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Cook SI, Bryant C, Phillips LJ. Development and validation of the positive evaluation core beliefs scale for social anxiety. J Anxiety Disord 2024; 105:102890. [PMID: 38878519 DOI: 10.1016/j.janxdis.2024.102890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
Fear of positive evaluation (FPE) is becoming recognised as an important component of social anxiety that is distinct from fear of negative evaluation (FNE). While core belief scales exist for fear of negative evaluation (FNE), none has been developed for FPE. Therefore, this paper describes the development and validation of a measure of core beliefs that is specific to FPE. An exploratory factor analysis was performed on 60 initial items with an Australian undergraduate sample, in which a confirmatory factor analysis was performed with an independent Australian general population sample. A series of further analyses were performed to test convergent and divergent validity. The Positive Evaluation Core Beliefs Scale (PECS) emerged as a 17-item two-factor psychometrically valid measure that correlates more strongly with measurement of FPE than FNE. The PECS measure offers a new opportunity for researchers and clinicians to better explore cognitions associated with social anxiety.
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Affiliation(s)
- Sarina I Cook
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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2
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Liu Q, Davey D, Jimmy J, Ajilore O, Klumpp H. Network Analysis of Behavioral Activation/Inhibition Systems and Brain Volume in Individuals With and Without Major Depressive Disorder or Social Anxiety Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:551-560. [PMID: 37659443 PMCID: PMC10904669 DOI: 10.1016/j.bpsc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) and major depressive disorder (MDD) are characterized by behavioral abnormalities in motivational systems, namely the behavioral inhibition system (BIS) and behavioral activation system (BAS). Limited studies indicate brain volume in regions that support emotion, learning/memory, reward, and cognitive functions relate to BIS/BAS. To increase understanding of BIS/BAS, the current study used a network approach. METHODS Patients with SAD (n = 59), patients with MDD (n = 64), and healthy control participants (n = 36) completed a BIS/BAS questionnaire and structural magnetic resonance imaging scans; volumetric regions of interest comprised cortical and limbic structures based on previous BIS/BAS studies. A Bayesian Gaussian graphical model was used for each diagnostic group, and groups were compared. Among network metrics, bridge centrality was of primary interest. Analysis of variance evaluated BIS/BAS behaviors between groups. RESULTS Bridge centrality showed hippocampus positively related to BAS, but not to BIS, in the MDD group; no findings were observed in the SAD or control groups. Yet, network density (i.e., overall strength of relationships between variables) and degree centrality (i.e., overall relationship between one variable to all other variables) showed that cortical (e.g., precuneus, medial orbitofrontal) and subcortical (e.g., amygdala, hippocampus) regions differed between diagnostic groups. Analysis of variance results showed BAS was lower in the MDD/SAD groups compared with the control group, while BIS was higher in the SAD group relative to the MDD group, which in turn was higher than the control group. CONCLUSIONS Preliminary findings indicate that network-level aberrations may underlie motivational abnormalities in MDD and SAD. Evidence of BIS/BAS differences builds on previous work that points to shared and distinct motivational differences in internalizing psychopathologies.
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Affiliation(s)
- Qimin Liu
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Delaney Davey
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
| | - Jagan Jimmy
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
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3
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Himle JA, LeBeau RT, Jester JM, Kilbourne AM, Weaver A, Brydon DM, Tucker KM, Hamameh N, Castriotta N, Craske MG. Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial. J Anxiety Disord 2024; 104:102875. [PMID: 38763062 DOI: 10.1016/j.janxdis.2024.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=-.25, CI=-0.49 to -0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=-.098 [-0.19-0.008]) and depression (beta=-0.18 [-0.34-0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA; Department of Psychiatry, Medical School, University of Michigan, USA.
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Jennifer M Jester
- Department of Psychiatry, Medical School, University of Michigan, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, Medical School, University of Michigan, USA; Quality Enhancement Research Initiative, US Department of Veterans Affairs, Washington, DC, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | | | | | - Natalie Castriotta
- University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, USA; Department of Psychiatry & Biobehavioral Sciences, USA
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4
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Kim BH, Park SY, Park CI, Bang M, Kim HJ, Lee SH. Altered cortical thickness of the superior frontal gyrus and fusiform gyrus in individuals with subthreshold social anxiety. Sci Rep 2023; 13:21822. [PMID: 38071248 PMCID: PMC10710474 DOI: 10.1038/s41598-023-49288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
Subthreshold social anxiety (SSA) is a condition in which individuals experience social anxiety that does not reach the threshold required for a clinical diagnosis of a social anxiety disorder (SAD). Although SSA may not impair lives as severely as SAD, it can affect social functioning. However, only a few studies focused on structural neural correlates of SSA. We recruited 65 individuals with SSA and used the Leibowitz Social Anxiety Scale to assess their social and performance anxiety levels and other relevant measures of social anxiety. Voxel-wise whole-brain correlational analyses showed a positive association between the cortical thickness (CT) of the superior frontal gyrus (SFG) and social anxiety levels and a negative correlation between the CT of the fusiform gyrus (FG) and performance anxiety levels in individuals with SSA. Exploratory Pearson's correlation analyses showed significant positive correlations between the CT of the SFG and Generalized Anxiety Disorder-7 total scores and negative associations between the CT of the FG and Beck Anxiety Inventory total scores. Our study provides insight into the neural basis of SSA, particularly performance anxiety, by highlighting the association between CT in specific brain regions and SSA characteristics.
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Affiliation(s)
- Byoung-Ho Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - So-Young Park
- CHA University School of Medicine, Seongnam, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea.
- CHA University School of Medicine, Seongnam, Republic of Korea.
