Instruments for the assessment of social anxiety disorder: Validation studies

Subjective, behavioral and neurobiological effects of cannabis and cannabinoids in social anxiety

Social anxiety disorder (SAD) is a debilitating disorder, characterized by fear and anxiety in social situations. Evidence suggests that the levels of SAD are rising, in particularly after the COVID-19 pandemic. Serotonin and noradrenaline reuptake inhibitors and cognitive-behavioral therapy are effective treatments for SAD. Nevertheless, a significant number of patients do not respond well to these therapeutic options. During the last years, Cannabis and cannabinoid-containing products have been investigated for the treatment of different neuropsychiatric disorders. Nevertheless, their efficacy for the treatment of anxiety disorders is still a matter of debate. The purpose of this review was to investigate subjective, behavioral, and neurobiological effects of Cannabis and cannabinoids in social anxiety and SAD. A search in the PubMed database for articles published between the years of 2003-2023 was conducted. One hundred and seventeen (117) original studies were identified. After the exclusion criteria, eighteen (18) studies were selected. The studies investigated the effects of the cannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in patients or healthy volunteers submitted to tasks that assessed social anxiety. Results showed that CBD decreases social anxiety, producing an inverted U-shaped curve, with anxiety measurements being reduced at intermediate doses administered orally (300-600 mg), but not at lower or higher doses. THC either reduces (lower doses, 6-7.5 mg) or increases (higher doses) social anxiety measurements. CBD attenuates the anxiogenic effects of THC. The effects of THC and CBD in anxiety are associated to the modulation of fronto-limbic regions. Further clinical trials, conducted with male and female patients and larger cohorts are still necessary to consolidate these results.

Molecular and neurocircuitry mechanisms of social avoidance

Humans and animals live in social relationships shaped by actions of approach and avoidance. Both are crucial for normal physical and mental development, survival, and well-being. Active withdrawal from social interaction is often induced by the perception of threat or unpleasant social experience and relies on adaptive mechanisms within neuronal networks associated with social behavior. In case of confrontation with overly strong or persistent stressors and/or dispositions of the affected individual, maladaptive processes in the neuronal circuitries and its associated transmitters and modulators lead to pathological social avoidance. This review focuses on active, fear-driven social avoidance, affected circuits within the mesocorticolimbic system and associated regions and a selection of molecular modulators that promise translational potential. A comprehensive review of human research in this field is followed by a reflection on animal studies that offer a broader and often more detailed range of analytical methodologies. Finally, we take a critical look at challenges that could be addressed in future translational research on fear-driven social avoidance.

Verbal Abuse Related to Self-Esteem Damage and Unjust Blame Harms Mental Health and Social Interaction in College Population

Verbal abuse is an emotional abuse intended to inflict intense humiliation-denigration-fear as perceived by exposed person. Network-based approaches have been applied to explore the integrative-segregated patterns of associations among the psychological features and external stimuli for diverse populations; few studies reported for verbal abuse effects in college population. Self-reporting measurements acquired form 5,616 college students were used for network analyses. Escalating cascades of verbal abuse from differential sources (parents, peers, or supervisors; network 1) and directed associations among verbal abuse severity-psychopathology-social interaction (network 2) were estimated using the directed acyclic graphs. Principal connectors of verbal abuse–psychopathology–social interaction were shown using the graph theory metrics calculated from the intra-individual covariance networks (network 3). Directed propagating patterns of verbal abuse phenomena differed by source (network 1). Severe peer-related verbal abuse affected psychomotor changes and influenced irritability (network 2). Verbal abuse of self-esteem damage and unjust blame served as connectors in the verbal abuse-psychopathology-social interaction; influence of smartphone overuse-related distress was stronger in cases with more severe verbal abuse (network 3). Verbal abuse that damages self-esteem and conveys unjust blame harms mental health and social interaction for college population.