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Neufeld CB, Palma PC, Caetano KA, Brust-Renck PG, Curtiss J, Hofmann SG. A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder. Int J Clin Health Psychol 2019; 20:29-37. [PMID: 32021616 PMCID: PMC6994736 DOI: 10.1016/j.ijchp.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions-an individual and a group intervention-in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms.
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Affiliation(s)
- Carmem Beatriz Neufeld
- Universidade de São Paulo, Brazil
- Corresponding author. Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil.
| | | | - Kátia A.S. Caetano
- Universidade de São Paulo, Brazil
- Boston University, United States of America
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Disability profile/clinician-rated: validity for Brazilian university students with social anxiety disorder. SPANISH JOURNAL OF PSYCHOLOGY 2014; 16:E48. [PMID: 23866244 DOI: 10.1017/sjp.2013.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Functional impairment scales are important to assess Social Anxiety Disorder (SAD) patients. The present study aims to evaluate the reliability, internal consistency, validity and factorial structure of the Disability Profile/Clinician-Rate (DP) scale, as well as to present an interview-guide to support its application by clinicians. University students (n = 173) of both genders participated in the study (SAD = 84 and Non-SAD = 89), with ages ranging between 17 and 35 years, systematically diagnosed. The SAD group presented more difficulties when compared to the Non-SAD group. The DP presented, for the SAD group, internal consistency of 0.68 (lifetime) and 0.67 (last two weeks). Inter-rater reliability varied from 0.75 to 0.93. Two factors were extracted and the correlation among such factors and the Social Phobia Inventory subscales presented association between fear and avoidance symptoms and the functional impairments. The scale presents good psychometric properties and can contribute to the assessment of functional impairments.
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Paes F, Baczynski T, Novaes F, Marinho T, Arias-Carrión O, Budde H, Sack AT, Huston JP, Almada LF, Carta M, Silva AC, Nardi AE, Machado S. Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat Social Anxiety Disorder: Case Reports and a Review of the Literature. Clin Pract Epidemiol Ment Health 2013; 9:180-8. [PMID: 24278088 PMCID: PMC3837365 DOI: 10.2174/1745017901309010180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/11/2022]
Abstract
Objectives: Social anxiety disorder (SAD) is a common and debilitating anxiety disorders. However, few studies had been dedicated to the neurobiology underlying SAD until the last decade. Rates of non-responders to standard methods of treatment remain unsatisfactorily high of approximately 25%, including SAD. Advances in our understanding of SAD could lead to new treatment strategies. A potential non invasive therapeutic option is repetitive transcranial magnetic stimulation (rTMS). Thus, we reported two cases of SAD treated with rTMS Methods: The bibliographical search used Pubmed/Medline, ISI Web of Knowledge and Scielo databases. The terms chosen for the search were: anxiety disorders, neuroimaging, repetitive transcranial magnetic stimulation. Results: In most of the studies conducted on anxiety disorders, except SAD, the right prefrontal cortex (PFC), more specifically dorsolateral PFC was stimulated, with marked results when applying high-rTMS compared with studies stimulating the opposite side. However, according to the “valence hypothesis”, anxiety disorders might be characterized by an interhemispheric imbalance associated with increased right-hemispheric activity. With regard to the two cases treated with rTMS, we found a decrease in BDI, BAI and LSAS scores from baseline to follow-up. Conclusion: We hypothesize that the application of low-rTMS over the right medial PFC (mPFC; the main structure involved in SAD circuitry) combined with high-rTMS over the left mPFC, for at least 4 weeks on consecutive weekdays, may induce a balance in brain activity, opening an attractive therapeutic option for the treatment of SAD.
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Affiliation(s)
- Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil ; National Institute for Translational Medicine (INCT-TM), Brazil
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Binelli C, Ortiz A, Muñiz A, Gelabert E, Ferraz L, S Filho A, Crippa JAS, Nardi AE, Subirà S, Martín-Santos R. Social anxiety and negative early life events in university students. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2013; 34 Suppl 1:S69-74. [PMID: 22729450 DOI: 10.1590/s1516-44462012000500006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.
