The etiology of social anxiety disorder: An evidence-based model

A Mediation Model of Social Anxiety Development During Early Childhood Stuttering

PURPOSE

Stuttering is associated with clinically significant social anxiety, which emerges during early childhood for some, but not all, children who begin to stutter. The purpose of this review article is to develop a model of social anxiety development during early childhood stuttering and to present an empirical method by which it can be tested.

METHOD

We propose a mediation model of how the exposure variable of stuttering may lead to an outcome of social anxiety. Our model includes confounder and mediator variables. We explain the concepts and procedures of mediation analysis and present a method to test our model.

RESULTS

We present the idea that negative peer responses to stuttering and negative self-perception of children are mediators of social anxiety development. We propose several confounder variables that involve children, their parents, and the home environment. We depict our model with a directed acyclic graph, and we present details of how it can be tested with a longitudinal research design.

DISCUSSION

This is the first attempt to model the development of social anxiety shortly after stuttering onset with an empirically testable method. The intended benefit of this innovation is to direct future clinical directions for the clinical management of stuttering arising shortly after childhood onset.

The Shared and Distinct Mechanisms Underlying Fear of Evaluation in Social Anxiety: The Roles of Negative and Positive Evaluation

Social anxiety disorder (SAD) is associated with persistent fear of negative evaluation (FNE) and fear of positive evaluation (FPE), which play critical roles in the development and maintenance of anxiety symptoms. However, it remains unclear how FNE and FPE contribute to the common and different symptoms of social anxiety. In this review, we tried to elucidate the shared and distinct mechanisms underlying fear of evaluation and clarify the impact of FNE and FPE on social anxiety by integrating the theories, external expressions, and internal mechanisms. First, FNE and FPE share evolutionary functions but have distinct motivations for maintaining social role stability. Second, FNE and FPE share similar emotions and avoidance behaviors but contribute to distinct comorbid symptoms in SAD, including eating disorders and alcohol abuse. Third, FNE and FPE share emotional and social pain circuits but have different dysfunctions in the prefrontal, cingulate, and reward brain regions, which are associated with rejection sensitivity and anhedonia features. Overall, this review sheds light on the cognitive and neural mechanisms of SAD based on fear of evaluation, highlighting both the shared and distinctive aspects of FNE and FPE. These insights have important implications for the development of effective interventions for social anxiety.

Changes in network centrality of anxiety and depression symptoms associated with childhood trauma among Chinese college students

BACKGROUND

Childhood trauma is strongly linked to anxiety and depression, significantly increasing the risk of negative outcomes in adulthood. This study employed network analysis to investigate the complex interplay of anxiety and depression symptoms among Chinese college students, focusing on identifying the core symptoms most directly affected by childhood trauma and those exerting the greatest influence on others.

METHODS

Data were collected from December 2020 to January 2021 from 2,266 college students at 16 institutions in southwestern and eastern coastal China. Depression, anxiety, and childhood trauma were assessed using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Childhood Trauma Questionnaire-28, respectively. Separate symptom networks were constructed for participants with and without childhood trauma experiences. Central indices were employed to identify the central symptom within each network. The accuracy and stability of the networks were then evaluated. Finally, a network comparison test was used to analyze differences in network properties between the trauma and non-trauma groups.

RESULTS

Loss of Energy and Worry too much were the central symptoms in the non-trauma group, while anhedonia and nervousness were the central symptoms in the trauma group. There was a significant difference in the global strength of the network between the trauma group and the non-trauma group (pFDR< 0.01), but no significant difference in the distribution of edge weights between the two networks (pFDR =0.14). Anhedonia, Suicide ideation and Feeling afraid in the trauma group showed increased network centrality compared with the non-trauma group.

CONCLUSIONS

This study demonstrates the profound impact of childhood trauma on the central symptoms of anxiety and depression in college students. Further research is warranted to investigate the specific pathways through which these symptoms develop, with the goal of developing targeted interventions for this vulnerable population.

Social stress task with parental support or self-instruction decreases negative cognitions in children with social anxiety disorder

Social anxiety disorder (SAD) is highly prevalent in childhood, yet research on cognitive processes in children with SAD is limited. This study examined anticipatory rumination (AR), self-focused attention (SFA), and post-event processing (PEP) in children with SAD and healthy controls (HC), and the impact of possible influencing factors (two conditions: parental support, self-instruction). Based on adult cognitive models, we hypothesized that children with SAD would report more negative and similar positive AR, more internal SFA, similar external focus, more negative and similar positive PEP compared to HCs. We predicted that both conditions would reduce negative AR, internal SFA, and negative PEP, with stronger effects in HCs. Participants (ages 9-14; SAD: n = 43, HC: n = 48) completed two speech tasks (T1, T2) in front of a peer audience. Children with SAD reported more negative AR, internal SFA, and negative PEP than HCs in both sessions. All children reported more negative AR, internal SFA, and negative PEP in T1 than T2. Surprisingly, these effects were equally strong in both groups. Condition effects were comparable across groups, with reduced negative cognitive processes in T2. These findings highlight cognitive biases in childhood SAD and the need for further research on their modifiability.

Parsing the heterogeneity of social motivation in autism

BACKGROUND

Social motivation is posited as a key factor in the expression of the autism phenotype. However, lack of precision in both conceptualization and measurement has impeded a thorough understanding of its diverse presentation and associated outcomes. This study addresses this gap by identifying subgroups of autism characterized by deficits in distinct facets of social motivation, relative to normative benchmarks.

METHODS

Data were from 509 participants with autism, aged 5-to-21 years (M = 10.43, SD = 3.67; 81% male), enrolled in the Healthy Brain Network. Latent profile analysis was employed to identify subgroups characterized by unique configurations of reticence, seeking, and maintaining facets of social motivation, derived from a comprehensive multi-instrument factor analysis of symptom and screening measures. Pearson's chi-square tests and one-way analysis of variance were performed to explore subgroup differences in demographic characteristics, cognitive abilities, co-occurring psychopathologies, and other aspects of social functioning.

RESULTS

Four distinct subgroups were identified: Engaged (n = 247), exhibiting the fewest challenges across each area; Inhibited (n = 143), characterized by high reticence, mild challenges in seeking, and few challenges in maintaining; Aloof (n = 68), characterized by challenges with seeking and maintaining but relatively low reticence; and Avoidant (n = 52), characterized by the highest challenges across all areas. Subgroups did not differ in terms of chronological age or sex. The Engaged subgroup exhibited the fewest challenges in other aspects of social functioning and co-occurring psychopathologies, while the Avoidant subgroup exhibited the greatest challenges, and with the Inhibited and Aloof profiles falling in between.

