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Baljé AE, Greeven A, Deen M, van Giezen AE, Arntz A, Spinhoven P. Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial. J Anxiety Disord 2024; 104:102860. [PMID: 38714138 DOI: 10.1016/j.janxdis.2024.102860] [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: 08/23/2023] [Revised: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. METHODS We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). RESULTS Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. CONCLUSION GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.
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Affiliation(s)
- Astrid E Baljé
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Anja Greeven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Mathijs Deen
- Institute of Psychology/Leiden University, Leiden, the Netherlands; Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Anne E van Giezen
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands.
| | - Philip Spinhoven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
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Zech JM, Patel TA, Cougle JR. Safety Behaviors Predict Long-Term Treatment Outcome Following Internet-Based Treatment of Adults with Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Ambusaidi A, Al-Huseini S, Alshaqsi H, AlGhafri M, Chan MF, Al-Sibani N, Al-Adawi S, Qoronfleh MW. The Prevalence and Sociodemographic Correlates of Social Anxiety Disorder: A Focused National Survey. CHRONIC STRESS 2022; 6:24705470221081215. [PMID: 35252735 PMCID: PMC8894948 DOI: 10.1177/24705470221081215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
Abstract
Background Social Anxiety Disorder (SAD) is among the most common anxiety disorders worldwide with data largely emerging from the Euro-American and Pacific Rim populations. In contrast, there is a dearth of studies among the populations of Arabian Gulf countries including Oman. This study has two interrelated aims: (i) to explore the prevalence of SAD among Omani adults, and (ii) to tease out the links between socio-demographic factors and SAD in Oman. Methods A cross-sectional study via an online survey was conducted among 1019 adult Omani nationals residing in Oman. The presence of SAD was assessed using the Arabic version of the Liebowitz Social Anxiety Scale (LSAS). Results Nearly half the participants (45.9%, n = 468) exhibited “caseness” for SAD as defined by LSAS. In the multivariate logistic analysis, participants below 40 years of age were 1.6 times (OR = 1.568, p = .026) more likely to have caseness for SAD than those who were 40 and older. Women were 1.3 times (OR = 1.348, p = .038) more likely to exhibit caseness for SAD than men. Participants who had secondary or undergraduate education were respectively 1.5 times (OR = 1.45, p = .014) and 2.5 times (OR = 2.509, p < .001) to have caseness for SAD than those who were graduates. Conclusion The present data suggest that 45.9% of the participants reached the cut-off for caseness in LSAS, which is high compared to reports from other populations. The present accrued frequency is discussed within the context of the accrued response rate, socio-cultural factors as well as the tendency for self-reported measures to “produce” spurious results is also highlighted which, in turn, calls for studies that adopt more inclusive survey methods.
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Affiliation(s)
- Aamal Ambusaidi
- Department of Behavioral Medicine, College of Medicine & Health Sciences/Sultan Qaboos University Hospital, Muscat, Oman
| | - Salim Al-Huseini
- Department of Psychiatry, Al-Massarah Hospital, Ministry of Health, Muscat, Oman
| | - Hiba Alshaqsi
- Department of Psychiatry, Al-Massarah Hospital, Ministry of Health, Muscat, Oman
| | - Manal AlGhafri
- Department of Psychiatry, Al-Massarah Hospital, Ministry of Health, Muscat, Oman
| | - Moon-Fai Chan
- Department of Family Medicine and Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nasser Al-Sibani
- Department of Behavioral Medicine, College of Medicine & Health Sciences/Sultan Qaboos University Hospital, Muscat, Oman
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences/Sultan Qaboos University Hospital, Muscat, Oman
| | - M. Walid Qoronfleh
- Q3CG Research Institute (QRI), Research & Policy Division, Ypsilanti, MI, USA
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Examining Whether Social Anxiety Influences Satisfaction in Romantic Relationships. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractResearch investigating social anxiety and the impacts on romantic relationships remains scarce. An online questionnaire examining romantic relationship status, social anxiety and depression symptomology, relationship satisfaction, and several relationship processes was completed by 444 adults. Individuals with higher social anxiety were less likely to be in romantic relationships. For the 188 adults in our sample in current relationships, relationship satisfaction was not influenced by social anxiety when controlling for depression. Although it was proposed that self-disclosure, social support, trust, and conflict initiation might influence romantic relationship satisfaction, none of these mechanisms interacted with social anxiety to explain additional variance in relationship satisfaction. These findings indicate that depression symptomology may be a treatment target for socially anxious individuals wishing to improve romantic relationship satisfaction.
