Cognitive behavioural therapy as an effective treatment for social anxiety, perfectionism, and rumination

Psychotherapies for social anxiety disorder in adults: A systematic review and Bayesian network meta-analysis

Psychotherapies for social anxiety disorder (SAD) encompass various protocols and delivery formats; consequently, an investigation into the relative efficacy of different treatments is needed. This study aimed to compare the efficacy of different common psychotherapies for SAD and identify the most effective psychotherapies for SAD. Using a Bayesian network meta-analysis, we compared the relative efficacy of six common psychotherapies: cognitive behavioral therapy (CBT), cognitive restructuring (CR), exposure therapy (ET), psychodynamic therapy (PDT), interpersonal therapy (IPT), and mindfulness-based interventions (MBI). Sensitivity analyses were conducted to test the robustness of the results. This network meta-analysis included 92 studies up to June 2024, covering 90 randomized controlled trials. The findings suggested that, compared with the waitlist control group, all included psychotherapies showed varying degrees of efficacy in reducing SAD symptoms severity. Specifically, CBT was generally the most effective psychotherapy. The Clark and Wells CBT protocol showed the highest efficacy (SMD: 1.42, 95 % CrI: [1.14, 1.70]), while Andersson and Carlbring's Internet-based CBT ranked highly (SMD: 1.15, 95 % CrI: [0.87, 1.42]). PDT was the most effective non-CBT treatment (SMD: 0.98, 95 % CrI: [0.61, 1.36]). Guided therapies appeared more effective than unguided ones, and Internet-based treatments were comparable to face-to-face therapies. This study can aid clinicians in optimizing treatment choices and selecting appropriate formats when treating patients with SAD.

Exploring the prevalence of nomophobia, its contributing factors, and the relationship with social interaction anxiety among nursing students

BACKGROUND

Nomophobia and social anxiety have significant negative implications for the physical and mental health of students, as well as their academic performance. Considering the variability in findings across studies on the prevalence of nomophobia and social anxiety, this study aimed to investigate the prevalence of nomophobia, its associated factors, and its relationship with social interaction anxiety among nursing students.

METHODS

This cross-sectional descriptive-analytical study was conducted between August 22nd and September 23rd, 2023, at the School of Nursing and Midwifery in Kermanshah, located in western Iran. A convenience sampling method was employed, resulting in the recruitment of 258 participants. Data were collected using a three-part questionnaire, including a demographic information form, the Nomophobia Questionnaire (NMP-Q) to assess the severity of nomophobia, and the Social Interaction Anxiety Scale (SIAS) to measure social anxiety levels. Data were analyzed using STATA, version 14. Descriptive statistics were used to summarize demographic and clinical characteristics. The Chi-square test, one-way analysis of variance, the Pearson correlation coefficient, and linear regression modeling were employed for inferential analysis.

RESULTS

All participating nursing students (n = 258) exhibited some degree of nomophobia. The prevalence of mild, moderate, and severe nomophobia was 40.7%, 40.3%, and 19%, respectively. Furthermore, 25.6% of the students experienced social anxiety. A significant positive correlation was found between nomophobia scores and social interaction anxiety (r =.37, P <.001). Social interaction anxiety emerged as the only significant independent predictor of nomophobia (P <.001), explaining 21% of the variance in nomophobia scores.

CONCLUSIONS

The results indicate both the prevalence of nomophobia and social anxiety, as well as the correlation between these two factors among students. Considering the numerous risks associated with nomophobia and social interaction anxiety, it is essential to optimize technology use and improve social interactions among students. Identifying students at risk of nomophobia and social interaction anxiety and providing psychological counseling services to them should be prioritized.