CONCLUSIONS

This study highlights the heterogeneous nature of deficits in social motivation in autism relative to normative benchmarks, suggesting potential avenues for tailored interventions aimed at addressing the specific challenges experienced by individuals within each subgroup. Nevertheless, there remains a need to develop more refined measurement tools capable of capturing even finer-grained aspects and diverse expressions of social motivation, facilitating further characterization of individual differences across diagnostic boundaries.

Risk factor patterns define social anxiety subtypes in adolescents with brain and clinical feature differences

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

The prelimbic prefrontal cortex mediates the development of lasting social avoidance as a consequence of social threat conditioning

Social avoidance is highly detrimental for natural behavior. Despite much research on this topic, the mechanisms underlying the development of social avoidance as a consequence of social-related traumatic experiences remain highly elusive. To investigate this issue, we adapted a mouse model of social threat conditioning in which mice received shock punishment during exploration of an unfamiliar conspecific. This resulted in prominent and lasting reductions in social behavior, effects that were not observed in mice that received shock punishment in the absence of a social stimulus. Furthermore, the effects of social threat conditioning were independent of contextual settings, sex variables, and particular identity of the unfamiliar conspecifics that predicted shock punishment. Shedding new light into the neurobiological bases for this phenomenon, we found that optogenetic silencing of the prelimbic (PL), but not infralimbic (IL), prefrontal cortex during social threat conditioning produced profound forgetting and restoration of social behavior during subsequent sociability tests. Significant forgetting and recovery of social behavior was also observed with prelimbic inhibition of NMDARs. Collectively, these findings are consistent with the notion that social-related trauma is a prominent risk factor for social avoidance, and that traumatic experiences that involve social elements engage learning-related mechanisms in corticolimbic networks to promote long-term representations of social threat.

Longitudinal analysis of anxiety and sleep disorders in the Korean population with disabilities, from 2006 to 2017: Incidence, prevalence, and association with disability type and severity

BACKGROUND

Individuals with disabilities often face a higher risk of concurrent psychological problems, yet comprehensive assessments of the anxiety and sleep disorders in this population remain limited. This study examined longitudinal trends in the incidence and prevalence of anxiety and sleep disorders among people with disabilities and explored their associations with disability type and severity.

METHODS

Utilizing claim data from the National Health Insurance database and the National Disability Registry, which cover the entire Korean population, we estimated the age-standardized incidence and prevalence of anxiety and sleep disorders between 2006 and 2017. Logistic regression was used to analyze the associations between disability type and severity and these disorders.

RESULTS

The unadjusted incidence and prevalence of anxiety and sleep disorders were consistently higher among individuals with disabilities during the study period. A significant gap in the prevalence of these disorders persisted between individuals with and without disabilities in both sexes, even after accounting for socioeconomic status and comorbidities. However, the incidence showed mixed results, with some categories of disabilities showing lower likelihood of developing the conditions compared to individuals without disabilities.

CONCLUSIONS

Actions should also be taken to identify undiagnosed cases of anxiety and sleep disorders among individuals with disabilities. Moreover, individuals with disabilities who are diagnosed with these disorders should be more actively managed to avert the progression to the chronic stage.

Tri-level anxiety and depression symptom trajectory in adolescents: The role of emotion regulation diversity

Anxiety and depression are associated with impaired emotion regulation (ER). Recently, a novel construct named ER diversity has been proposed to assess the diversity in ER strategy use. Low ER diversity, particularly under stressful circumstances, may be a transdiagnostic vulnerability factor for anxiety and depression. This study utilized a longitudinal design to examine the association between ER diversity and transdiagnostic anxiety and depressive symptom trajectory in adolescents (N = 627 at baseline), while accounting for life stress. Measures of ER strategy use, chronic interpersonal life stress, neuroticism, and transdiagnostic dimensional symptoms of anxiety and depression were assessed. The ER diversity index and the traditional ER sum score were computed. Higher ER diversity index was associated with steeper decline in the Fears symptom factor over time, above and beyond the ER sum score and neuroticism. Moreover, chronic interpersonal life stress influenced these associations. When chronic interpersonal life stress was low, Fears declined over time regardless of the ER diversity level; when chronic interpersonal life stress was high, Fears only declined when ER diversity was high. Thus, low diversity in ER strategy use, particularly under stressful circumstances, may be a vulnerability factor for fear symptom development.

Screening social anxiety with the Social Artificial Intelligence Picture System

Social anxiety disorder (SAD) is a prevalent anxiety disorder marked by strong fear and avoidance of social scenarios. Early detection of SAD lays the foundation for the introduction of early interventions. However, due to the nature of social avoidance in social anxiety, the screening is challenging in the clinical setting. Classic questionnaires also bear the limitations of subjectivity, memory biases under repeated measures, and cultural influence. Thus, there exists an urgent need to develop a reliable and easily accessible tool to be widely used for social anxiety screening. Here, we developed the Social Artificial Intelligence Picture System (SAIPS) based on generative multi-modal foundation artificial intelligence (AI) models, containing a total of 279 social pictures and 118 control pictures. Social scenarios were constructed to represent core SAD triggers such as fear of negative evaluation, social interactions, and performance anxiety, mapping to specific dimensions of social anxiety to capture its multifaceted nature. Pictures devoid of social interactions were included as a control, aiming to reveal response patterns specific to social scenarios and to improve the system's precision in predicting social anxiety traits. Through laboratory and online experiments, we collected ratings on SAIPS from five dimensions. Machine learning results showed that ratings on SAIPS robustly reflected and predicted an individual's trait of social anxiety, especially social anxiety and arousal ratings. The prediction was reliable, even based on a short version with less than 30 pictures. Together, SAIPS may serve as a promising tool to support social anxiety screening and longitudinal predictions.

Anxiety During Employment-Seeking for Autistic Adults

BACKGROUND/OBJECTIVES

Autistic adults are more likely to be unemployed compared to neurotypical adults and those with disability. To address these poorer employment outcomes, it is important to consider factors that may be impacting on autistic adults' employment outcomes. Anxiety is a common co-occurring condition for autistic adults; however, there is little research on how anxiety affects or influences autistic people's experience across the employment-seeking process. The aim of this study was to explore whether anxiety is perceived to affect autistic adults' ability to engage in employment-seeking tasks.