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5
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Strand ER, Nordahl H, Hjemdal O, Nordahl HM. Metacognitive beliefs predict interpersonal problems in patients with social anxiety disorder. Scand J Psychol 2023; 64:819-824. [PMID: 37365879 DOI: 10.1111/sjop.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Patients with Social Anxiety Disorder (SAD) typically report interpersonal problems, and these are important targets in treatment beyond social anxiety symptoms as they impair quality of life, maintain emotion symptoms and effect on social functioning. What factors contribute to interpersonal problems? In the current study we set out to explore the role of metacognitive beliefs as correlates of interpersonal problems in patients treated for SAD when controlling for the effect of social phobic cognitions and symptoms. The sample consisted of 52 patients with a primary diagnosis of SAD participating in a randomized controlled trial comparing cognitive therapy, paroxetine, pill placebo, or the combination of cognitive therapy and paroxetine in treating SAD. Two hierarchical multiple linear regression analyses were conducted to explore change in metacognitions as predictors of change in interpersonal problems when controlling for change in social phobic cognitions and social anxiety. Change in metacognitions accounted for unique variance in interpersonal problems improvement beyond change in cognitions. Furthermore, change in cognitions overlapped with change in social anxiety symptoms, and when controlling the overlap between these three predictors, only change in metacognitions was uniquely associated with improvement in interpersonal problems. This finding indicates that metacognitions are linked to interpersonal problems in patients with SAD with the implication that treatment should aim to modify metacognitive beliefs to alleviate interpersonal dysfunction.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olav's Hospital, Nidaros DPS, Trondheim, Norway
| | - Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans M Nordahl
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, St. Olav's Hospital, Trondheim, Norway
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Kamhout S, Olivier JM, Morris J, Brimhall HR, Black BL, Gabrielsen TP, South M, Lundwall RA, Nielsen JA. Binocular rivalry in autistic and socially anxious adults. Front Psychiatry 2023; 14:1181797. [PMID: 37547197 PMCID: PMC10400451 DOI: 10.3389/fpsyt.2023.1181797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Social anxiousness is a pervasive symptom in both social anxiety disorder and autism spectrum conditions. Binocular rivalry, which occurs when different images are presented to each eye, has been used to explore how visual and cognitive processing differs across various clinical diagnoses. Previous studies have separately explored whether individuals with autism or anxiety experience binocular rivalry in ways that are different from neurotypical individuals. Methods We applied rivalry paradigms that are similar to those used in previous studies of autism and general anxiety to individuals experiencing symptoms of social anxiousness at clinical or subclinical levels. We also incorporated rivalrous stimuli featuring neutral and emotional facial valances to explore potential overlap of social processing components in social anxiety and autism. Results We hypothesized that higher levels of social anxiousness would increase binocular rivalry switch rates and that higher levels of autistic traits would decrease switch rates. However, stimulus condition did not affect switch rates in either diagnostic group, and switch rate was not significantly predictive of dimensional measures of either autism or social anxiety. Discussion This may suggest a common mechanism for atypical visual cognition styles previously associated with social anxiety and autism. Alternatively, differences in switch rates may only emerge at higher trait levels than reported by the participants in our studies. Furthermore, these findings may be influenced by sex differences in our unique sample.
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Affiliation(s)
- Sarah Kamhout
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Joshua M. Olivier
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Jarom Morris
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | | | - Braeden L. Black
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Terisa P. Gabrielsen
- Department of Counseling Psychology and Special Education, Brigham Young University, Provo, UT, United States
| | - Mikle South
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Rebecca A. Lundwall
- Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Jared A. Nielsen
- Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Psychology, Brigham Young University, Provo, UT, United States
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7
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Goodman FR, Birg JA, Daniel KE, Kashdan TB. Stress generation in social anxiety and depression: A two-study community assessment. J Affect Disord 2023; 329:285-292. [PMID: 36801422 PMCID: PMC10062494 DOI: 10.1016/j.jad.2023.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Stress generation theory suggests that people engage in certain behaviors that causally generate "dependent" stressful life events. Stress generation has primarily been studied in the context of depression with limited consideration of anxiety. People with social anxiety exhibit maladaptive social and regulatory behaviors that may uniquely generate stress. METHOD Across two studies, we examined if people with elevated social anxiety experienced more dependent stressful life events than those lower in social anxiety. On an exploratory basis, we examined differences in perceived intensity, chronicity, and self-blame of stressful life events. As a conservative test, we examined whether observed relationships held after covarying depression symptoms. Community adults (Ns = 303; 87) completed semi-structured interviews about recent stressful life events. RESULTS Participants with higher social anxiety symptoms (Study 1) and social anxiety disorder (SAD; Study 2) reported more dependent stressful life events than those with lower social anxiety. In Study 2, healthy controls rated dependent events as less impactful than independent events; those with SAD rated dependent and independent events as equally impactful. Regardless of social anxiety symptoms, participants placed greater blame on themselves for the occurrence of dependent than independent events. LIMITATIONS Life events interviews are retrospective and preclude conclusions about short-term changes. Mechanisms of stress generation were not assessed. CONCLUSIONS Results provide initial evidence for the role of stress generation in social anxiety that may be distinct from depression. Implications for assessing and treating unique and shared features of affective disorders are discussed.
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Affiliation(s)
- Fallon R Goodman
- George Washington University, Department of Psychological and Brain Sciences, United States of America.
| | - Jessica A Birg
- University of South Florida, Department of Psychology, United States of America
| | - Katharine E Daniel
- University of Virginia, Department of Psychology, United States of America
| | - Todd B Kashdan
- George Mason University, Department of Psychology, United States of America
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8
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Carlton CN, Garcia KM, Honaker M, Richey JA, Ollendick TH. 5-year follow-up of adolescents with social anxiety disorder: Current functioning during COVID-19. Psychiatry Res 2023; 322:115118. [PMID: 36842399 PMCID: PMC9940468 DOI: 10.1016/j.psychres.2023.115118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
The present study followed-up adolescents with social anxiety disorder (SAD) during the COVID-19 pandemic, approximately 5-years following their participation in an Attention Bias Modification Training (ABMT) program (Ollendick et al., 2019). The current study aimed to evaluate current functioning and quality of life (QoL) during the emerging adulthood period. Participants included 27 young adults who completed a randomized controlled trial of ABMT and were available for follow-up. Participants filled out self-report measures of QoL and functioning and underwent a clinical interview to assess current severity of social anxiety. Clinician-rated symptoms of SAD significantly decreased from post-treatment to 5-year follow-up. Additionally, results demonstrated that social anxiety severity was significantly related to poorer self-reported physical and psychological health as well as poorer functioning with regard to social distancing fears during COVID-19. Lastly, when evaluating change in symptoms over time, increases in social anxiety severity over a 5-year period significantly predicted worsened social distancing fears during COVID-19.