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Affiliation(s)
- Cynthia Binelli
- Department of Psychiatry, Hospital Parc Taulí, Barcelona, Spain
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Binelli C, Ortiz A, Muñiz A, Gelabert E, Ferraz L, Filho AS, Crippa JAS, Nardi AE, Subirà S, Martín-Santos R. Social anxiety and negative early life events in university students. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70055-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A review on predictors of treatment outcome in social anxiety disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70016-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mululo SCC, de Menezes GB, Vigne P, Fontenelle LF. A review on predictors of treatment outcome in social anxiety disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:92-100. [DOI: 10.1590/s1516-44462012000100016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/03/2011] [Indexed: 12/16/2022]
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Baptista CA, Loureiro SR, de Lima Osório F, Zuardi AW, Magalhães PV, Kapczinski F, Filho AS, Freitas-Ferrari MC, Crippa JAS. Social phobia in Brazilian university students: prevalence, under-recognition and academic impairment in women. J Affect Disord 2012; 136:857-61. [PMID: 22018945 DOI: 10.1016/j.jad.2011.09.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 07/02/2011] [Accepted: 09/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the fact that public speaking is a common academic activity and that social phobia has been associated with lower educational achievement and impaired academic performance, little research has examined the prevalence of social phobia in college students. The aim of this study was to evaluate the prevalence of social phobia in a large sample of Brazilian college students and to examine the academic impact of this disorder. METHODS The Social Phobia Inventory (SPIN) and the MINI-SPIN, used as the indicator of social phobia in the screening phase, were applied to 2319 randomly selected students from two Brazilian universities. For the second phase (diagnostic confirmation), four psychiatrists and one clinical psychologist administered the SCID-IV to subjects with MINI-SPIN scores of 6 or higher. RESULTS The prevalence of social phobia among the university students was 11.6%. Women with social phobia had significantly lower grades than those without the disorder. Fear of public speaking was the most common social fear. Only two of the 237 students with social phobia (0.8%) had previously received a diagnosis of social phobia and were under treatment. LIMITATIONS Social phobia comorbidities were not evaluated in this study. The methods of assessment employed by the universities (written exams) may mask the presence of social phobia. This was not a population-based study, and thus the results are not generalizable to the entire population with social phobia. CONCLUSION Preventive strategies are recommended to reduce the under-recognition and the adverse impact of social phobia on academic performance and overall quality of life of university students.
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Affiliation(s)
- Carlos Alberto Baptista
- Department of Neurosciences and Behavior, Division of Psychiatry, Faculty of Medicine of Ribeirão Preto, University of São Paulo and INCT Translational Medicine (INCT-TM, CNPq), Brazil
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Chagas MHN, Nardi AE, Manfro GG, Hetem LAB, Andrada NC, Levitan MN, Salum GA, Isolan L, Ferrari MCF, Crippa JAS. [Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder]. ACTA ACUST UNITED AC 2011; 32:444-52. [PMID: 21308267 DOI: 10.1590/s1516-44462010005000029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/14/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.
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Affiliation(s)
- Marcos Hortes N Chagas
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, and Hospital das Clínicas-Terceiro Andar, Ribeirão Preto, SP, Brazil
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Chen JT, Lin CC, Wang SC, Liao SC, Chen JY, Liu CY, Lee MB. Finding social phobia patients from the Internet. Psychiatry Res 2011; 190:121-5. [PMID: 21546095 DOI: 10.1016/j.psychres.2011.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 01/26/2011] [Accepted: 03/30/2011] [Indexed: 11/29/2022]
Abstract
Patients with social phobia commonly resist face-to-face assessments, and a number of alternative assessment methods based on the Internet are being developed. The aim of this study was to identify patients with social phobia on the Internet and characterize their condition, using the Social Phobia Inventory (SPIN). In Stage I, this study recruited 1307 participants from the Internet, most of whom were well-educated young females, who had remained unmarried and unemployed. The Internet-based SPIN demonstrated excellent internal consistency (Cronbach's α=0.937) and good test-retest reliability (intraclass correlation coefficient=0.942). In Stage II, we examined the discriminant validity of the SPIN via structured telephone interviews. The area under the receiver operating characteristic curve used to discriminate social phobia was 0.871 with an optimal cut-off point of 24 on the total score for the SPIN. According to the SPIN scores, 919 of Stage I participants (70.3%) reached the threshold of social phobia, 531 of which (57.8%) had never sought professional help. These results suggest that the Internet is a potential avenue through which to find untreated patients with social phobia.