METHODS

Online, semi-structured interviews were conducted with 12 autistic adults (22-52 years) who were actively seeking employment or had sought employment in the last 18 months. Interview transcripts were analysed using thematic analysis.

RESULTS

Three themes were generated from the data analysis. Theme 1, Finding the "sweet spot", identified some level of anxiety-but not too much-was helpful in performing the employment-seeking tasks and this "spot" could vary depending on the person and the task. Theme 2, Anxiety affects the ability to perform and function, encapsulates the autistic person's experience when anxiety is too high. The third theme, The "vicious cycle" of anxiety and employment-seeking behaviours, explores participants' ongoing experience of anxiety on their employment-seeking behaviours.

CONCLUSIONS

The findings suggest that autistic job candidates would benefit from tailored accommodations and adjustments offered throughout the recruitment process, to reduce anxiety and improve employment-seeking outcomes for autistic candidates.

Neural Markers of Treatment Response in Pediatric Anxiety and PTSD

Pediatric anxiety disorders and post-traumatic stress disorder (PTSD) are associated with elevated threat sensitivity and impaired emotion regulation, accompanied by dysfunction in the neural circuits involved in these processes. Despite established treatments like cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors, many children do not achieve remission, underscoring the importance of understanding the neurobiological underpinnings of these disorders. This review synthesizes current research on the neural predictors of treatment response and the neurofunctional changes associated with treatment in pediatric anxiety and PTSD during threat and reward processing. Several key findings emerged. First, enhanced threat/safety discrimination in the amygdala predicted better outcomes of pediatric anxiety and PTSD treatments. Second, differences in pretreatment activation within the lateral prefrontal and dorsal anterior cingulate cortices predicted treatment response, likely reflecting baseline executive control differences. Third, post-CBT decreases in activation in default mode, visuo-attentional, and sensorimotor areas may support treatment-related increases in task engagement. Finally, functional connectivity between the amygdala and other limbic, prefrontal, and default mode network nodes predicts treatment response in anxiety and PTSD, highlighting its potential as a biomarker for therapeutic efficacy. Understanding these neurofunctional markers could lead to more targeted interventions, optimizing treatment planning and potentially leading to the development of "pretreatment" strategies to enhance the efficacy of existing treatments. This review highlights the necessity for future research to establish more direct links between neuroimaging findings and clinical outcomes to facilitate the translation of these findings into clinical practice.

Testing theoretical processes that maintain paediatric social anxiety: A comparison between children and adolescents with social anxiety disorder, other mental disorders, and non-clinical controls

BACKGROUND

Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples.

METHODS

641 children and adolescents aged 6-17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis.

RESULTS

Participants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks.

CONCLUSIONS

Paediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction.

Psychological interventions for social anxiety disorder in children and adolescents: A systematic review and network meta-analysis

BACKGROUND

Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents.

METHODS

Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829.

RESULTS

In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %).

CONCLUSION

These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies.

Social anxiety and bullying victimization: A three-level meta-analysis of cross-sectional and longitudinal studies

BACKGROUND

Numerous studies have explored the association between social anxiety and bullying victimization. However, inconsistency are found regarding the strength and the direction of this relationship. Moreover, it remains unclear how different subtypes of bullying victimization associate with social anxiety.

OBJECTIVE

The purpose of this study was to conduct a meta-analysis to systematically investigate the cross-sectional and longitudinal relationships between social anxiety and bullying victimization.

PARTICIPANTS AND SETTING

Individuals experiencing social anxiety and bullying victimization.

METHODS

The present study employed three-level random effects model to combine the correlation coefficients r to indicate the strength of the cross-sectional association between social anxiety and bullying victimization. Cross-lagged regressions were utilized to examine the prospective relationship between both variables.

RESULTS

A total of 133 cross-sectional studies reporting 220 effect sizes were included in the meta-analysis, and the results showed a significant moderate association between social anxiety and bullying victimization (r = 0.268, 95 % CI [0.244, 0.292]). Nineteen longitudinal studies were also identified, revealing that social anxiety at Time 1 significantly predicted bullying victimization at Time 2 (β = 0.067, 95 % CI [0.038, 0.096]). However, bullying victimization did not significantly predict subsequent social anxiety (β = 0.012, 95 % CI [-0.026, 0.049]). Subgroup analyses revealed that social anxiety had the strongest association with relational victimization (r = 0.382, 95 % CI [0.335, 0.430]), followed by reputational victimization (r = 0.254, 95 % CI [-0.171, 0.337]), physical victimization (r = 0.226, 95 % CI [0.144, 0.308]) and overt victimization (r = 0.202, 95 % CI [0.146, 0.257]). Social anxiety was significantly more associated with traditional bullying victimization (r = 0.281, 95 % CI [0.233, 0.328]) than cyberbullying victimization (r = 0.177, 95 % CI [0.137, 0.218]; p < 0.001).

CONCLUSIONS

Social anxiety was found to be moderately associated with and prospectively predict bullying victimization. Future research and interventions could focus on reducing social anxiety to prevent bullying victimization.

Research hot topics and frontiers in social anxiety over the past decade: a CiteSpace bibliometric analysis based on Web of Science database from 2013 to 2023

Objective

To understand the current study of social anxiety (SA) over the past decade, and to analyze the research hot topics and frontiers in this field.

Methods

CiteSpace 6.2.R3 was used to analyze the literature on SA collected in the Web of Science Core Collection database from 2013 to 2023.

Results

A total of 9940 literature were included after the screening, and the annual publication volume showed a steady increase. The results emphasize that Zvolensky MJ, Pine DS, and Heimberg RG are important authors in the field of SA. The United States has the highest number of publications, with the University of California System contributing the most. Research hotspots include cognitive impairment, risk factors, complications, neuroimaging, and intervention strategies. SA related to the "theory of mind", "bullying victimization", "mobile phone", "network analysis", "technology", and "satisfaction" are emerging research foci.

Conclusion

This study identifies the current situation and trends of SA research, and provides a reference for future research topics and directions.

The impact of audience dynamics on public speaking anxiety in virtual scenarios: An online survey

BACKGROUND

Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised.

METHODS

The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA.

RESULTS

The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores.

CONCLUSIONS

This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity.

New insights into recalled parental behavior in social anxiety disorder: A cluster analytic approach

BACKGROUND

Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables.

METHODS

This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables.