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Affiliation(s)
- Corinne N Carlton
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States.
| | - Katelyn M Garcia
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Makayla Honaker
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - John A Richey
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Thomas H Ollendick
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
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9
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Metts AV, LeBeau RT, Craske MG, Himle JA. Perceived interpersonal competence as a predictor of clinical outcomes in a randomized controlled trial for social anxiety and employment. Cogn Behav Ther 2023; 52:146-162. [PMID: 36409226 PMCID: PMC9839579 DOI: 10.1080/16506073.2022.2137578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
This study explored relationships among perceived interpersonal competence and demographic and work history variables in a randomized control trial for social anxiety disorder (SAD) that compared work-related group cognitive behavioral therapy plus vocational services (WCBT+VSAU) to vocational services only (VSAU-alone). Intervention effects of perceived interpersonal competence on treatment outcomes over 12 weeks were also examined. Data from 250 job seekers with SAD (59.2% Female; 40.8% Black/African American; 82.4% Non-Hispanic/non-Latino/a) were analyzed. We predicted negative relationships between perceived interpersonal competence and symptoms/impairment and that individuals with lower perceived interpersonal competence would benefit more quickly in WCBT+VSAU relative to VSAU-alone. Results indicated that perceived interpersonal competence did not vary by gender, race, ethnicity, homeless status, or employment history. There were no intervention effects of perceived interpersonal competence regarding social anxiety or overall functional impairment, but results supported negative relationships between perceived interpersonal competence and lower social anxiety and overall functional impairment in both conditions. Separately, perceived interpersonal competence moderated effects in the depression model such that there were faster declines in depression at lower perceived interpersonal competence levels in WCBT+VSAU, but not in VSAU-alone. Results indicate the value of attending to perceived interpersonal competence in interventions, which may result in mood benefits.
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Affiliation(s)
- Allison V. Metts
- Department of Psychology, University of California, Los Angeles, USA
| | - Richard T. LeBeau
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Joseph A. Himle
- School of Social Work University of Michigan, USA
- Department of Psychiatry, University of Michigan, USA
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Gupta K, Semwal J, Sharma N, Srivastava A, Vyas S. Do social phobia and depression go hand in hand? A cross-sectional study among school-going adolescents of Northern region of India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:321. [PMID: 36568011 PMCID: PMC9768701 DOI: 10.4103/jehp.jehp_1805_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The preeminent mental health conditions, namely social phobia and depression among adolescents, usually remain incognito. The transition period from childhood to adulthood makes adolescents more liable for low amour-propre, loneliness, and even increases the suicidal tendencies among them. To burgeon the knowledge regarding social phobia and depression among adolescents, the present study was put forward with the objective to assess the prevalence of social anxiety disorders (social phobia) and depression among adolescents. MATERIALS AND METHODS A cross-sectional study was conducted for 2 months on 600 students aged 10-19 years belonging to classes VIII-XII of government and private schools in the Dehradun district recruited through multistage random sampling technique. A pre-tested semi-structured questionnaire having sociodemographic details, validated self-administered tools, Social Phobia Inventory tool, and Kutchers Adolescent Depression Scale (Cronbach's alpha: 0.77 and 0.79) were used. Statistical package for social sciences, version 23 was used for data analysis. Chi-square test, Fisher exact test, and Pearson correlation analysis were used for analysis. RESULTS Prevalence of social phobia was found to be 37% among school-going adolescents. Further, 23.7% of the study participants had mild social phobia, while moderate and severe phobia was seen among 11.5% and 2.3%, respectively. Females had more moderate and severe social phobia than males. Adolescents of government schools had more moderate affective distress and somatic distress as compared to adolescents of private schools. CONCLUSION Social phobia and depression among school-going adolescents are on the upsurge. The present study shows that social phobia and depression have a strong correlation among themselves, which needs to be addressed as expeditiously as possible. Coping strategies and social skill therapy and programs are pressing priorities for the fulgent future of adolescents.
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Affiliation(s)
- Kezia Gupta
- Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Jayanti Semwal
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Neha Sharma
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Abhay Srivastava
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Shaili Vyas
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
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11
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Aluh DO, Azeredo-Lopes S, Cardoso G, Pedrosa B, Grigaitė U, Dias M, Xavier M, Caldas-de-Almeida JM. Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative. Psychiatry Res 2022; 315:114734. [PMID: 35872402 DOI: 10.1016/j.psychres.2022.114734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Sofia Azeredo-Lopes
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Miguel Xavier
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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12
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Stravynski A, Lachance L. An Interpersonal Approach to the Treatment of Social Anxiety Disorder (Social Phobia): A Component Analysis. PSYCHIAT CLIN PSYCH 2022; 32:33-44. [PMID: 38764897 PMCID: PMC11099670 DOI: 10.5152/pcp.2022.21246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/19/2022] [Indexed: 05/21/2024] Open
Abstract
Background Most treatments of social anxiety disorder aim at anxiety reduction. To what extent this leads to improved social functioning remains unclear. An effective alternative aiming primarily at social functioning- the Interpersonal Approach- is available. The present study sought to identify its active ingredients. Methods This is a randomized controlled study; 102 social anxiety disorder individuals were randomly assigned to 3 versions of the Interpersonal Approach. A total of 76 patients completed treatment and 67, a 1-year follow-up. The patients met Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for social anxiety disorder. The study was carried out in an experimental clinic for the treatment of social anxiety disorder at the Research Center of Louis-H. Lafontaine Hospital in Montreal, Canada. Results No clinically meaningful change occurred during the waiting list. A significant and equivalent improvement was obtained in all treatment conditions in social functioning, anxiousness, and general psychopathology, maintaining over a 12-month follow-up. Remission rates improved progressively with 54% remission at 1-year follow-up. All variants of the Interpersonal Approach resulted in similar improvements. Conclusion The Interpersonal Approach in all its versions has proved to be effective in reducing anxiety complaints and improving social functioning. The combined improvement in these 2 outcomes accounts for the significant remission rates seen at 1-year follow-up. Two active features were common to all: (1) targeting and ultimately dissolving long-standing habits of self-protection across various spheres of life and (2) fostering participatory interpersonal patterns of behavior, enacted by patients systematically and repeatedly between sessions.