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Hahn CM, Hahn IG, Campbell LJ. Social Anxiety and Depression in Romantic Relationships: A Three-Sample Exploration. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Social anxiety contributes to a variety of interpersonal difficulties and dysfunctions. Socially anxious adults are less likely to marry and more likely to divorce than are non-anxious adults. The present pre-registered study investigated incremental variance accounted for by social anxiety in relationship satisfaction, commitment, trust, and social support. Methods: Three independent samples of adults (N = 888; 53.7% female; Mage = 35.09 years) involved in a romantic relationship completed online self-report questionnaires. Both social anxiety and depression were significantly correlated with relationship satisfaction, commitment, dyadic trust, and social support. Hierarchical regression analyses were conducted with each sample to investigate the incremental variance accounted for by each of social anxiety and depression in relationship satisfaction, commitment, dyadic trust, and social support. Subsequent meta-analyses were run to determine the strength and replicability of the hierarchical models. Results: Results suggest that social anxiety is a robust predictor of unique variance in both perceived social support and commitment. Depression was a robust predictor of unique variance in relationship satisfaction, dyadic trust, social support, and commitment. Discussion: These results help to further understanding of social anxiety in romantic relationships and provide direction for future research and clinical intervention.
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Geronikolou S, Chrousos G. COVID-19-Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results. JMIR Form Res 2021; 5:e21156. [PMID: 33400681 PMCID: PMC7860927 DOI: 10.2196/21156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects.
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Affiliation(s)
- Styliani Geronikolou
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Lowe R, Menzies R, Onslow M, Packman A, O'Brian S. Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:59-74. [PMID: 33400555 PMCID: PMC8608149 DOI: 10.1044/2020_jslhr-20-00144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/16/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.
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Affiliation(s)
- Robyn Lowe
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ross Menzies
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Onslow
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sue O'Brian
- Australian Stuttering Research Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
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Scott JH, Yap K, Francis AJ, Schuster S. Perfectionism and its relationship with anticipatory processing in social anxiety. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica H. Scott
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia,
| | - Keong Yap
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia,
| | | | - Sharynn Schuster
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia,
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Hajure M, Abdu Z. Social Phobia and Its Impact on Quality of Life Among Regular Undergraduate Students of Mettu University, Mettu, Ethiopia. Adolesc Health Med Ther 2020; 11:79-87. [PMID: 32607041 PMCID: PMC7308132 DOI: 10.2147/ahmt.s254002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background Social anxiety disorder is a serious and disabling mental health problem that begins before or during adolescence, with the potential to significantly interfere with an individual’s daily functioning and overall quality of life. Objective The aims of this study were to assess the prevalence, severity, and quality of life towards social anxiety disorder among students of Mettu University, Ethiopia. Subjects and Methods A cross-sectional study was conducted among a stratified sample of 523 undergraduate students to identify the prevalence, correlates of social anxiety disorder, and impacts on quality life. All participants completed the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and World Health Organization Quality of Life-Brief Form, Turkish Version (WHOQOL-BREF-TR). Of 523 students, 26% were screened positive for social anxiety disorder. About 69.4% and 17.4% of the students had mild and moderate symptoms of social anxiety disorder, respectively. WHOQOL BREF-TR scores showed that students with social phobia had significantly lower quality of life quality than those without social phobia. Being criticized by others or fear of parties was the most commonly feared situations. Talking to strangers was the most commonly avoided situations. Being females, current tobacco use, and family history of psychiatric illness were factors significantly associated with social phobia symptoms using logistic regression analysis. Conclusion The current study shows high prevalence of social phobia among the university students and its significant negative effects on quality of life which require prompt identification and treatment. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/ggViE65C2Fo
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Affiliation(s)
| | - Zakir Abdu
- Department of Psychiatry, Mettu University, Mettu, Oromia, Ethiopia
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Zaffar W, Arshad T. The relationship between social comparison and submissive behaviors in people with social anxiety: Paranoid social cognition as the mediator. Psych J 2020; 9:716-725. [DOI: 10.1002/pchj.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2019] [Accepted: 01/30/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Warisha Zaffar
- Centre for Clinical Psychology University of the Punjab Lahore Pakistan
| | - Tehreem Arshad
- Centre for Clinical Psychology University of the Punjab Lahore Pakistan
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Menzies RG, Packman A, Onslow M, O'Brian S, Jones M, Helgadóttir FD. In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1614-1624. [PMID: 31112442 DOI: 10.1044/2019_jslhr-s-18-0340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.