RESULTS

The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness.

LIMITATIONS

The present study is cross-sectional, therefore unable to confirm causal interpretations.

CONCLUSION

Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality.

Testing, revision and application of the social anxiety scale for Chinese social media users

This study aims to modify the Social Anxiety Scale for Social Media Users (SAS-SMU) to make it more suitable for assessing social anxiety among Chinese social media users, taking into account the unique cultural nuances and social media usage patterns in China. Consequently, a systematic approach was adopted, involving three distinct studies. Study 1 involved translating the English scale into Chinese, conducting interviews with Chinese social media users, and subsequently revising the scale items based on the interview data to ensure cultural appropriateness. Study 2 employed an online survey to collect data and examine the reliability and construct validity of the revised scale, including a two-phase approach: an exploratory factor analysis (EFA) was conducted with 500 participants to identify the underlying factor structure, and a subsequent confirmatory factor analysis (CFA) with 408 participants was used to cross-validate the results. Thus far, this study has developed a social anxiety scale for Chinese mobile social media users (SAS-CMSMU) consisted of 11 items on three factors: Interaction Anxiety, Privacy Concern Anxiety, and Shared Content Anxiety. Study 3 (N = 1,006) applied the SAS-CMSMU to assess social anxiety among Wechat users. The results indicated that participants showed a high level of overall social anxiety (M = 3.646 > 3). Specifically, Privacy Anxiety was the most pronounced, followed by Shared Content Anxiety and Interaction Anxiety. Moreover, significant statistical differences in social anxiety levels were found among WeChat users across gender, age, education, income, and relationship status.

Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis

Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals' vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.

Cognitive behavioral group therapy for social anxiety disorder - A critical review of methodological designs

Social anxiety disorder (SAD) is highly prevalent with significant lifetime impacts, especially when left untreated. Cognitive behavioral therapy is the current gold standard treatment with successful patient outcomes. Cognitive behavioral group therapy (CBGT) is one form that provides unique benefits to participants including normalization of symptoms and social support, as well as providing increased access to treatment at a lower per-session cost. Research on this mode of treatment has been ongoing for over 20 years, but we still have much to learn about its overall efficacy. The goals of this critical review were to summarize and evaluate the most current research, including an analysis of the overall methodological design quality, and provide recommendations for the enhancement of future studies based on best practices. Recent studies included some best practice design elements used in measuring efficacy such as the use of comparison groups, masking procedures, fidelity assessments, and consideration of clinical significance in outcomes. However, many gaps exist such as a lack of consensus around measures and therapy manuals, as well as baseline competencies of facilitators. Future studies should consider incorporating additional best practice elements aligning with study goals to strengthen designs and provide the field with even more confidence in this mode of treatment.

The Reciprocal Relations between Parental Psychological Control and Social Anxiety and the Mediating Role of Self-Concept Clarity Among Chinese Early Adolescents

Although parental psychological control has been well-documented as a significant predictor of social anxiety among adolescents, few studies examine how changes in parental psychological control and adolescent social anxiety are reciprocally related at the within-person level, especially in Chinese culture. This longitudinal study examined reciprocal relations between parental psychological control and social anxiety, and the potential mediating role of self-concept clarity, by disentangling between- and within-person effects. A total of 4731 students (44.9% girls; Mage = 10.91 years, SD = 0.72) participated in a four-wave longitudinal study with 6-month intervals. Results from random intercept cross-lagged panel modeling indicated that parental psychological control directly predicted social anxiety, and vice versa. Parental psychological control indirectly predicted social anxiety via self-concept clarity, and social anxiety also indirectly predicted parental psychological control via self-concept clarity. These findings reveal a vicious cycle of mutual influence between parental psychological control and adolescent social anxiety in Chinese youth, and highlight the crucial role of self-concept clarity in the interplay between parenting and adolescent social functioning.

Conflicting patterns of cardiovascular reactivity, self-report, and behavior associated with social anxiety during a conversation with a close friend

Social anxiety (SA) is characterized by anxious symptomology and fear during social situations, but recent work suggests that SA may not necessarily be associated with negative interpersonal and intrapersonal outcomes in support contexts. The current research investigates the discrepancies between self-perceptions, behavior, and physiological responses associated with SA in social support conversations with close friends. Specifically, we examined the associations between SA and positive and negative affect, perceptions of demands and resources, and responsiveness. Additionally, we used the biopsychosocial model of challenge and threat to understand the physiological responses associated with SA. Participants (79.9% White, 9.8% Black or African American, 10.3% Multiple races or other; 78.7% Female), totaling 172 undergraduate friend dyads, completed self-report measures and had physiological responses recorded while they discussed a problem unrelated to the friendship. Trained coders rated responsive behaviors exhibited during the conversation. Results revealed that greater SA was associated with greater negative perceptions of social interactions (greater negative affect, fewer perceived resources, and greater perceived demands). However, cardiovascular reactivity and behavioral responses within the conversation, as well as perceptions of partners' behavior after the conversation, contrasted with these negative perceptions. Indeed, greater SA was associated with greater sympathetic arousal (indicative of greater task engagement), but not with greater challenge or threat, and SA was not associated with perceived partner responsiveness or responsive behaviors. These results add to the growing body of research that suggests people with greater SA show inconsistencies between their conscious appraisals of social situations and their physiological responses.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.

Distinct characteristics of social anxiety among youths with childhood sexual abuse: A latent profile analysis

BACKGROUND

Childhood sexual abuse (CSA) is one type of childhood trauma that has long-term effects on physical and mental health, predisposing to social anxiety.

OBJECTIVE

This study attempted to investigate the characteristics of different subgroups of social anxiety among youths with CSA experiences.

PARTICIPANTS AND SETTING

83,219 participants were recruited in a cross-sectional study from 63 colleges and universities in Jilin Province, China.

METHODS

The main variables were measured by a series of self-report questionnaires. Latent profile analysis was used to classify different subgroups of social anxiety, and multiple logistic regression was employed to investigate factors influencing transitions between different subgroups.

RESULTS

3022 (3.63 %) youths who suffered from CSA (46.8 % were male, Mage = 19.57, SD = 1.76) could be divided into four subgroups of social anxiety: low-risk social anxiety (16.4 %), medium-risk social anxiety with high public speaking anxiety (30.3 %), medium-risk social anxiety with no prominent characteristics (22.9 %), and high-risk social anxiety (30.4 %). Shy bladder and bowel and virtual life orientation increased the level of social anxiety from low to medium and high risk. Smoking and drinking were more prevalent in the low- and medium-risk subgroups than in the high-risk subgroup.