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Affiliation(s)
- Ariel Stravynski
- Department of Psychology, University of Montreal, Montreal, Canada; Department of Education and Pedagogy, University of Quebec at Montreal, Montreal, Canada
| | - Lise Lachance
- Department of Psychology, University of Montreal, Montreal, Canada; Department of Education and Pedagogy, University of Quebec at Montreal, Montreal, Canada
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Sheena MK, Jimmy J, Burkhouse KL, Klumpp H. Anterior cingulate cortex activity during attentional control corresponds with rumination in depression and social anxiety. Psychiatry Res Neuroimaging 2021; 317:111385. [PMID: 34563988 PMCID: PMC8559256 DOI: 10.1016/j.pscychresns.2021.111385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
Rumination and worry are transdiagnostic perseverative cognitions that have overlapping and distinct characteristics. While the mechanisms of perseverative cognitions remain incomplete, limited data indicate anterior cingulate cortex (ACC) as it relates to top-down functions contributes to perseverative cognitions in internalizing conditions. The current study extends this work in patients with major depression (n = 39) or social anxiety (n = 42). During fMRI, participants viewed images comprising letter strings superimposed on task-irrelevant threatening or neutral faces. To moderate task difficulty, there was a low perceptual load condition where the target letter was in a string of identical letters and high load condition with the target letter in a mixed letter string increasing task difficulty. Regions of interest (ROI) comprised dorsal ACC and rostral ACC. Bilateral amygdala was also examined. Results showed diagnostic groups had similar levels of rumination and worry. Exploratory hierarchical regression analysis comprising clinical measures, task performance, and the 4 ROIs revealed significantly less dorsal ACC engagement during low (vs. high) load to task-irrelevant faces corresponded with more rumination, but not worry, regardless of diagnostic status. However, the ACC finding did not survive Bonferroni correction. Preliminary results suggest dorsal ACC response during attentional control may serve as a transdiagnostic mechanism of rumination.
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Affiliation(s)
- Michelle K Sheena
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Rm 457, Chicago, Illinois, USA.
| | - Jagan Jimmy
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Rm 457, Chicago, Illinois, USA
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Rm 457, Chicago, Illinois, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Rm 457, Chicago, Illinois, USA
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Beidel DC, Tuerk PW, Spitalnick J, Bowers CA, Morrison K. Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial. Behav Ther 2021; 52:1351-1363. [PMID: 34656191 PMCID: PMC8531536 DOI: 10.1016/j.beth.2021.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.
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Affiliation(s)
| | - Peter W Tuerk
- Department of Human Services, University of Virginia
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15
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Crane ME, Atkins MS, Becker SJ, Purtle J, Olino TM, Kendall PC. The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial. Implement Sci Commun 2021; 2:107. [PMID: 34556182 PMCID: PMC8460198 DOI: 10.1186/s43058-021-00213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments. Method Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT. Discussion This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments. Trial registration This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00213-x.
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Affiliation(s)
- Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Marc S Atkins
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois, Chicago, 1747 West Roosevelt Road, Suite 155, Chicago, IL, 60608, USA
| | - Sara J Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, Room 351, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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16
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Correlates of Obtaining Employment among Veterans Receiving Treatment for Severe PTSD in Specialized Intensive Programs. Psychiatr Q 2021; 92:981-994. [PMID: 33409927 DOI: 10.1007/s11126-020-09864-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
Severe Post-Traumatic Stress Disorder (PTSD) has been identified as a significant impediment to employment. However, little is known about correlates of employment recovery after a period of not working among veterans with severe PTSD treated in specialized intensive treatment programs. This study examines rates and correlates of transitioning from not being employed at admission to working four months after discharge using national Veterans Health Administration (VHA) program evaluation data on veterans engaged in specialized intensive PTSD treatment (N = 27,339). Results suggest that only 5.68% of the sample made the transition to employment while 10.6% lost employment, 8.9% worked both at admission and following discharge, and 74.9%, did not work either at admission or following discharge. Multinomial regression analysis found that compared to other groups, veterans who became employed were younger, less likely to receive service-connected disability payments, and experienced a significantly greater reduction in PTSD symptoms. Findings from this study highlight that this distinct population has very poor employment outcomes and deserves more attention, and that reducing PTSD symptoms can lead to improved employment outcomes. Efforts to integrate evidence-based vocational rehabilitation practice into residential PTSD treatment targeting PTSD symptoms is encouraged.
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17
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De Nadai AS, Etherton JL. Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination. J Cogn Psychother 2021; 35:221-231. [PMID: 34362861 DOI: 10.1891/jcpsy-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.
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18
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Kuo JR, Zeifman RJ, Morrison AS, Heimberg RG, Goldin PR, Gross JJ. The moderating effects of anger suppression and anger expression on cognitive behavioral group therapy and mindfulness-based stress reduction among individuals with social anxiety disorder. J Affect Disord 2021; 285:127-135. [PMID: 33647580 DOI: 10.1016/j.jad.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/17/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND . Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR. METHODS . One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period. RESULTS . From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT. LIMITATIONS . Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions. CONCLUSIONS . Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.
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Affiliation(s)
- Janice R Kuo
- Department of Psychology, Palo Alto University, 1791 Arastradero Rd., Palo Alto, CA 94304, United States.
| | - Richard J Zeifman
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Amanda S Morrison
- Department of Psychology, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542, United States
| | - Richard G Heimberg
- Department of Psychology, Temple University, Weiss Hall 1701 N. 13t St., Philadelphia, PA 19122, United States
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, UC Davis Health System, Sacramento, CA 98517, United States
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA 94305, United States
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19
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Mahon CP, Pachankis JE, Kiernan G, Gallagher P. Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1015-1032. [PMID: 33398699 DOI: 10.1007/s10508-020-01845-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/10/2020] [Accepted: 09/19/2020] [Indexed: 06/12/2023]
Abstract
Minority stress processes represent clear determinants of social anxiety among sexual minority populations. Yet sources of resilience to social anxiety are less explored as are stressors experienced from within sexual minority communities (i.e., intraminority stress). Based on minority stress theory and the psychological mediation framework, we hypothesized that experiences of discrimination and intraminority stress would predict proximal minority stress processes, including internalized homonegativity, sexual concealment behavior, and rejection sensitivity, as well as two resilience factors-sense of coherence and LGBTQ community connectedness-to explain social anxiety among sexual minority individuals. Self-identified cisgender sexual minority women (n = 245) and men (n = 256) residing in the Republic of Ireland completed an online survey. Results from a structural equation modeling analysis indicated that the data fit the hypothesized model well for both women and men. For both sexual minority women and men, experiences of discrimination and intraminority stress were indirectly associated with social anxiety via two paths (1) increased rejection sensitivity and (2) reduced sense of coherence. Intraminority stress was indirectly associated with social anxiety via increased concealment behavior for sexual minority men only. Experiences of discrimination were indirectly associated with social anxiety via a sequential pathway through increased proximal minority stress (i.e., concealment behavior and internalized homonegativity), and reduced LGBTQ community connectedness solely among sexual minority women. Findings are discussed in terms of implications for future research and clinical practice with sexual minority individuals who suffer from social anxiety.