Efficacy of cognitive behavioral therapy in treating repetitive negative thinking, rumination, and worry - a transdiagnostic meta-analysis

Repetitive negative thinking (RNT) is a transdiagnostic process associated with the onset, maintenance, and risk of relapse of various mental disorders. However, previous research syntheses addressing the effect of cognitive behavioral therapy (CBT) on RNT are limited to specific diagnoses, treatments, or RNT constructs (transdiagnostic RNT, worry, rumination). In the present meta-analysis, we integrate findings from randomized controlled trials (RCTs) of CBT on RNT across diagnoses, intervention types, and RNT constructs. We investigate the following questions: What is the overall transdiagnostic efficacy of CBT interventions on all post-treatment RNT outcomes? Which RNT construct is addressed most effectively? Are RNT-specific treatments superior in reducing RNT than less specific approaches? Inclusion criteria were met by 55 studies with a total of 4,970 participants. The overall post-treatment effect of CBT interventions on RNT compared to respective control groups was moderate in favor of CBT (g = -0.67). Treatment efficacy did not differ significantly by RNT construct. RNT-specific interventions (g = -0.99) were significantly more efficacious in reducing RNT than less specific approaches (g = -0.56). Treatment efficacy was not significantly enhanced by individual or in-person settings. Our results advocate a dissemination of RNT-specific treatments in research and practice and a general improvement of CBT treatments by focusing on relevant transdiagnostic processes such as RNT.

Exploring the Dimensions of Perfectionism in Adolescence: A Multi-Method Study on Mental Health and CBT-Based Psychoeducation

BACKGROUND

Perfectionism in adolescents can have both adaptive and maladaptive forms, with implications for mental health and school performance. This study aimed to investigate the relationships among perfectionism, mental health factors, and emotional regulation in adolescents and to evaluate the efficacy of psychoeducational interventions.

METHODS

Two studies were conducted: (1) A cross-sectional study (n = 261) examined the correlations among perfectionism, mental health factors, and emotional regulation. (2) An experimental study (n = 115) evaluated the effects of psychoeducation on perfectionism and healthy habits compared with a control group. The measures included questionnaires on perfectionism, depression, anxiety, stress, and emotional regulation.

RESULTS

Study 1 found that maladaptive perfectionism was positively correlated with depression (r = 0.52, p < 0.001), anxiety (r = 0.48, p < 0.001), stress (r = 0.45, p < 0.001), and difficulties in emotional regulation (r = 0.39, p < 0.001). Adaptive perfectionism was negatively correlated with deficits in emotional understanding (r = -0.31, p < 0.05). Study 2 showed that psychoeducational interventions reduced maladaptive perfectionism (mean difference = -5.7, p < 0.05, Cohen's d = 0.62) and depression levels (mean difference = -3.2, p < 0.05, Cohen's d = 0.38) but increased stress in the experimental groups. No significant changes were observed in adaptive perfectionism or the anxiety level.

CONCLUSIONS

These findings highlight the complex relationships among perfectionism, mental health, and emotional regulation in adolescents. Targeted interventions can reduce maladaptive perfectionism and its associated negative effects. Further research is needed on the long-term outcomes and refinement of interventional strategies.

Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis

INTRODUCTION

The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms.

METHODS

We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out.

RESULTS

A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership.

CONCLUSIONS

These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.

Mechanisms Linking Perfectionism and Social Anxiety: The Role of Hostility and Disqualification of Positive Social Outcomes

While considerable research has focused on maladaptive perfectionism as a risk factor for social anxiety, little attention has been given to the mechanisms that mediate the effects. We integrated perfectionism with the bivalent fear of evaluation model of social anxiety to investigate 2 hypothesized mechanisms: hostile attribution bias and disqualification of positive social outcomes (DPSO). Specifically, we hypothesized that individuals with maladaptive perfectionism develop hostile attribution biases which then lead to DPSO, which in turn predisposes them to social anxiety. Participants were 242 individuals from the general population who completed measures of perfectionism, hostile attribution bias, DPSO, and social anxiety. A test of multiple mediators using bootstrapping supported the hypothesized multiple mediator models. The results suggested that maladaptive perfectionism predisposes an individual to social anxiety through hostile attribution bias and DPSO. The results further suggested that DPSO but not hostile attribution bias operates as an individual mediator in the perfectionism-social anxiety relationship. The findings from this study provide support for the bivalent fear of evaluation model of social anxiety; however, the use of a cross-sectional design limited our ability to find true cause-and-effect relationships.

Intolerance of Uncertainty Scale-12: Psychometric Properties of This Construct Among Iranian Undergraduate Students

Background

Uncertainty intolerance (IU), the tendency to think or react negatively toward uncertain events may have implication on individuals' mental health and psychological wellbeing. The Intolerance of Uncertainty Scale-12 (IU-12) is commonly used across the globe to measure IU, however, its' psychometric properties are yet to be evaluated in Iran with a Persian-speaking population. Therefore, the purpose of this research was to translate and validate the IU-12 among Iranian undergraduate students.