CONCLUSIONS

There was heterogeneity in different subgroups of social anxiety among youths with CSA experiences. Potential targeted prevention and intervention suggestions could be beneficial in mitigating the risk of social anxiety and further preventing the aggravation of risk between subgroups.

Satisfaction with social connectedness is associated with depression and anxiety symptoms in neurodiverse first-semester college students

LAY ABSTRACT

How satisfied people feel with their social connections and support is related to mental health outcomes for many different types of people. People may feel less socially connected at some times in their life-like when they start college. Feeling disconnected from others could lead to depression or anxiety. The transition to college may be especially difficult for autistic students as they are more likely to have difficulties adjusting socially. In our study, we asked 263 college students to answer questions about their emotions and social satisfaction twice per week during their first semester of college. We found that students who reported being less satisfied with their social connectedness (either at the beginning or throughout the semester) tended to express more symptoms of depression and anxiety. This relationship between social satisfaction and anxiety was even stronger for people who had a strong desire for social interaction (i.e. were more socially motivated). Students with more autistic traits tended to report more mood concerns, and they also reported being less satisfied with friendships at the beginning of the semester. This information may help to support ongoing efforts to better address mental health in autistic college students by encouraging efforts to improve social satisfaction.

Daily-life reactivity and emotion regulation in children with social anxiety disorder

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.

Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity

Background: The present study aims to elucidate the association between adverse childhood experiences, parental bonding, fatherhood, and social anxiety symptoms among emerging adults within an Iranian context. Methods: This prospective cross-sectional study utilized self-reported assessments to evaluate fatherhood, parental bonding, anxious thoughts, and childhood trauma. The study was administered to 242 university students exhibiting social anxiety symptoms. Among the participants, 181 (74.8%) were boys and 61 (25.2%) were girls between the ages of 18 and 29. In terms of educational background, 64.9% of them held a bachelor's degree, and 35.1% held a master's degree. A majority of them (84.3%) were of middle-class socio-economic status, 6.6% were of low income, and 9.1% were of high income. Results: Analysis via multiple linear regression revealed that individuals with adverse childhood experiences exhibited heightened levels of social anxiety symptoms (R2 = 0.32) compared to their counterparts without such experiences. Furthermore, fatherhood (R2 = 0.28), paternal bonding (R2 = 0.26), and maternal bonding (R2 = 0.26) were all significantly and equally associated with variance in social anxiety symptoms. The findings underscored the substantial correlation between ACEs, fatherhood, and both maternal and paternal bonding with social anxiety symptoms in adulthood. Conclusions: Accordingly, the study emphasizes the importance of thoroughly assessing the multifaceted contributors to social anxiety. Such insights are pivotal for the design and implementation of community-based preventive interventions aimed at reducing the societal burden of social anxiety disorders.

The Relationship Between Social Anxiety Disorder and ADHD in Adolescents and Adults: A Systematic Review

OBJECTIVE

This review aimed to systematically gather empirical data on the link between social anxiety disorder and ADHD in both clinical and non-clinical populations among adolescents and adults.

METHOD

Literature searches were conducted in PsycInfo, PubMed, Scopus, and Web of Science, resulting in 1,739 articles. After screening, 41 articles were included. Results were summarized using a narrative approach.

RESULTS

The prevalence of ADHD in adolescents and adults with SAD ranged from 1.1% to 72.3%, while the prevalence of SAD in those with ADHD ranged from 0.04% to 49.5%. Studies indicate that individuals with both SAD and ADHD exhibit greater impairments. All studies were judged to be of weak quality, except for two studies which were rated moderate quality.

DISCUSSION

Individuals with SAD should be screened for ADHD and vice versa, to identify this common comorbidity earlier. Further research is needed to better understand the prevalence of comorbid ADHD and SAD in adolescents.

The prelimbic prefrontal cortex mediates the development of lasting social phobia as a consequence of social threat conditioning

Social phobia is highly detrimental for social behavior, mental health, and productivity. Despite much previous research, the behavioral and neurobiological mechanisms associated with the development of social phobia remain elusive. To investigate these issues, the present study implemented a mouse model of social threat conditioning in which mice received electric shock punishment upon interactions with unfamiliar conspecifics. This resulted in immediate reductions in social behavior and robust increases in defensive mechanisms such as avoidance, freezing, darting, and ambivalent stretched posture. Furthermore, social deficits lasted for prolonged periods and were independent of contextual settings, sex variables, or particular identity of the social stimuli. Shedding new light into the neurobiological factors contributing to this phenomenon, we found that optogenetic silencing of the prelimbic (PL), but not the infralimbic (IL), subregion of the medial prefrontal cortex (mPFC) during training led to subsequent forgetting and development of lasting social phobia. Similarly, pharmacological inhibition of NMDARs in PL also impaired the development of social phobia. These findings are consistent with the notion that social-related trauma is a prominent risk factor for the development of social phobia, and that this phenomenon engages learning-related mechanisms within the prelimbic prefrontal cortex to promote prolonged representations of social threat.

Abstract Figure

Bullying victimization and bullying perpetration, social anxiety, and social withdrawal in Portuguese adolescents: A reciprocal association model

Further research is needed to clarify the association of the different forms of bullying with social anxiety and social withdrawal over time in adolescents. This two-wave panel study with a 1-year time lag (October 2021-October 2022) examined the cross-lagged relationships between bullying victimization and bullying perpetration, social anxiety (i.e., fear or distress in social situations), and social withdrawal (i.e., consistent, and deliberate social solitude). Participants were 485 middle school students (234 girls) attending the seventh or eighth grade at Time 1 (T1) (Mage = 12.67 years, SD = 1.14 years). Social anxiety and social withdrawal were assessed using subscales of the Social and Emotional Competencies Evaluation Questionnaire. Bullying perpetration and bullying victimization were assessed using the Bullying and Cyberbullying Behavior Questionnaire-Short Form. The within-wave associations between the study variables were similar at T1 and Time 2 (T2), with the exception that the association between bullying perpetration and social anxiety was much weaker at T1 than at T2. The results of the path analysis showed that T1 bullying perpetration predicted T2 social anxiety, and that T1 bullying victimization predicted T2 social withdrawal. We also found a reciprocal relationship between social anxiety and social withdrawal. These findings highlight the importance of preventive and remediation interventions to reduce social anxiety in adolescents who engage in and experience bullying behavior.

