Analogue observational methods in the assessment of social functioning in adults

This article provides a clinically oriented overview of analogue observational methods used in the assessment of problematic social functioning, specifically skill deficits and social anxiety. This article emphasizes role-play assessment methods, the predominant method used in clinical settings. An examination of the psychometric characteristics of analogue assessment methods is presented, followed by a review of procedural and structural considerations that may impact the quality of assessment data. Of special concern are the potential impacts of instructional variables, structured versus ideographic role-played situations, confederate characteristics and behavior, molar and molecular levels of assessment, self-ratings versus clinician ratings of functioning, and physical attractiveness. Finally, published and empirically evaluated analogue observation tests are critically reviewed with an emphasis on features that may impact their utility in clinical practice.

Generalization of social anxiety to sporting and athletic situations: gender, sports involvement, and parental pressure

Although researchers have documented that social anxiety may occur in a wide range of interpersonal and performance situations, little attention has been paid to the potential influence of social anxiety on participation in athletics or physical activity. The performance demands of sport and potential social evaluative nature of exercise make it likely that social anxiety would generalize to these situations. Given the physical and psychological benefits of engaging in regular physical activity, avoidance of such activities by socially anxious individuals may have profound health consequences. One-hundred and eighty undergraduate university students completed a battery of standardized social anxiety measures, and a series of 5-point Likert-type questions examining fear and avoidance of sporting and athletic situations. Results indicated that social anxiety and fear of negative evaluation were generally related to social-evaluative fears in sporting or athletic situations, particularly for women. Furthermore, social anxiety was positively correlated with avoidance of individual sporting activities, but not with avoidance of team activities. Further analyses revealed social anxiety did not differ by competition level. However, for men, familial pressure to play sports during high school was associated with higher fear of negative evaluation. Implications for the assessment and treatment of social anxiety disorder are discussed.

Analogue observational methods in the assessment of social functioning in adults

This article provides a clinically oriented overview of analogue observational methods used in the assessment of problematic social functioning, specifically skill deficits and social anxiety. This article emphasizes role-play assessment methods, the predominant method used in clinical settings. An examination of the psychometric characteristics of analogue assessment methods is presented, followed by a review of procedural and structural considerations that may impact the quality of assessment data. Of special concern are the potential impacts of instructional variables, structured versus ideographic role-played situations, confederate characteristics and behavior, molar and molecular levels of assessment, self-ratings versus clinician ratings of functioning, and physical attractiveness. Finally, published and empirically evaluated analogue observation tests are critically reviewed with an emphasis on features that may impact their utility in clinical practice.

PlantsP: a functional genomics database for plant phosphorylation

The PlantsP database is a curated database that combines information derived from sequences with experimental functional genomics information. PlantsP focuses on plant protein kinases and protein phosphatases. The database will specifically provide a resource for information on a collection of T-DNA insertion mutants (knockouts) in each protein kinase and phosphatase in Arabidopsis thaliana. PlantsP also provides a curated view of each protein that includes a comprehensive annotation of functionally related sequence motifs, sequence family definitions, alignments and phylogenetic trees, and descriptive information drawn directly from the literature. PlantsP is available at http://PlantsP.sdsc.edu.

Cognitive-behavioral group therapy versus phenelzine in social phobia: long-term outcome

To evaluate the effects of maintenance treatment and durability of gains after treatment discontinuation, responders to either phenelzine (PZ) or cognitive-behavioral group therapy (CBGT) from an acute trial comparing these two treatments as well as pill placebo and a psychotherapy control (educational supportive group therapy) were enrolled into maintenance and treatment-free follow-up phases.

EXPERIMENTAL DESIGN

Responders to an acute trial contrasting PZ and CBGT entered a six-month maintenance phase. Patients who continued to respond through the maintenance phase entered a six-month treatment free phase. Patients receiving pill placebo or educational supportive group therapy in the acute trial did not enter the long term study.

PRINCIPAL OBSERVATIONS

PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment-free follow-up. There was a greater relapse among patients with generalized social phobia with phenelzine.

CONCLUSIONS

PZ and cognitive-behavioral group therapy may differ in their long term effects. The superiority seen with PZ on some measures in the acute study persisted in patients who maintained their gains over the course of maintenance and treatment-free follow-up. However, CBGT may lead to a greater likelihood of maintaining response after treatment has terminated. Replication with larger samples is needed, as is a study of the acute and long-term efficacy of combined PZ and CBGT.

Future directions in the treatment of anxiety disorders: an examination of theory, basic science, public policy, psychotherapy research, clinical training, and practice

This article represents a transcribed roundtable discussion on anxiety disorders that took place at the 1998 Society for Psychotherapy Research in Snowbird, Utah. Eminent experts in the field of anxiety disorders took part in a discussion that focused on issues related to theory, basic science, public policy, therapy research, clinical training, and practice. Important topics addressed by the panel included the role of theory in research and clinical practice, the importance of psychopharmacological interventions, efficacy versus effectiveness research, the impact of public policy on research advancement, and the interface between basic science, research, and clinical practice.