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Affiliation(s)
- Ross G Menzies
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Ann Packman
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Mark Onslow
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, New South Wales
| | - Mark Jones
- School of Public Health, The University of Queensland, Brisbane, Australia
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McEnery C, Lim MH, Tremain H, Knowles A, Alvarez-Jimenez M. Prevalence rate of social anxiety disorder in individuals with a psychotic disorder: A systematic review and meta-analysis. Schizophr Res 2019; 208:25-33. [PMID: 30722947 DOI: 10.1016/j.schres.2019.01.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
Social anxiety disorder (SAD) is characterised as an excessive fear of negative judgment from others and is considered one of the most disabling of the mental ill health conditions. Research findings indicate that it is also a significant issue for individuals diagnosed with a psychotic disorder, with prevalence rates of social anxiety ranging from 8% to 36%. This study was conducted to address the variance of the reported prevalence rates of comorbid SAD amongst individuals with a psychotic disorder diagnosis. Via a systematic review, we collated all available literature on the prevalence of SAD in individuals with a psychotic disorder, and evaluated the prevalence results via meta-analysis. We also synthesised all psychosocial outcomes attributed to SAD comorbidity and conducted a narrative review of the relevant findings. Across 25 studies providing data from 1980 to May 2018 and spanning 13 countries (N = 92,522), we found a pooled prevalence rate of 21% (16%-26%). In outpatient samples, (17 studies), the prevalence was 25% (19%-31%), statistically significantly higher (z = 5.12, p < .001) than that of the inpatient studies six studies, which was 9% (7%-12%). We also found that SAD comorbidity is associated with increased depression, poorer social function, poorer subjective quality of life, greater negative self-evaluation, and greater insight. The results from this systematic review and meta-analysis suggest that SAD is prevalent amongst individuals with a psychotic disorder. More consistent screening for SAD and the development of theoretically driven and empirically supported tailored treatments are recommended.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Hailey Tremain
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Ann Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
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Koyuncu A, İnce E, Ertekin E, Tükel R. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context 2019; 8:212573. [PMID: 30988687 PMCID: PMC6448478 DOI: 10.7573/dic.212573] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Comorbid disorders are highly prevalent in patients with social anxiety disorder, occurring in as many as 90% of patients. The presence of comorbidity may affect the course of the disease in several ways such as comorbidity in patients with social anxiety disorder (SAD) is related to earlier treatment-seeking behavior, increased symptom severity, treatment resistance and decreased functioning. Moreover, comorbidities cause significant difficulties in nosology and diagnosis, and may cause treatment challenges. In this review, major psychiatric comorbidities that can be encountered over the course of SAD as well as comorbidity associated diagnostic and therapeutic challenges will be discussed.