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Affiliation(s)
- Conor P Mahon
- School of Psychology, Dublin City University, 620 Collins Ave Ext, Glasnevin, Dublin 9, D09 X984, Ireland.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Gemma Kiernan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Pamela Gallagher
- School of Psychology, Dublin City University, 620 Collins Ave Ext, Glasnevin, Dublin 9, D09 X984, Ireland
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20
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Zsido AN, Varadi-Borbas B, Arato N. Psychometric properties of the social interaction anxiety scale and the social phobia scale in Hungarian adults and adolescents. BMC Psychiatry 2021; 21:171. [PMID: 33771109 PMCID: PMC7995698 DOI: 10.1186/s12888-021-03174-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although social anxiety disorder is one of the most frequent disorders, it often remained unrecognized. Utilizing brief, yet reliable screening tools, such as the Social Interaction Anxiety Scale (SIAS-6) and the Social Phobia Scale (SPS-6) are helping to solve this problem in parts of Western Europe and the US. Still some countries, like Hungary, lag behind. For this purpose, previous studies call for further evidence on the applicability of the scales in various populations and cultures, as well as the elaborative validity of the short forms. Here, we aimed to provide a thorough analysis of the scales in five studies. We employed item response theory (IRT) to explore the psychometric properties of the SIAS-6 and the SPS-6 in Hungarian adults (n = 3213, age range:19-80) and adolescents (n = 292, age range:14-18). RESULTS In both samples, IRT analyses demonstrated that the items of SIAS-6 and SPS-6 had high discriminative power and cover a wide range of the latent trait. Using various subsamples, we showed that (1) the scales had excellent convergent and divergent validity in relation to domains of anxiety, depression, and cognitive emotion regulation in both samples. Further, that (2) the scales discriminated those with a history of fainting or avoidance from those without such history. Lastly, (3) the questionnaires can discriminate people diagnosed with social anxiety disorder (n = 30, age range:13-71) and controls. CONCLUSIONS These findings suggest that the questionnaires are suitable for screening for SAD in adults and adolescents. Although the confirmation of the two-factor structure may be indicative of the validity of the "performance only" specifier of SAD in DSM-V, the high correlation between the factors and the similar patter of convergent validity might indicate that it is not a discrete entity but rather a part of SAD; and that SAD is latently continuous.
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Affiliation(s)
- Andras N. Zsido
- Institute of Psychology, University of Pécs, 6, Ifjusag street, Pécs, Baranya H-7624 Hungary
| | - Brigitta Varadi-Borbas
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Nikolett Arato
- Institute of Psychology, University of Pécs, 6, Ifjusag street, Pécs, Baranya H-7624 Hungary
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21
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David OA, Canta A, Salagean I, Valenza G, Mennin DS. The phobic applying for a job: Differential efficacy of reappraising or faking on subjective states, physiological reactions and performance. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.110243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Cook SI, Meyer D, Knowles SR. Relationships between psychoevolutionary fear of evaluation, cognitive distortions, and social anxiety symptoms: A preliminary structural equation model. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12215] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sarina I. Cook
- Department of Psychology, Swinburne University of Technology, Melbourne, Australia,
| | - Denny Meyer
- Department of Statistics, Swinburne University of Technology, Melbourne, Australia,
| | - Simon R. Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Australia,
- Department of Medicine, The University of Melbourne, Melbourne, Australia,
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia,
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia,
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Clauss J. Extending the neurocircuitry of behavioural inhibition: a role for the bed nucleus of the stria terminalis in risk for anxiety disorders. Gen Psychiatr 2019; 32:e100137. [PMID: 31922088 PMCID: PMC6937153 DOI: 10.1136/gpsych-2019-100137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
Behavioural inhibition is a biologically based risk factor for anxiety disorders. Children with behavioural inhibition are shy, cautious and avoidant of new situations. Much research on behavioural inhibition has focused on the amygdala as an underlying neural substrate and has identified differences in amygdala function and volume; however, amygdala findings have yet to lead to meaningful interventions for prevention or treatment of anxiety disorders. The bed nucleus of the stria terminalis (BNST) is a prime candidate to be a neural substrate of behavioural inhibition, given current evidence of BNST function and development in human research and animal models. Children with behavioural inhibition have an increased startle response to safety cues and an increased cortisol response to social evaluative situations, both of which are mediated by the BNST. In rodents, activation of the BNST underlies contextual fear responses and responses to uncertain and sustained threat. Non-human primates with anxious temperament (the macaque equivalent of behavioural inhibition) have increased BNST activity to ambiguous social situations, and activity of the BNST in anxious temperament is significantly heritable. Importantly, the BNST is sexually dimorphic and continues to develop into adulthood, paralleling the development of anxiety disorders in humans. Together, these findings suggest that further investigation of the BNST in behavioural inhibition is necessary and may lead to new avenues for the prevention and treatment of anxiety disorders.
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Affiliation(s)
- Jacqueline Clauss
- Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
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Himle JA, LeBeau RT, Weaver A, Brydon DM, Bybee D, Kilbourne AM, Rose RD, Tucker KM, Kim R, Perez M, Smith FN, Sinco BR, Levine S, Hamameh N, Golenberg Z, McKiver M, Wierzbicki PT, Hasratian AM, Craske MG. Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety. Contemp Clin Trials Commun 2019; 16:100464. [PMID: 31701038 PMCID: PMC6831710 DOI: 10.1016/j.conctc.2019.100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA.,Department of Psychiatry, Medical School, University of Michigan, USA
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | - Deborah Bybee
- Department of Psychology, Michigan State University, USA
| | - Amy M Kilbourne
- Department of Psychiatry, Medical School, University of Michigan, USA.,Department of Learning Health Sciences, Medical School, University of Michgan, USA
| | - Raphael D Rose
- Department of Psychology, University of California Los Angeles, USA
| | | | - Richard Kim
- Department of Psychology, University of California Los Angeles, USA
| | - Marcelina Perez
- Department of Psychology, University of California Los Angeles, USA
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Miles MM, Szwedo DE, Allen JP. Learning to cope with anxiety: Long-term links from adolescence to adult career satisfaction. J Adolesc 2018; 64:1-12. [PMID: 29408094 DOI: 10.1016/j.adolescence.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
This study examined the long-term effect of anxiety on career satisfaction for young adults in the United States. The abilities to positively cope with stress and function competently as an adult were examined as potential moderators of this link, and adolescent developmental precursors of these abilities were also investigated. Analyses revealed a negative association between anxiety at age 21 and career satisfaction at age 27. However, this association was ameliorated for youth with better coping skills and functional competence at age 24. Autonomy and relatedness behaviors with best friends and mothers were examined as potential predictors of these moderators, with positive autonomy and relatedness from friends at age 13 emerging as the sole predictor of these skills. Results suggest that although anxiety may inhibit career satisfaction for many youth, positive coping and adult functional competence skills may allow anxious individuals to achieve career satisfaction. Moreover, these skills may be promoted through peer relationships in early adolescence.