Interpretive biases for ambiguous stimuli in social anxiety

A growing body of literature suggests that individuals with high levels of general anxiety form threatening interpretations of ambiguous events. Although theoretical formulations of pathological social anxiety emphasize the importance of a negative interpretive-style in the etiology and maintenance of the disorder, we are unaware of any study that documents this presumed phenomenon. To address this issue, we assessed for possible interpretive biases in a group of high and low socially-anxious students. The results indicated that socially-anxious subjects showed more threatening interpretations of ambiguous, interpersonal events when compared to the low-anxious participants. However, this bias was marked not so much by an outright negative interpretation style, but rather by a failure of the socially-anxious subjects to show a positive interpretation as was evinced by the low-anxious individuals. These group differences in interpretive style appeared to be influenced by trait aspects of social anxiety rather than differences in current mood state. No group differences emerged in interpretations of events that involved non-personal stimuli suggesting there is content specificity in the interpretive biases associated with social-anxiety.

Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome

BACKGROUND

This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy (CBGT) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia.

METHODS

One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill placebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibility to CBGT). The "allegiance effect," ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoretically divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment.

RESULTS

After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition. However, response to phenelzine therapy was more evident after 6 weeks, and phenelzine therapy was also superior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances.

CONCLUSIONS

After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive response. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect.

Successful interdisciplinary intervention with an initially treatment-resistant social phobic

Despite very successful treatments for social phobia, with many studies reporting as many as 75% of social phobics making clinically significant gains with 3 months of treatment or less, some social phobics fail to respond to treatment. This case presents a women with social phobia who received several trials of treatment for severe public-speaking fears but failed to improve, as demonstrated by persistent reports of fear and avoidance equal to those before treatment. With the assistance of a speech language pathologist, this client received combined therapy that included cognitive-behavioral therapy to treat her public-speaking fear and avoidance and voice therapy to treat excessive muscle contractions in the respiratory and phonatory systems. Overall, the combined treatment was successful, with the client's self-reported levels of fear and avoidance of public speaking decreasing dramatically. Specific improvements during voice therapy and implications for the treatment of social phobia are also discussed.

Genetic dissection of interaction between poliovirus 3D polymerase and viral protein 3AB

Poliovirus RNA-dependent RNA polymerase 3D and viral protein 3AB are both thought to be required for the initiation of RNA synthesis. These two proteins physically associate with each other and with viral RNA replication complexes found on virus-induced membranes in infected cells. An understanding of the interface between 3D and 3AB would provide a first step in visualizing the architecture of the multiprotein complex that is assembled during poliovirus infection to replicate and package the viral RNA genome. The identification of mutations in 3D that diminish 3D-3AB interactions without affecting other functions of 3D polymerase is needed to study the function of the 3D-3AB interaction in infected cells. We describe the use of the yeast two-hybrid system to isolate and characterize mutations in 3D polymerase that cause it to interact less efficiently with 3AB than wild-type polymerase. One mutation, a substitution of leucine for valine at position 391 (V391L), resulted in a 3AB-specific interaction defect in the two-hybrid system, causing a reduction in the interaction of 3D polymerase with 3AB but not with another viral protein or a host protein tested. In vitro, purified 3D-V391L polymerase bound to membrane-associated 3AB with reduced affinity. Poliovirus that contained the 3D-V391L mutation was temperature sensitive, displaying a pronounced conditional defect in RNA synthesis. We conclude that interaction between 3AB and 3D or 3D-containing polypeptides plays a role in RNA synthesis during poliovirus infection.

Cognition and social functioning in schizophrenia

This article reviews three studies investigating the relationship between information processing and social functioning in schizophrenia. The most consistent finding is the association between vigilance performance on a hybrid continuous performance/span of apprehension task and various indices of social functioning (e.g., ward behavior). However, the nature of the information processing-social functioning relationships is mutable and appears dependent on a number of factors (e.g., cross-sectional versus longitudinal designs). This article concludes with a discussion of treatment implications and future research directions.

The use of a non-invasive method to measure intrapulmonary shunt during one-lung anaesthesia

The Non Invasive Virtual Shunt computer program has previously been described and validated. The system has subsequently been developed to give a real time, continuous trace of virtual shunt. A portable computer connected to routine monitoring equipment displays a plot of virtual shunt updated every 10 s. A practical use of this device in the clinical setting of one-lung anaesthesia is described. The equipment was used to monitor shunt before, during and after surgery in three patients. In one case, a displaced double lumen bronchial tube was detected before there was any other indication of the problem.