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Affiliation(s)
- Ahmet Koyuncu
- Academy Social Phobia Center, Atatürk Mah. İkitelli Cad. No:126 A/Daire:6 Küçükçekmece/Istanbul, Turkey
| | - Ezgi İnce
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Erhan Ertekin
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Raşit Tükel
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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McEnery C, Lim MH, Knowles A, Rice S, Gleeson J, Howell S, Russon P, Miles C, D'Alfonso S, Alvarez-Jimenez M. Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis. Front Psychiatry 2019; 10:581. [PMID: 31474889 PMCID: PMC6702333 DOI: 10.3389/fpsyt.2019.00581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ann Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Simmone Howell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Penni Russon
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Chris Miles
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Simon D'Alfonso
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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15
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2018. [DOI: 10.1177/0004867418799453] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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Boettcher J, Magnusson K, Marklund A, Berglund E, Blomdahl R, Braun U, Delin L, Lundén C, Sjöblom K, Sommer D, von Weber K, Andersson G, Carlbring P. Adding a smartphone app to internet-based self-help for social anxiety: A randomized controlled trial. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2018.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Iverach L, Jones M, Lowe R, O'Brian S, Menzies RG, Packman A, Onslow M. Comparison of adults who stutter with and without social anxiety disorder. JOURNAL OF FLUENCY DISORDERS 2018; 56:55-68. [PMID: 29602052 DOI: 10.1016/j.jfludis.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 05/14/2023]
Abstract
PURPOSE Social anxiety disorder is a debilitating anxiety disorder associated with significant life impairment. The purpose of the present study is to evaluate overall functioning for adults who stutter with and without a diagnosis of social anxiety disorder. METHOD Participants were 275 adults who stuttered (18-80 years), including 219 males (79.6%) and 56 females (20.4%), who were enrolled to commence speech treatment for stuttering. Comparisons were made between participants diagnosed with social anxiety disorder (n = 82, 29.8%) and those without that diagnosis (n = 193, 70.2%). RESULTS Although the socially anxious group was significantly younger than the non-socially anxious group, no other demographic differences were found. When compared to the non-socially anxious group, the socially anxious group did not demonstrate significantly higher self-reported stuttering severity or percentage of syllables stuttered. Yet the socially anxious group reported more speech dissatisfaction and avoidance of speaking situations, significantly more psychological problems, and a greater negative impact of stuttering. CONCLUSION Significant differences in speech and psychological variables between groups suggest that, despite not demonstrating more severe stuttering, socially anxious adults who stutter demonstrate more psychological difficulties and have a more negative view of their speech. The present findings suggest that the demographic status of adults who stutter is not worse for those with social anxiety disorder. These findings pertain to a clinical sample, and cannot be generalized to the wider population of adults who stutter from the general community. Further research is needed to understand the longer-term impact of social anxiety disorder for those who stutter.
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Affiliation(s)
- Lisa Iverach
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Mark Jones
- School of Public Health, University of Queensland, Level 2, Public Health Building, Herston Road, Herston, QLD, 4006, Australia.
| | - Robyn Lowe
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Susan O'Brian
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Ross G Menzies
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Ann Packman
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
| | - Mark Onslow
- The University of Sydney, Faculty of Health Science, Australian Stuttering Research Centre, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
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Iverach L, Jones M, Lowe R, O'Brian S, Menzies RG, Packman A, Onslow M. Characteristics of adults who stutter by treatments sought. LOGOP PHONIATR VOCO 2018; 44:134-142. [PMID: 29569967 DOI: 10.1080/14015439.2018.1452976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Several treatment approaches are available for adults who stutter, including speech treatment, cognitive behaviour therapy (CBT) treatment for anxiety, and a combination of both. It is useful to determine whether any differences exist between adults who stutter enrolled in different types of treatment. Therefore, the purpose of this study was to compare demographic, speech, and psychological characteristics of adults who stutter enrolled in speech, psychological, and combined treatment programs. Participants were 288 adults who stuttered (18-80 years) enrolled in one of three different treatment programs: Speech Treatment for stuttering (n = 134), Anxiety Treatment for anxiety about stuttering (n = 70), or Speech Treatment for Stuttering With or Without Anxiety Treatment (n = 84). Participants completed a range of demographic, speech, and psychological measures prior to the start of treatment. A significantly higher proportion of participants in the Anxiety Treatment group were in a personal relationship than the other treatment groups. The Anxiety Treatment group had higher average age than the other treatment groups. The Speech Treatment group also demonstrated significantly higher self-rated stuttering severity than the Anxiety Treatment group, even though there were no significant difference between groups for clinician-rated percentage of syllables stuttered. Although most characteristics of adults who stuttered did not vary by treatment type, the present findings suggest that adults who stutter enrolled in speech treatment perceived their stuttering as more severe, which may have prompted treatment seeking. Further research is needed regarding the supportive influence of personal relationship for those with the disorder.
