-esteem. Importantly, the effect of the social evaluation on social learning was moderated by self-esteem changes. Specifically, an increase in self-esteem, as induced by positive evaluation, was associated with increased learning from social, but decreased learning from individual information. A decrease in self-esteem in response to negative evaluation was associated with decreased learning from individual information. These data suggest that increases in self-esteem in response to positive evaluation can induce a shift in the inclination to use social versus non-social information and may open one up to constructive learning from others.

Context and domain matter: the error-related negativity in peer presence predicts fear of negative evaluation, not global social anxiety, in adolescents

BACKGROUND

Social anxiety symptoms are most likely to emerge during adolescence, a developmental window marked by heightened concern over peer evaluation. However, the neurocognitive mechanism(s) underlying adolescent social anxiety remain unclear. Emerging work points to the error-related negativity (ERN) as a potential neural marker of exaggerated self/error-monitoring in social anxiety, particularly for errors committed in front of peers. However, social anxiety symptoms are marked by heterogeneity and it remains unclear exactly what domain(s) of social anxiety symptoms are associated with ERN variation in peer presence, particularly within the adolescent period.

METHODS

To advance and deepen the mechanistic understanding of the ERN's putative role as a neural marker for social anxiety in adolescence, we leveraged a social manipulation procedure and assessed a developmentally salient domain of social anxiety during adolescence - fear of negative evaluation (FNE). Adolescents residing in Hanzhong, a small city in the southwestern region of mainland China, had EEG recorded while performing a flanker task, twice (peer presence/absence); FNE, as well as global social anxiety symptoms, was assessed.

RESULTS

Overall ERN increases in peer presence. FNE specifically, but not global levels of social anxiety symptoms, predicted ERN in peer presence.

CONCLUSIONS

These data are the first demonstration that the ERN relates to a specific domain of social anxiety in adolescents, as well as the first evidence of such relations within a non-WEIRD (Western, Educated, Industrialized, Rich and Democratic) sample. Results have important implications for theory and research into adolescent social anxiety.