Relationship between ADIS clinician's severity rating and self-report measures among social phobics

Although global clinical rating scales have been a mainstay of clinical research, little is known about the relationship between these measures and other assessment modalities. The present study examined the Clinician's Severity Rating (CSR) from the Anxiety Disorders Interview Schedule in a sample of 186 social phobics. It was hypothesized that the CSR would be related to higher fear of negative evaluation, behavioral avoidance, social anxiety, and dysphoria, and that four self-report measures reflecting each of these common features of social phobia would contribute individually to predict clinicians' judgments of clinical severity using the CSR. Multiple regression analyses supported these hypotheses, accounting for nearly 33% of the variance in the CSR. The role of subtype of social phobia was also investigated. Overall, these results support the utility of the CSR for use with social phobics, but the relatively low proportion of variance accounted for raises further questions. Directions for future research are also discussed.

Dismantling cognitive-behavioral group therapy for social phobia

The efficacy of Heimberg's (1991) Cognitive-Behavioral Group Therapy (CBGT) [Unpublished manuscript] for social phobia has been demonstrated in several studies in recent years. However, little is known about the mechanisms underlying the treatment's success. In order to determine whether the cognitive restructuring component of CBGT is essential, this study compared CBGT to an exposure-based treatment without formal cognitive restructuring. A wait-list control was also included. In general, Ss in the active treatment conditions improved and control Ss did not improve on a variety of self-report, clinician, and behavioral measures. Limited evidence indicated that Ss in the non-cognitive treatment may have made somewhat greater gains on some measures. Although CBGT Ss reported more improvement than exposure-alone Ss in subjective anxiety during an individualized behavioral test at posttreatment, this difference disappeared at 6-month follow-up. Surprisingly, CBGT was less effective than in previous controlled trials, and possible reasons for this are discussed. Implications of the results for cognitive theory and cognitive-behavioral therapy for social phobia are addressed.

Non-invasive estimation of venous admixture: validation of a new formula

We have developed a computer program that estimates venous admixture (intra-pulmonary shunt) from four measurements: haemoglobin concentration, end-tidal carbon dioxide tension (PE'CO2), fractional inspired oxygen concentration (FIO2) and pulse oximetry (SpO2). The formula was tested on patients in an intensive therapy unit by using it to estimate shunt while it was measured simultaneously by a standard, invasive method. A total of 101 measurements were made in 29 patients. After correcting the systematic errors in the assumed differences between PE'CO2 and arterial PCO2, and between SpO2 and co-oximetrically measured SaO2, and correcting for a trend in the arteriovenous oxygen concentration difference (C(a-v))2) with shunt, the bias of the non-invasive minus invasive shunt differences was negligible, with no significant dependence on shunt. The limits of agreement were then +/- 16% shunt overall (+/- 13% within patients). When SaO2 was used instead of SpO2, the limits were +/- 11% (+/- 8% within patients).

Information processing and social competence in chronic schizophrenia

The relationship between social competence and information processing among individuals with chronic schizophrenia was investigated. Thirty-eight inpatients participated in a role play test of social competence and completed a battery of information-processing tasks. Information processing was found to be significantly related to social competence, even after controlling for patient demographics, chronicity, and symptomatology. Higher global social competence was related to more efficient early information processing on a continuous performance/span of apprehension task. Composite indices of specific social competence (i.e., paralinguistic and nonverbal skills) were related to other aspects of information processing (e.g., reaction time). Implications for behavioral assessment and cognitive rehabilitation are discussed.

Global social skill ratings: measures of social behavior or physical attractiveness?

Calvert reviewed the literature on social skills and physical attractiveness and concluded that many ratings of social skill may be confounded by the physical attractiveness of the target individual, possibly due to a general perception that physical attractiveness and social competence are positively correlated. In order to examine the influence of physical attractiveness on social skill ratings, Ss made global ratings of social skill and attractiveness for a confederate whose appearance and behavior had been altered to appear attractive or unattractive and socially skilled or unskilled in an assertiveness and heterosocial vignette. The results indicated that the same skilled behavior was viewed as more competent when performed by an attractive person compared to an unattractive person. Attractiveness had no influence on ratings of generally incompetent behavior. Thus, it appears that physical attractiveness does not compensate for poor interpersonal skills, but a skilled, attractive individual may be judged to have particularly good skills. Implications for the assessment of social skills are discussed.