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Affiliation(s)
- Maddison M Miles
- James Madison University, Department of Psychology, 91 E. Grace St./MSC 7704, Harrisonburg, VA 22807, USA.
| | - David E Szwedo
- James Madison University, Department of Psychology, 91 E. Grace St./MSC 7704, Harrisonburg, VA 22807, USA.
| | - Joseph P Allen
- University of Virginia, Department of Psychology, P.O Box 400400, Charlottesville, VA 22904, USA.
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26
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Nordahl H, Wells A. Social anxiety and work status: the role of negative metacognitive beliefs, symptom severity and cognitive-behavioural factors. J Ment Health 2017. [PMID: 28648099 DOI: 10.1080/09638237.2017.1340622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Psychological health has a profound effect on personal and occupational functioning with Social Anxiety Symptoms in particular having a major effect on ability to work. Recent initiatives have focused on treating psychological illness with cognitive-behavioural models with a view to increasing return to work. However, the psychological correlates of work status amongst individuals with elevated mental health symptoms such as social anxiety are under-explored.Aims: This study reports a test of unique predictors of work status drawing on variables that have been given centre stage in cognitive-behavioural models and in the metacognitive model of psychological disorder.Methods: The sample consisted of high socially anxious individuals who reported to be working (n = 102) or receiving disability benefits (n = 102).Results: A comparison of these groups showed that those out of work and receiving benefits had greater symptom severity, higher avoidance and use of safety behaviours, greater self-consciousness, and elevated negative metacognitive beliefs and beliefs about the need to control thoughts. However, when the covariance's between these variables were controlled, only negative metacognitive beliefs significantly predicted out-of-work status.Conclusions: Our finding might be important because CBT does not focus on metacognitive beliefs, but targets components that in our analysis had no unique predictive value for work status.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Adrian Wells
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, and.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
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Klumpp H, Fitzgerald JM, Kinney KL, Kennedy AE, Shankman SA, Langenecker SA, Phan KL. Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation. NEUROIMAGE-CLINICAL 2017; 15:25-34. [PMID: 28462086 PMCID: PMC5403806 DOI: 10.1016/j.nicl.2017.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/23/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
Background Cognitive Behavioral Therapy (CBT) for social anxiety disorder (SAD) and other internalizing conditions attempts to improve emotion regulation. Accumulating data indicate anterior cingulate cortex (ACC), and to a lesser extent amygdala, activation in various tasks predicts treatment outcome. However, little is known about ACC and amygdala activation to emotion regulation in predicting clinical improvement following CBT in SAD. Methods Before treatment, 38 SAD patients completed implicit and explicit emotion regulation paradigms during fMRI. Implicit regulation involved attentional control over negative distractors. Explicit regulation comprised cognitive reappraisal to negative images. Pre-CBT brain activity was circumscribed to anatomical-based ACC sub-regions (rostral, dorsal) and amygdala masks, which were submitted to ROC curves to examine predictive validity as well as correlational analysis to evaluate prognostic change in symptom severity. Results More rostral (rACC) activity in implicit regulation and less rACC activity during explicit regulation distinguished responders (34%) from non-responders. Greater amygdala response in implicit regulation also foretold responder status. Baseline rACC and amygdala activity during attentional control correlated with pre-to-post CBT change in symptom severity such that more activation was related to greater decline in symptoms. No significant correlations were observed for explicit regulation. Conclusions Across forms of regulation, rACC activity predicted responder status whereas amygdala as a neuromarker was limited to implicit regulation. While the direction of effects (enhanced vs. reduced) in rACC activity was task-dependent, results suggest SAD patients with deficient regulation benefited more from CBT. Findings support previous studies involving patients with depression and suggest the rACC may be a viable marker of clinical improvement in SAD. Anterior cingulate cortex is a replicated treatment neuromarker in depression. Cognitive behavioral therapy (CBT) is evidence-based psychotherapy for social phobia. CBT attempts to improve emotion regulation ability. Baseline anterior cingulate cortex activity in regulation predicted CBT response. Baseline amygdala activity during regulation also predicted CBT response.
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Affiliation(s)
- Heide Klumpp
- Mood and Anxiety Disorders Research Program, Department of Psychiatry (HK, AEK, SAL, KLP), University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology (HK, JMF, KLK, SAS, KLP), University of Illinois at Chicago, Chicago, IL, United States.
| | - Jacklynn M Fitzgerald
- Department of Psychology (HK, JMF, KLK, SAS, KLP), University of Illinois at Chicago, Chicago, IL, United States
| | - Kerry L Kinney
- Department of Psychology (HK, JMF, KLK, SAS, KLP), University of Illinois at Chicago, Chicago, IL, United States
| | - Amy E Kennedy
- Mood and Anxiety Disorders Research Program, Department of Psychiatry (HK, AEK, SAL, KLP), University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service (AEK, KLP), Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Stewart A Shankman
- Department of Psychology (HK, JMF, KLK, SAS, KLP), University of Illinois at Chicago, Chicago, IL, United States
| | - Scott A Langenecker
- Mood and Anxiety Disorders Research Program, Department of Psychiatry (HK, AEK, SAL, KLP), University of Illinois at Chicago, Chicago, IL, United States
| | - K Luan Phan
- Mood and Anxiety Disorders Research Program, Department of Psychiatry (HK, AEK, SAL, KLP), University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology (HK, JMF, KLK, SAS, KLP), University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service (AEK, KLP), Jesse Brown VA Medical Center, Chicago, IL, United States
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Ratnani IJ, Vala AU, Panchal BN, Tiwari DS, Karambelkar SS, Sojitra MG, Nagori NN. Association of social anxiety disorder with depression and quality of life among medical undergraduate students. J Family Med Prim Care 2017; 6:243-248. [PMID: 29302525 PMCID: PMC5749064 DOI: 10.4103/2249-4863.219992] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001). Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.