Linear and curvilinear association of pain tolerance and social anxiety symptoms among youth with different subgroups of childhood trauma

BACKGROUND

Social anxiety is a common symptom that occurs after exposure to childhood trauma (CT), and pain tolerance is a protective factor against social anxiety in generic populations with CT. However, few studies have investigated whether and how this association varies across different CT subgroups. Thus, this study aimed to investigate (1) the effects of pain tolerance on social anxiety symptoms among youth with different subgroups of CT; (2) the nonlinear relationship between pain tolerance and social anxiety symptoms among different CT categories.

METHODS

In this study, 15,682 college or university students with experiences of CT were identified in a large sample and divided into five CT subgroups. Linear and quadratic regression models were conducted to explore the association between pain tolerance and social anxiety symptoms among youth with different CT subgroups.

RESULTS

The results of model revealed a linear relationship between pain tolerance and social anxiety symptoms among youth with most CT subgroups. Notably, an inverted U-shaped curve was found between pain tolerance and social anxiety symptoms in youth with emotional abuse. Social anxiety symptoms increased gradually with pain tolerance scores between 0 and 16, and then sharply decreased when scores reached above 16.

LIMITATIONS

Limited by self-report measurements, the results of this study focused only on perceived pain tolerance and ignored behavioral pain tolerance.

CONCLUSION

These findings highlight the importance of assessing pain tolerance thresholds in youth with emotional abuse and improving pain tolerance to prevent social anxiety symptoms in youth with different subgroups of CT.

The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.

Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents

Anxiety and depression are prevalent and impairing psychiatric problems for children and adolescents. In this review, the authors summarize information about their prevalence and impact, the most common assessment methods, the main components of cognitive behavioral therapy (CBT), and research on the effectiveness of CBT for these disorders. Future directions, including improving access to CBT through technology-based approaches and increasing personalization of treatment, are discussed.

The effect of social anxiety on threat acquisition and extinction: a systematic review and meta-analysis

Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms.

Childhood psychological maltreatment and social anxiety in college students: The roles of parasympathetic nervous system activity and parent-child separation experience

BACKGROUND

Childhood psychological maltreatment is a risk factor for social anxiety in adulthood. Parent-child separation, as one of the most serious adversities in early life, may exacerbate the risk of psychological maltreatment and influence the interactions between childhood psychological maltreatment and biological sensitivity to stress in relation to social anxiety. However, there has been a dearth of work on this issue.

OBJECTIVE

This study investigated the interactive effects between childhood psychological maltreatment and parasympathetic nervous system (PNS) activity on social anxiety in college students by comparing those who experienced parent-child separation versus those who did not. Potential sex differences in the aforementioned associations were tested as an exploratory aim.

PARTICIPANTS AND SETTING

Data were obtained from 264 college students (Mage = 18.45 years, SD = 0.69), including 156 students who experienced parent-child separation and 108 students without this experience.

METHODS

Participants completed measures of childhood psychological maltreatment and social anxiety and reported their parent-child separation experience. The data of PNS activity, measured by respiratory sinus arrhythmia (RSA) reactivity, were obtained during the Trier Social Stress Test (TSST) in the lab.

RESULTS

Childhood psychological maltreatment was positively associated with college students' social anxiety. RSA reactivity moderated the relationship between childhood psychological maltreatment and college students' social anxiety, and the moderating role of RSA reactivity varied with parent-child separation experience and sex.

CONCLUSIONS

Parent-child separation experience influenced the biosocial interactions between childhood psychological maltreatment and PNS activity in relation to individuals' social anxiety, and this effect persisted in adulthood.

Interpersonal sensitivity as a mediator linking interpersonal stressors and social anxiety: Longitudinal mediation analysis using parallel process latent growth curve modeling

BACKGROUND

Little is known about the mechanism between interpersonal stressors and social anxiety in college students. This study was to investigate the mediating effect of interpersonal sensitivity between interpersonal stressors and social anxiety.

METHODS

The data was taken from a large-scale health-related cohort among Chinese college students. This study used data from the first four waves, including 4191 participants. The latent growth curve mediation model was used to examine the potential mediating role of interpersonal sensitivity in the relationship between interpersonal stressors and social anxiety over time.

RESULTS

Both levels and changes in interpersonal stressors were positively associated with subsequent levels and changes in social anxiety. Mediation analysis showed that interpersonal sensitivity mediated the relationship between interpersonal stressors and social anxiety.

LIMITATION

All variables were collected based on self-report.

CONCLUSIONS

Interpersonal stressor is a significant risk factor for social anxiety, and this association appears to be mediated by interpersonal sensitivity. It is necessary to evaluate and intervene against interpersonal sensitivity related to interpersonal stressors for the prevention of social anxiety.

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Does gaze anxiety predict actual gaze avoidance and is it more informative than social anxiety?

BACKGROUND AND OBJECTIVES

In recent years eye-tracking studies have provided converging evidence that socially anxious individuals avoid looking at other people's faces in social situations. In addition to these objective measures, the Gaze Anxiety Rating Scale (GARS) has increasingly been used as a self-report measure of gaze avoidance. However, extant results concerning its predictive validity were inconsistent. Moreover, no study has considered social anxiety and gaze anxiety together to examine their relative contributions to actual gaze behavior.

METHODS

To address these two questions, eye-tracking data collected from 81 female students during the initial 6 min of a face-to-face conversation with a female confederate were analyzed. Gaze anxiety and social anxiety were measured via the GARS and the Leibowitz Social Anxiety Scale.

RESULTS

The results revealed that gaze anxiety was associated with reduced face gaze while speaking. Social anxiety was not only associated with decreased face gaze during speaking, but also across the initial conversation. Moreover, there was no evidence that gaze anxiety made an additional contribution to social anxiety in predicting face gaze behavior.

LIMITATIONS

This study examined face gaze instead of eye gaze. Additionally, the self-report data were not collected on the same day as the eye-tracking data.

CONCLUSIONS

The findings indicate that, in a community sample, gaze anxiety does predict actual gaze behavior during a face-to-face initial encounter, but social anxiety is a stronger predictor.