Materials and Methods

The multi-stage cluster random sampling was employed to recruit 410 Iranian undergraduate students (260 females) from the Azad University to complete the IU-12, the Depression Anxiety Stress Scale-2, and the Penn State Worry Questionnaire in a cross-sectional design. In this study, face validity, content validity, construct validity, and concurrent validity were measured and Construct Reliability (CR) and Cronbach's alpha were used to measure reliability.

Results

The impact score of the translated IU-12 indicated acceptable face validity (value of impact score was greater than 1.5). The value of Content Validity Index (CVI) and the value of Content Validity Ratio (CVR) were above 0.7 and 0.78, respectively. The values of CVI and CVR indicated the items had acceptable content validity and were deemed essential to the measure. The measurement model analysis showed the measure with two subscales had good fit indices (CMIN/df = 2.75, p < 0.01, RMSEA = 0.07, TLI = 0.94, CFI = 0.95, GFI = 0.94). A Confirmatory Factor Analysis (CFA) indicated the scale was composed of the two subscales found in the English-version of the scale (prospective anxiety and inhibitory anxiety), and no items were removed from the scale. The values of CR (0.86) and Cronbach's alphas (0.89) showed the measure had appropriate internal consistency.

Conclusion

The findings support the psychometric properties of the Persian version of the IU-12. This scale could be used to reliably and accurately measure uncertainty intolerance among undergraduate students in Iran.

Intervention for Nigerian preservice historians' maladaptive academic perfectionism: Implications for history lecturers

BACKGROUND

Individuals enrolled in a university program that will lead to a degree in history are considered preservice historians in the context of this study. Their goal is to become professional historians after graduating from the university. The purpose of this study was to determine whether cognitive behavioral coaching (CBC) had an effect on maladaptive academic perfectionism in Nigerian preservice historians.

METHOD

The study included a randomized sample of 98 preservice historians from Nigerian public universities in the country's Southeast zone [49 preservice historians were assigned to the cognitive behavioral coaching group-CBC Group, while 49 preservice historians were assigned to the waitlist control group-Waitlist control Group].

RESULTS

The finding indicate that preservice historians' maladaptive academic perfectionism decreased significantly following cognitive behavioral coaching. There was also a significant interaction effect of time and group on the reduction of preservice historians' maladaptive academic perfectionism.

CONCLUSION

This study suggests that cognitive behavioral coaching is an effective intervention for preservice historians who struggle with maladaptive academic perfectionism. The study's implications for history lecturers were discussed. Future study could investigate how maladaptive academic perfectionism affects postgraduate history students and how CBC can help them.

Courage: A Potential Mediator of the Relationship Between Personality and Social Anxiety

Social anxiety is one of the most prevalent and chronic mental-health conditions in young adults. To date, no studies have been conducted about the relationships between the Big Five personality dimensions, courage, and social anxiety among Malaysian undergraduate students. Therefore, this study was designed to examine courage as a potential mediator of the association between the Big Five personality dimensions and social anxiety among Malaysian Undergraduates. In this study, 500 Malaysian undergraduate students (205 males and 295 females) completed a series of questionnaires. Structural equation modelling (AMOS-SEM) revealed that, of the Big Five, neuroticism and social anxiety were positively correlated. Extraversion, conscientiousness, openness to experience, and agreeableness, as well as courage, were negatively correlated with social anxiety. Courage mediated the relationship between the Big Five personality dimensions and social anxiety. The main contribution of the present research is to show how the Big Five personality dimensions may contribute to social anxiety. The findings of this study also could be implicated for counselling practice for undergraduate students in Malaysia as a collectivist setting and other collectivist settings around the world.