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Affiliation(s)
- Imran Jahangirali Ratnani
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
| | - Ashok Ukabhai Vala
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
| | - Bharat Navinchandra Panchal
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
| | - Deepak Sachchidanand Tiwari
- Department of Psychiatry, M. P. Shah Government Medical College, Guru Gobind Singh Government Hospital, Jamnagar, Gujarat, India
| | - Smruti S Karambelkar
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
| | - Milankumar G Sojitra
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
| | - Nidhi N Nagori
- Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India
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Bas-Hoogendam JM, Blackford JU, Brühl AB, Blair KS, van der Wee NJ, Westenberg PM. Neurobiological candidate endophenotypes of social anxiety disorder. Neurosci Biobehav Rev 2016; 71:362-378. [DOI: 10.1016/j.neubiorev.2016.08.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/15/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
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Himle JA, Bybee D, Steinberger E, Laviolette WT, Weaver A, Vlnka S, Golenberg Z, Levine DS, Heimberg RG, O'Donnell LA. Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial. Behav Res Ther 2014; 63:169-76. [PMID: 25461793 DOI: 10.1016/j.brat.2014.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 10/14/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
Abstract
We designed and pilot-tested a group-based, work-related cognitive-behavioral therapy (WCBT) for unemployed individuals with social anxiety disorder (SAD). WCBT, delivered in a vocational service setting by vocational service professionals, aims to reduce social anxiety and enable individuals to seek, obtain, and retain employment. We compared WCBT to a vocational services as usual control condition (VSAU). Participants were unemployed, homeless, largely African American, vocational service-seeking adults with SAD (N = 58), randomized to receive either eight sessions of WCBT plus VSAU or VSAU alone and followed three months post-treatment. Multilevel modeling revealed significantly greater reductions in social anxiety, general anxiety, depression, and functional impairment for WCBT compared to VSAU. Coefficients for job search activity and self-efficacy indicated greater increases for WCBT. Hours worked per week in the follow-up period did not differ between the groups, but small sample size and challenges associated with measuring work hours may have contributed to this finding. Overall, the results of this study suggest that unemployed persons with SAD can be effectively treated with specialized work-related CBT administered by vocational service professionals. Future testing of WCBT with a larger sample, a longer follow-up period, and adequate power to assess employment outcomes is warranted.
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Abstract
Anxiety disorders are the most common psychiatric condition presenting to primary care practitioners. Yet they can be easily overlooked or misdiagnosed. Patients that struggle with anxiety disorders are more likely to seek treatment from primary care providers than mental health specialists. Given the costs in terms of debilitation and associated financial burden, and increased risk of suicide, the identification and successful treatment of anxiety is imperative. By means of clinical acumen and the use of screening tools, the provider can develop expertise in recognition and effective treatment of anxiety disorders.
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Affiliation(s)
- Heidi Combs
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 9th Avenue Box 359911, Seattle, WA 98103, USA.
| | - Jesse Markman
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 9th Avenue Box 359911, Seattle, WA 98103, USA
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Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014; 14 Suppl 1:S1. [PMID: 25081580 PMCID: PMC4120194 DOI: 10.1186/1471-244x-14-s1-s1] [Citation(s) in RCA: 457] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. METHODS These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. RESULTS These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. CONCLUSIONS Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.
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Affiliation(s)
- Martin A Katzman
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Pierre Bleau
- Department of Psychiatry, McGill University, Montreal, QC, H3A 1A1, Canada
| | - Pierre Blier
- Department of Psychiatry and Cellular/Molecular Medicines, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
| | - Pratap Chokka
- Department of Psychiatry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Kevin Kjernisted
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, L8N 3K7, Canada
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Himle JA, Weaver A, Bybee D, O'Donnell L, Vlnka S, Laviolette W, Steinberger E, Golenberg Z, Levine DS. Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder. Psychiatr Serv 2014; 65:924-30. [PMID: 24733524 PMCID: PMC4198508 DOI: 10.1176/appi.ps.201300201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.
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Affiliation(s)
- Joseph A Himle
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Addie Weaver
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Deborah Bybee
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Lisa O'Donnell
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Sarah Vlnka
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Wayne Laviolette
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Edward Steinberger
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Zipora Golenberg
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Debra Siegel Levine
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
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Blackford JU, Clauss JA, Avery SN, Cowan RL, Benningfield MM, VanDerKlok RM. Amygdala-cingulate intrinsic connectivity is associated with degree of social inhibition. Biol Psychol 2014; 99:15-25. [PMID: 24534162 DOI: 10.1016/j.biopsycho.2014.02.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 01/11/2023]
Abstract
The tendency to approach or avoid novel people is a fundamental human behavior and is a core dimension of social anxiety. Resting state fMRI was used to test for an association between social inhibition and intrinsic connectivity in 40 young adults ranging from low to high in social inhibition. Higher levels of social inhibition were associated with specific patterns of reduced amygdala-cingulate cortex connectivity. Connectivity was reduced between the superficial amygdala and the rostral cingulate cortex and between the centromedial amygdala and the dorsal anterior cingulate cortex. Social inhibition also modulated connectivity in several well-established intrinsic networks; higher social inhibition correlated with reduced connectivity with default mode and dorsal attention networks and enhanced connectivity in salience and executive control networks. These findings provide important preliminary evidence that social inhibition reflects differences in the underlying intrinsic connectivity of the brain in the absence of social stimuli or stressors.
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Affiliation(s)
- Jennifer Urbano Blackford
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States.
| | - Jacqueline A Clauss
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Neuroscience Graduate Program, Vanderbilt Brain Institute, Nashville, TN, United States
| | - Suzanne N Avery
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Neuroscience Graduate Program, Vanderbilt Brain Institute, Nashville, TN, United States
| | - Ronald L Cowan
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States; Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Margaret M Benningfield
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Ross M VanDerKlok
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States
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Iza M, Wall MM, Heimberg RG, Rodebaugh TL, Schneier FR, Liu SM, Blanco C. Latent structure of social fears and social anxiety disorders. Psychol Med 2014; 44:361-370. [PMID: 23480876 DOI: 10.1017/s0033291713000408] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite its high prevalence and associated levels of impairment, the latent structure of social anxiety disorder (SAD) is not well understood, with published studies reporting inconsistent results. Furthermore, it is unknown whether the latent structure of social fears in individuals with and without SAD is the same. METHOD Exploratory factor analysis (EFA) and confirmatory factor analysis followed by multiple indicators multiple causes (MIMIC) analysis were conducted on 13 commonly feared social situations assessed in a nationally representative sample including individuals with SAD and those with social fears but who did not meet DSM-IV criteria for SAD. RESULTS An EFA conducted in the full sample, including individuals with no social fears (88% of the sample), yielded only one factor. When the sample was restricted to those with at least one social fear, the EFA yielded three factors, in both the subsample with at least one social fear but no SAD and the subsample with SAD. The three factors represented feared situations related to public performance, close scrutiny and social interaction. The MIMIC analyses further indicated that the three-factor structure was able to explain differences in prevalence of social fears across a broad range of sociodemographic covariates. CONCLUSIONS Among individuals with at least one social fear and those with DSM-IV SAD the latent structure of social fears appears to be best described by three factors, although this may partially depend on how the sample is specified. These results may help reconcile the findings of different numbers of factors identified in previous studies.