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Affiliation(s)
- Jian-Ting Chen
- Department of General Psychiatry, Bali Psychiatric Center, New Taipei City, Taiwan
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Rodrigues H, Figueira I, Gonçalves R, Mendlowicz M, Macedo T, Ventura P. CBT for pharmacotherapy non-remitters--a systematic review of a next-step strategy. J Affect Disord 2011; 129:219-28. [PMID: 20863573 DOI: 10.1016/j.jad.2010.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 08/20/2010] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Non-remission rates to pharmacotherapy for anxiety disorders are related to higher relapse rates, decreased quality of life and greater functional impairment. Here we sought to investigate the efficacy of cognitive-behavior therapy (CBT) as a next-step strategy in the treatment of patients with anxiety disorders who did not remit after a pharmacological intervention. METHOD We carried out a systematic review in the ISI, Pubmed and PsycINFO/PsychLit databases. Studies that did not use CBT and that did not focus on resistance to drug therapy were excluded. We considered resistant patients who failed to respond (did not fully remit) to an adequate trial of pharmacotherapy and still exhibited residual symptoms of anxiety disorder. RESULTS We identified 603 references in our survey, of which 17 were included: eight were on OCD, five on panic disorder, and four on PTSD. No studies were found on social anxiety disorder and generalized anxiety disorder. We observed a lack of standardization of terminology and of definitions of resistance, which makes comparison of results difficult. Finally, all of the identified studies showed benefits from the addition of CBT as a next-step strategy. LIMITATIONS A limited number of randomized controlled studies were found. CONCLUSIONS CBT seems to be a promising next-step strategy for patients with anxiety disorders who did not remit with drug-based therapies. However, further clinical trials with strong methodological designs are needed to definitely establish its efficacy in this population.
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Affiliation(s)
- Helga Rodrigues
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil.
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Freitas-Ferrari MC, Hallak JEC, Trzesniak C, Filho AS, Machado-de-Sousa JP, Chagas MHN, Nardi AE, Crippa JAS. Neuroimaging in social anxiety disorder: a systematic review of the literature. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:565-80. [PMID: 20206659 DOI: 10.1016/j.pnpbp.2010.02.028] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/21/2010] [Accepted: 02/28/2010] [Indexed: 11/16/2022]
Abstract
Brain imaging techniques allow the in vivo evaluation of the human brain, leading to a better understanding of its anatomical, functional and metabolic substrate. The aim of this current report is to present a systematic and critical review of neuroimaging findings in Social Anxiety Disorder (SAD). A literature review was performed in the PubMed Medline, Scielo and Web of Science databases using the following keywords: 'MRI', 'functional', 'tomography', 'PET', 'SPECT', 'spectroscopy', 'relaxometry', 'tractography' and 'voxel' crossed one by one with the terms 'social anxiety' and 'social phobic', with no limit of time. We selected 196 articles and 48 of them were included in our review. Most of the included studies have explored the neural response to facial expressions of emotion, symptoms provocation paradigms, and disorder-related abnormalities in dopamine or serotonin neurotransmission. The most coherent finding among the brain imaging techniques reflects increased activity in limbic and paralimbic regions in SAD. The predominance of evidence implicating the amygdala strengthens the notion that it plays a crucial role in the pathophysiology of SAD. The observation of alterations in pre-frontal regions and the reduced activity observed in striatal and parietal areas show that much remains to be investigated within the complexity of SAD. Interesting, follow-up designed studies observed a decrease in perfusion in these same areas after either by pharmacological or psychological treatment. The medial prefrontal cortex provided additional support for a corticolimbic model of SAD pathophysiology, being a promising area to investigation. Furthermore, the dopaminergic and GABAergic hypotheses seem directed related to its physiopathology. The present review indicates that neuroimaging has contributed to a better understanding of the neurobiology of SAD. Although there were several methodological differences among the studies, the global results have often been consistent, reinforcing the evidence of a specific cerebral circuit involved in SAD, formed by limbic and cortical areas.
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Affiliation(s)
- Maria Cecilia Freitas-Ferrari
- Department of Neuroscience and Behavior of the Ribeirão Preto Medical School, University of São Paulo, INCT Translational Medicine (CNPq), São Paulo, Brazil
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