Religious Perfectionism Scale: Assessment of Validity and Reliability Among Undergraduate Students in Iran

Religious perfectionism is a construct that may help to either improve mental health or cause mental health difficulties. The Religious Perfectionism Scale (RPS; Wang in J Relig Health 59: 318-333, 2020) is a useful tool for assessing religious perfectionism around the world, but its psychometric properties have yet to be tested in Iran. The sample in the present study consisted of 300 Iranian undergraduate students (180 females) from Azad University who completed the RPS, the Depression Anxiety Stress Scale-2, and the Moral Perfectionism Scale. The impact score was used to determine face validity, and the values of the impact score for all translated items were greater than 1.5, meaning that the items had satisfactory face validity. The Content Validity Index (CVI) values were above the acceptable cutoff score of 0.7, indicating the acceptable content validity of items. The Content Validity Ratio (CVR) scores were greater than the cutoff score of the Lawshe table (.78), indicating the satisfactory essentiality of the items. To measure construct validity, the results of a confirmatory factor analysis (CFA) using AMOS software confirmed the scale with two subscales (zealous religious dedication and religious self-criticism). No item was removed from the scale as all factor loading values were greater than 0.49. The findings support the psychometric properties of the scale for measuring religious perfectionism among undergraduate students in Iran.

Caregiver burden and coping strategies in caregivers of older patients with stroke

Background

Coping strategies play a key role in modulating the physical and psychological burden on caregivers of stroke patients. The present study aimed to determine the relationship between the severity of burden of care and coping strategies amongst a sample of Iranian caregivers of older stroke patients. It also aimed to examine the differences of coping strategies used by male and female caregivers.

Methods

A total of 110 caregivers of older patients who previously had a stroke participated in this descriptive and cross-sectional study. The Zarit Burden Interview and Lazarus coping strategies questionnaires were used for data collection. Questionnaires were completed by the caregivers, who were selected using convenience sampling. The collected data were analyzed using Pearson's correlations and independent t-tests.

Results

The mean age of participants was 32.09 ± 8.70 years. The majority of the caregivers sampled reported mild to moderate (n = 74, 67.3%) burden. The most commonly used coping strategies reported were positive reappraisal and seeking social support. Results of the independent t-test showed that male caregivers used the positive reappraisal strategy (t(110) = 2.76; p = 0.007) and accepting responsibility (t(110) = 2.26; p = 0.026) significantly more than female caregivers. Pearson’s correlations showed a significant positive correlation between caregiver burden and emotional-focused strategies, including escaping (r = 0.245, p = 0.010) and distancing (r = 0.204, p = 0.032).

Conclusions

Caregivers with higher burden of care used more negative coping strategies, such as escape-avoidance and distancing. In order to encourage caregivers to utilize effective coping skills, appropriate programs should be designed and implemented to support caregivers. Use of effective coping skills to reduce the level of personal burden can improve caregiver physical health and psychological well-being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00556-z.

Low Level of Perfectionism as a Possible Risk Factor for Suicide in Adolescents With Attention-Deficit/Hyperactivity Disorder

Introduction: Suicide is one of the leading causes of death among adolescents. Although it is known that both perfectionism and attention-deficit/hyperactivity disorder ('ADHD') are important risk factors for suicide, there are no studies that have investigated the relationship between suicidal behavior and perfectionism among people with ADHD. Aim: The current study investigates the association between perfectionism and suicide in adolescents with ADHD. Method: Subjects included 88 adolescents with ADHD and 96 non-clinical control adolescents. We used the Multidimensional Perfectionism Scale to evaluate perfectionism as well as its separate traits, and the Mini International Neuropsychologic Interview Kid to evaluate psychiatric disorders and suicidal behavior. Differences between the groups were statistically evaluated using t-tests, a Poisson regression analysis with suicide as a discrete variable, and a logistic regression analysis with suicide as a binary variable. Results: Compared to the control group, the ADHD group showed a significantly lower level on the adaptive 'Organization' trait of perfectionism, but not on any other trait, and a significantly higher level of suicidal behavior. Logistic regression results indicated a significant association for perfectionism in general (OR = 0.93, p = 0.003), and for the 'Personal Standards' trait (OR: 0.82, p = 0.039). Poisson regression analysis also showed a significant association with perfectionism in general (IRR = 0.90; p < 0.001) and with the 'Personal standards' trait model (IRR = 0.81, p = 0.019). Discussion: Our results indicate that a low level of perfectionism, in particular 'Personal standards', may be a risk factor for suicidal behavior in adolescents with ADHD. We recommend that psychoeducation and therapy of adolescents with ADHD should consider focusing on adaptive perfection as a possible risk factor for suicide as well.