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Affiliation(s)
- M Iza
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - M M Wall
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - R G Heimberg
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - T L Rodebaugh
- Department of Psychology, Washington University Campus, St Louis, MO, USA
| | - F R Schneier
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - S-M Liu
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - C Blanco
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Clauss JA, Blackford JU. Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. J Am Acad Child Adolesc Psychiatry 2012; 51:1066-1075.e1. [PMID: 23021481 PMCID: PMC3611590 DOI: 10.1016/j.jaac.2012.08.002] [Citation(s) in RCA: 351] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 07/11/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Behavioral inhibition (BI) has been associated with increased risk for developing social anxiety disorder (SAD); however, the degree of risk associated with BI has yet to be systematically examined and quantified. The goal of the present study was to quantify the association between childhood BI and risk for developing SAD. METHOD A comprehensive literature search was conducted to identify studies that assessed both BI and SAD. Meta-analyses were performed to estimate the odds ratio (OR) of the association between BI and SAD in children. RESULTS Seven studies met inclusion criteria. BI was associated with a greater than sevenfold increase in risk for developing SAD (odds ratio = 7.59, p < .00002). This association remained significant even after considering study differences in temperament assessment, control group, parental risk, age at temperament assessment, and age at anxiety diagnosis. CONCLUSIONS Identifying early developmental risk factors is critical for preventing psychiatric illness. Given that 15% of all children show extreme BI, and that almost half of these inhibited children will eventually develop SAD, we propose that BI is one of the largest single risk factors for developing SAD.
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Moitra E, Dyck I, Beard C, Bjornsson AS, Sibrava NJ, Weisberg RB, Keller MB. Impact of stressful life events on the course of panic disorder in adults. J Affect Disord 2011; 134:373-6. [PMID: 21658775 PMCID: PMC3170458 DOI: 10.1016/j.jad.2011.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/04/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Panic disorder with/without agoraphobia (PD/PDA) is a prevalent anxiety disorder, associated with impairment in quality of life and functionality, as well as increased healthcare utilization. Extant research shows a relationship between stressful life events (SLEs) and the onset of panic attacks in adults who ultimately develop PD/PDA. However, limited attention has been paid to how SLEs might affect the severity of panic symptoms in individuals with PD/PDA. In this study, we examined the relationship between SLEs and panic symptom severity in adults with PD/PDA. METHODS Four hundred-eighteen adults with PD/PDA from the Harvard/Brown Anxiety Research Program (HARP), a long-term prospective longitudinal observational multicenter study of adults with a current or past history of anxiety disorders were included in this study. We examined occurrence of SLEs and their impact on panic symptom severity 12-weeks pre- and post-SLE. RESULTS A time-slope effect showed that participants had worsened panic symptoms over the course of the 12-weeks after family/friends/household and work SLEs. That is, their symptoms worsened progressively after the event, rather than immediately thereafter (i.e., significant symptom change within the same week of the event). LIMITATIONS The sample may not be representative of the general population. CONCLUSIONS These findings provide new insights into how SLEs affect panic symptoms in adults with PD/PDA in that household-related SLEs, such as serious family arguments, and work-related SLEs, such as being fired, put some adults at risk for worsened panic symptoms within 12-weeks of the event.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, United States.
| | - Ingrid Dyck
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Courtney Beard
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Andri S. Bjornsson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Nicholas J. Sibrava
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Risa B. Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Department of Family Medicine, Alpert Medical School of Brown University
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Fontani V, Mannu P, Castagna A, Rinaldi S. Social anxiety disorder: radio electric asymmetric conveyor brain stimulation versus sertraline. Patient Prefer Adherence 2011; 5:581-6. [PMID: 22163157 PMCID: PMC3234900 DOI: 10.2147/ppa.s27409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Social anxiety disorder (SAD) is a disabling condition that affects almost 5% of the general population. Many types of drugs have shown their efficacy in the treatment of SAD. There are also some data regarding psychotherapies, but no data are available today about the efficacy of brain stimulation techniques. The aim of the study is to compare the efficacy of noninvasive brain stimulation neuro psycho physical optimization (NPPO) protocol performed by radio electric asymmetric conveyor (REAC) with that of sertraline in adults with SAD. PATIENTS AND METHODS Twenty SAD patients on sertraline were compared with 23 SAD patients who refused any drug treatment and who chose to be treated with NPPO-REAC brain stimulation. This was a 6-month, open-label, naturalistic study. Patients on sertraline received flexible doses, whereas NPPO-REAC patients received two 18-session cycles of treatment. Clinical Global Improvement scale items "much improved" or "very much improved" and Liebowitz Social Anxiety Scale total score variation on fear and avoidance components were used to detect the results. The statistical analysis was performed with t-test. All measures <0.05 have been considered statistically significant. RESULTS Ten of 23 subjects on NPPO-REAC and six of the 20 taking sertraline were much improved or very much improved 1 month after the first NPPO-REAC cycle (t1). Sixteen of the subjects on NPPO-REAC and ten of the subjects taking sertraline were much improved or very much improved 1 month after the second NPPO-REAC cycle (t2). In respect of the Liebowitz Social Anxiety Scale, at t1 NPPO-REAC resulted in statistically more efficacy for sertraline on both fear and avoidance total scores. At t2, NPPO-REAC resulted in statistically more efficacy for sertraline on fear but not on avoidance. CONCLUSION NPPO-REAC is an effective treatment for SAD, allowing substantial and clinically meaningful reductions in symptoms and disability in comparison with sertraline.
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Affiliation(s)
- Vania Fontani
- Department of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence
| | - Piero Mannu
- Department of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence
- Psychic Studies Center, Cagliari, Italy
| | - Alessandro Castagna
- Department of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence
| | - Salvatore Rinaldi
- Department of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence
- Correspondence: Salvatore Rinaldi, Rinaldi Fontani Institute, Viale Belfiore 43, 50144 Florence, Italy, Tel +39 055 290307, Fax +39 055 290399, Email
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