Relative potency of vecuronium in male and female patients in Britain and Australia

We compared the potency of vecuronium when given to similar patients in Brisbane, Australia, and Cardiff, United Kingdom. Forty patients in each centre were anaesthetized using the same technique with propofol, fentanyl, nitrous oxide and vecuronium either 20 or 30 micrograms kg-1 by random allocation. Neuromuscular block was measured with similar Datex Relaxographs. There was no significant difference in potency between British and Australian patients. The ED50 and ED95 for a British male of average weight were 29.5 micrograms kg-1 (95% confidence limits 27.3-32.3 micrograms kg-1) and 51.3 micrograms kg-1 (44.3-63.9 micrograms kg-1), respectively. ED50 and ED95 for Australians were 5.5% greater, with confidence limits from 4% less to 17% greater. Females were significantly more sensitive to vecuronium than males, requiring 22% less drug to achieve the same degree of neuromuscular block (confidence limits 12-32%). The results are consistent with the ED50 being independent of body weight when the dose is expressed as microgram kg-2/3, but not as microgram or microgram kg-1.

Social anxiety in schizophrenia

The relationship between social anxiety and positive and negative symptomatology in schizophrenia was investigated. Thirty eight inpatients with schizophrenia completed a battery of self-report measures of anxiety, a modified Stroop task, and an unstructured role play. Positive symptoms were related to fear in a number of self-report domains (i.e., social and agoraphobic). Negative symptoms were related to global observational ratings of anxiety during the role play as well as specific behaviors associated with self-reported social anxiety (i.e., speech rate and fluency). Positive symptoms generally were not associated with role play ratings. Thus, specific behaviors related to social anxiety appear to be associated with negative symptoms, while self-report is associated with positive symptoms. Problems in the assessment of social anxiety in individuals with schizophrenia and implications of these findings for social skills training in this population are discussed.

The revised Stroop color-naming task in social phobics

Information processing was examined in a sample of social phobic individuals using a revised version of the Stroop color-naming task. In the first of two experiments, the response latencies of social phobics and matched community controls were compared when color-naming socially threatening words, physically threatening words and color words. Social phobics demonstrated greater response latencies regardless of type of stimulus word and additional interference in color-naming social threat words compared to the control group. The second experiment examined the cognitive structural change that has been hypothesized to accompany successful treatment of individuals with an anxiety disorder. Social phobics who were treated with cognitive-behavioral group therapy, phenelzine or pill placebo were classified as treatment responders or nonresponders, and their latencies to color-naming on the Stroop task were compared. Treatment responders showed a significant reduction in latencies to color-name social threat words (vs matched control words) while nonresponders did not. This effect was not demonstrated with color words or physically threatening words. Clinical implications and future research directions are discussed.

Validity of the distinction between generalized social phobia and avoidant personality disorder

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.

Avoidant personality disorder and the generalized subtype of social phobia

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.

Avoidant personality disorder and the generalized subtype of social phobia

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.

Validity of the distinction between generalized social phobia and avoidant personality disorder

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.

Amino acid and cDNA sequences of a vascular endothelial cell mitogen that is homologous to platelet-derived growth factor

Glioma-derived vascular endothelial cell growth factor (GD-VEGF) is a 46-kDa dimeric glycoprotein mitogen with apparently greater specificity for vascular endothelial cells than the well-characterized fibroblast growth factors. The GD-VEGF cDNA sequence encodes a 190-amino acid residue subunit that is converted, by removal of an amino-terminal hydrophobic secretory leader sequence, to the mature 164-residue subunit characterized by direct amino acid sequencing. The GD-VEGF homodimeric subunit is homologous to the platelet-derived growth factor A and B chains and its oncogene homologue v-sis.

DSM-III-R subtypes of social phobia. Comparison of generalized social phobics and public speaking phobics

Social phobic patients who fear most or all social interaction situations are labeled generalized social phobics in DSM-III-R. Thirty-five patients who met this criterion were compared with 22 social phobic patients whose fears were restricted to public speaking situations. Generalized social phobics were younger, less educated, and less likely to be employed, and their phobias were rated by clinical interviewers as more severe than those of public speaking phobics. Generalized social phobics appeared more anxious and more depressed and expressed greater fears concerning negative social evaluation. They performed more poorly on individualized behavioral tests and differed from public speaking phobics in their responses to cognitive assessment tasks. The two groups showed marked differences in their patterns of heart rate acceleration during the behavioral test. The implications of these findings for the classification and treatment of social phobic individuals are discussed.

Public and private self-consciousness and social phobia

The relationship between public and private self-consciousness and self-report questionnaires, clinician ratings, and various measures derived from an individualized simulation of an anxiety-provoking situation was examined in a sample of men and women seeking treatment for social phobia. As predicted, public, not private, self-consciousness was generally related to self-report and naive observer ratings of anxiety and to behavioral disruption during the simulation. The predicted relationship between public self-consciousness and how accurately subjects evaluated their performance in the anxiety-provoking situation was marginally supported. Hypotheses regarding the relationship between private self-consciousness and self-reported anxiety during an anxiety-provoking situation, and between private self-consciousness and the correspondence between physiological assessment and self-report, were not supported. The discussion focuses on methodological issues and the theoretical implications of the relationship between self-consciousness and social anxiety.