Self-processing characteristics from first-person and third-person perspectives in individuals with social anxiety disorder: insights into negative bias

Background

As one of the most common psychological problems, social anxiety disorder (SAD) has lots of negative effects on the physical and mental development of individuals, such as decreasing the quality of interpersonal relationships, and even causing depression, suicidal ideation, etc., as well as leads individuals to generate mental illness stigma. The mental illness stigma that individuals perceive affects not only how they perceive themselves (first-person perspective) but also how they perceive others' appraisals of them (third-person perspective), which further exacerbates their anxiety symptoms.

Objective

The study aims to explore the self-processing characteristics of individuals with social anxiety disorder from the first-person perspective and the third-person perspective.

Methods

This study adopted the self-referential paradigm to conduct the recognition memory test on individuals with social anxiety disorder (30 participants in experiment 1) and individuals without social anxiety disorder (31 participants in experiment 2) in the two experiments.

Results

In experiment 1, the recognition rate of individuals with social anxiety disorder under the self-appraisals condition was significantly higher than that under the condition of appraisals on mothers; in the three conditions of self-appraisals, appraisals on mothers and mothers' reflected appraisals, the recognition rate of negative trait adjectives was significantly higher than that of positive trait adjectives. In experiment 2, there was no significant difference in recognition rate of individuals without social anxiety disorder under the three conditions, and the recognition rate of positive trait adjectives was significantly higher than that of negative trait adjectives under the three conditions.

Conclusion

Individuals with social anxiety disorder have a negative bias in self-processing and are more likely to focus on self-information, which is different from the self-positive bias of individuals without social anxiety disorder. This study can be beneficial to know the self-cognitive characteristics of individuals with social anxiety disorder, help them get rid of negative cognitive patterns, and remove the mental illness stigma.

Prospective Associations Between Fears of Negative Evaluation, Fears of Positive Evaluation, and Social Anxiety Symptoms in Adolescence

Fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are independently associated with social anxiety symptoms in adolescence, though no study has tested these relations longitudinally. The current study examined longitudinal relations between FNE, FPE, and social anxiety symptoms using a multi-informant design, in addition to testing adolescent gender as a moderator. Adolescents (N = 113; Mage = 12.39; Girls = 44.2%) and parents completed measures of FNE, FPE, and two ratings of social anxiety approximately 6 months apart. FNE and FPE demonstrated significant stability over time, but neither predicted change in the other construct. Adolescent and parent-reported FNE, but not FPE, predicted increased social anxiety symptoms. Adolescent report of social anxiety symptoms predicted increased FPE over time, whereas parent report of social anxiety symptoms predicted increased FNE. Contrary to hypothesis, gender did not moderate any of the pathways in the model. Findings provide the first evidence that FNE may function as a risk factor for increased social anxiety in adolescence.

The role of interpretation biases and safety behaviours in social anxiety: an intensive longitudinal study

BACKGROUND

Interpretation bias and safety behaviours (Safe-B) have been proposed as factors perpetuating social anxiety (SA). However, longitudinal research on how they contribute to SA in everyday life is scarce.

AIM

The aim was to examine whether interpretation bias predicts daily Safe-B and SA. A mediated moderation was hypothesized, where the relationship between daily social stressors and Safe-B would be moderated by interpretation bias, and Safe-B, in turn, would mediate the association between stressors and SA levels. In addition, it was hypothesized that prior levels of SA would predict higher Safe-B use, especially in co-occurrence with stressors.

METHOD

An intensive longitudinal design was employed, with 138 vocational training students (51% men, mean age 20.15 years). They completed initial measures of SA and interpretation bias and 7-day diaries with measures of social stressors, Safe-B, and SA. They reported SA levels two months later.

RESULTS

Both stressors and interpretation bias in ambiguous situations predicted Safe-B, which in turn predicted daily SA levels. However, neither interpretation bias nor Safe-B predicted SA levels at the follow-up, and interpretation bias did not moderate the association between stressors and daily SA. In addition, the relationship between stressors and Safe-B was stronger in people with higher initial SA levels.

CONCLUSIONS

The results suggest that Safe-B are a mechanism through which earlier SA levels and interpretation bias contribute to higher SA levels in daily life.

Social interpretation inflexibility moderates emotional reactions to social situations in children and adolescents

Interpretation biases and inflexibility (i.e., difficulties revising interpretations) have been linked to increased internalizing symptoms. Although adolescence is a developmental period characterized by novel social situations and increased vulnerability to internalizing disorders, no studies have examined interpretation inflexibility in adolescents. Additionally, no studies (on adolescents or adults) have examined interpretation flexibility as a protective factor against adverse outcomes of interpersonal events. Using a novel task and a 28-day diary we examined relations among interpretation bias and inflexibility, internalizing symptoms, and negative interpersonal events in a sample of children and adolescents (N = 159, ages 9-18). At baseline, negative interpretation bias was positively correlated with social anxiety symptoms, and positive interpretation bias negatively correlated with social anxiety and depressive symptoms. Inflexible positive interpretations were correlated with higher social anxiety and depressive symptoms, while inflexible negative interpretations were correlated with higher social anxiety. Finally, interpretation inflexibility moderated daily associations between negative interpersonal events and depressive symptoms in daily life, such that higher inflexibility was associated with stronger associations between interpersonal events and subsequent depressive symptoms, potentially increasing depressive symptom instability. These results suggest that interpretation biases and inflexibility may act as both risk and protective factors for adolescent anxiety and depression.

Increasing the Efficacy of Treatment for Socially Anxious Youth Through Theoretically Derived Improvements: A Pilot Study

Cognitive behavioural therapy is the first line of treatment for social anxiety disorder; however, children with social anxiety disorder do not respond as well to generic cognitive behavioural therapy programs, compared to children with other anxiety disorders. The aim of the study was to provide a preliminary examination of the efficacy and applicability of a new disorder specific intervention for children with social anxiety disorder. Five children aged 7-13 years, with a primary or secondary DSM-5 diagnosis of social anxiety disorder were provided with an adapted version of the Cool Kids anxiety program. Three out of the five children were in remission from social anxiety disorder at the end of the intervention and at 3-month follow-up. Statistically significant improvements were also noted in overall anxiety symptoms and functioning. Preliminary evidence was found for the efficacy of a social anxiety version of the Cool Kids program.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Longitudinal relationship of empathy and social anxiety among adolescents: The mediation roles of psychological inflexibility and rejection sensitivity

INTRODUCTION

The purpose of study was to explore the roles of psychological inflexibility and rejection sensitivity in the relationship between (cognitive and affective) empathy and social anxiety among adolescents.

METHODS

A two-wave longitudinal design was adopted in the present study. A total of 2481 participants (41.60 % male; Mage = 16.48) aged from 13 to 21 in 2021 completed the Chinese Version of Interpersonal Reactivity Index (IRI-C), Short Mood and Feelings Questionnaire (SMFQ), Chinese version of the Acceptance and Action Questionnaire-II (AAQ-II), Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), Child Rejection Sensitivity Questionnaire (CRSQ), and Social Anxiety Scale for Adolescent (SAS-A) at baseline assessment (T1), and completed the SAS-A again three months later (T2).

RESULTS

(1) Results showed, personal distress at T1 could significantly and positively predict social anxiety at T2. (2) Mediation analyses results demonstrated that adolescents' experience avoidance and rejection sensitivity at T1 were significant mediators between cognitive empathy at T1 and social anxiety at T2, but with the opposite effect. As for affective empathy, rejection sensitivity at T1 significantly mediated the relationship between adolescents' empathic concern at T1 and social anxiety at T2. Furthermore, experience avoidance and rejection sensitivity at T1 significantly mediated the association between personal distress at T1 and social anxiety at T2.

CONCLUSIONS

Cognitive and affective empathy had different roles in contributing to adolescents' social anxiety. The findings in the current study can also provide empirical support for targeting adolescents' social anxiety by reducing personal distress directly and decreasing experiential avoidance and rejection sensitivity indirectly.

The relevance of social anxiety for understanding social functioning and facial emotion recognition in individuals at clinical high-risk for psychosis

AIM

Individuals at clinical high risk (CHR) for psychosis often experience poor social functioning and impaired facial emotion recognition (FER); however, the impact of frequently comorbid symptoms upon these processes is underexplored. In particular, social anxiety is characteristic of this population and also related to poor social functioning and FER biases, such as misinterpreting neutral faces as negative or threatening; however, little is known about how social anxiety relates to these processes in CHR individuals. The present study examined the overlap of social anxiety, social functioning, and FER accuracy and bias.

METHOD

Participants (CHR N = 62, healthy controls N = 52) completed the self-report Social Interaction Anxiety Scale (SIAS), Penn Emotion Recognition-40 (ER-40) behavioural task, and interviewer-rated Global Functioning Scale-Social (GFS-S). The ER-40 was used to assess both FER accuracy (e.g., overall number of correct responses) and bias (e.g., mislabelling neutral faces as angry).

RESULTS

Consistent with previous research, relative to controls, CHR participants had more social anxiety (d = -1.07), poorer social functioning (d = -1.62), and performed more poorly on the FER task (e.g., d = -.37). Within CHR participants, social anxiety was related to an anger detection bias (r = .28), above and beyond positive symptom severity, which in turn was related to FER accuracy (r = .26) and social functioning (r = -.28).

CONCLUSION

These findings suggest that ongoing work examining social processes within CHR individuals needs to account for social anxiety and that social anxiety may be a useful preventive intervention target.

The association between problematic internet use and social anxiety within adolescents and young adults: a systematic review and meta-analysis

Objective

Although numerous studies have investigated the association between problematic internet use (PIU) and social anxiety, the findings have no yet reached consistent. The present meta-analysis aims to examine the association between PIU and social anxiety within adolescents and young adults (age range: 14-24 years old).

Method

The meta-analysis systematically retrieved the studies prior to September 7, 2023 from Web of Science, PubMed, PsycINFO, Scopus, CNKI, and CQVIP. The meta-analysis based on random-effects model to conduct the research. Stata Version 17.0 and JASP 16.3.0 was used to analysis.

Results

The meta-analysis ultimately included 37 studies (37 effect sizes in total), involving a total of 36,013 subjects. Our findings indicated that the overall correlation between PIU and social anxiety was significant positive [r = 0.333, 95% CI (0.292, 0.373), p < 0.001]. Their association was significantly moderated by publication year, measurement tools for PIU and social anxiety but not significantly by culture context, developmental level and gender.

Conclusion

This meta-analysis suggests that social anxiety is a predictor of the development of PIU in adolescents and young adults. Furthermore, the study also finds the possibility that contemporary adolescents and youth may exhibit a more "global" behavior pattern, potentially emphasizing fewer differences between cultures, generations and genders.

Trajectories of social withdrawal and social anxiety and their relationship with self-esteem before, during, and after the school lockdowns

The closure of schools during the COVID-19 pandemic affected adolescents' social withdrawal and social anxiety. Yet, self-esteem may have acted as a protective factor during this period. This study aimed to compare the trajectories of social withdrawal and social anxiety before (Year 1), during (Year 2 and 3), and after (Year 4) the closure of schools imposed by the COVID-19-related lockdowns, and to investigate the association of self-esteem with these trajectories. Participants were 844 (50.6% boys) Portuguese adolescents (mean age 12.70 years, SD = 1.14). The Social and Emotional Competencies Evaluation Questionnaire (QACSE) was used to assess social withdrawal and social anxiety, while The Global Self-Esteem scale of the Self-Description Questionnaire II was used to measure self-esteem. Growth curve analysis showed that social withdrawal and social anxiety had more negative trajectories during the year in which the school closures occurred. In addition, adolescents reported higher social withdrawal after the lockdowns than before the pandemic. Higher self-esteem was associated with a more positive trajectory in social withdrawal. Therefore, the results showed the negative of impact of the closure of schools on adolescents' social anxiety and social withdrawal, and that self-esteem was a protective factor during these challenging and adverse events.

Neural evidence of face processing in social anxiety disorder: A systematic review with meta-analysis

Numerous previous studies have used event-related potentials (ERPs) to examine facial processing deficits in individuals with social anxiety disorder (SAD). However, researchers still need to determine whether the deficits are general or specific and what the dominant factors are behind different cognitive stages. Meta-analysis was performed to quantitatively identify face processing deficits in individuals with SAD. Ninety-seven results in 27 publications involving 1032 subjects were calculated using Hedges' g. The results suggest that the face itself elicits enlarged P1 amplitudes, threat-related facial expressions induce larger P2 amplitudes, and negative facial expressions lead to enhanced P3/LPP amplitudes in SAD individuals compared with controls. That is, there is face perception attentional bias in the early phase (P1), threat attentional bias in the mid-term phase (P2), and negative emotion attentional bias in the late phase (P3/LPP), which can be summarized into a three-phase SAD face processing deficit model. These findings provide an essential theoretical basis for cognitive behavioral therapy and have significant application value for the initial screening, intervention, and treatment of social anxiety.