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Affiliation(s)
- Lisa Iverach
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Mark Jones
- b School of Public Health , University of Queensland , Herston , Australia
| | - Robyn Lowe
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Susan O'Brian
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Ross G Menzies
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Ann Packman
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
| | - Mark Onslow
- a Australian Stuttering Research Centre , The University of Sydney , Lidcombe , Australia
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Harrewijn A, van der Molen MJW, van Vliet IM, Houwing-Duistermaat JJ, Westenberg PM. Delta-beta correlation as a candidate endophenotype of social anxiety: A two-generation family study. J Affect Disord 2018; 227:398-405. [PMID: 29154156 DOI: 10.1016/j.jad.2017.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/01/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by an extreme and intense fear and avoidance of social situations. In this two-generation family study we examined delta-beta correlation during a social performance task as candidate endophenotype of SAD. METHODS Nine families with a target participant (diagnosed with SAD), their spouse and children, as well as target's siblings with spouse and children performed a social performance task in which they gave a speech in front of a camera. EEG was measured during resting state, anticipation, and recovery. Our analyses focused on two criteria for endophenotypes: co-segregation within families and heritability. RESULTS Co-segregation analyses revealed increased negative delta-low beta correlation during anticipation in participants with (sub)clinical SAD compared to participants without (sub)clinical SAD. Heritability analyses revealed that delta-low beta and delta-high beta correlation during anticipation were heritable. Delta-beta correlation did not differ between participants with and without (sub)clinical SAD during resting state or recovery, nor between participants with and without SAD during all phases of the task. LIMITATIONS It should be noted that participants were seen only once, they all performed the EEG tasks in the same order, and some participants were too anxious to give a speech. CONCLUSIONS Delta-low beta correlation during anticipation of giving a speech might be a candidate endophenotype of SAD, possibly reflecting increased crosstalk between cortical and subcortical regions. If validated as endophenotype, delta-beta correlation during anticipation could be useful in studying the genetic basis, as well as improving treatment and early detection of persons at risk for developing SAD.
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Affiliation(s)
- Anita Harrewijn
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands.
| | - Melle J W van der Molen
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | - Jeanine J Houwing-Duistermaat
- Department of Medical Statistics and BioInformatics, Leiden University Medical Center, The Netherlands; Department of Statistics, University of Leeds, United Kingdom
| | - P Michiel Westenberg
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
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Yu M, Xu W, Xie Q, Zhu Y, Chasson GS, Wang J. Automatic thoughts as a predictor of internalizing and externalizing problems in Chinese adolescents: A test of the cognitive content-specificity hypothesis with age effects. Scand J Psychol 2017; 58:351-358. [DOI: 10.1111/sjop.12373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/22/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Meng Yu
- Beijing Key Laboratory of Applied Experimental Psychology; Faculty of Psychology, Beijing Normal University; Beijing PR China
| | - Wei Xu
- School of Psychology, Nanjing Normal University; Nanjing PR China
| | - Qiuyuan Xie
- Beijing Key Laboratory of Applied Experimental Psychology; Faculty of Psychology, Beijing Normal University; Beijing PR China
- Department of Social Work and Social Administration; University of Hong Kong; Hong Kong PR China
| | - Yawen Zhu
- Beijing Key Laboratory of Applied Experimental Psychology; Faculty of Psychology, Beijing Normal University; Beijing PR China
| | - Gregory S. Chasson
- Department of Psychology; Illinois Institute of Technology; Chicago IL USA
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology; Faculty of Psychology, Beijing Normal University; Beijing PR China
- Capital Medical University; Beijing PR China
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Gender differences in social anxiety disorder: A review. Clin Psychol Rev 2017; 56:1-12. [PMID: 28578248 DOI: 10.1016/j.cpr.2017.05.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 11/23/2022]
Abstract
Gender differences in social anxiety disorder (SAD) have not received much empirical attention despite the large body of research on the disorder, and in contrast to significant literature about gender differences in other disorders such as depression or posttraumatic stress disorder. To address this gap, we comprehensively reviewed the literature regarding gender differences in eight domains of SAD: prevalence, clinical presentation, functioning and impairment, comorbidity, course, treatment seeking, physiological arousal, and the oxytocin system. Findings from the present review indicate that women are more likely to have SAD and report greater clinical severity. Notwithstanding, men with the disorder may seek treatment to a greater extent. According to the present review, the course of SAD seems to be similar for men and women, and findings regarding gender differences in functional impairment and comorbidity are inconclusive. We highlight areas requiring future research and discuss the findings in the context of a number of theoretical perspectives. We believe that further research and integration of scientific findings with existing theories is essential in order to increase our understanding and awareness of gender differences in SAD, thus facilitating gender-sensitive and specifically-tailored interventions for both men and women with the disorder.
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Heeren A, McNally RJ. An integrative network approach to social anxiety disorder: The complex dynamic interplay among attentional bias for threat, attentional control, and symptoms. J Anxiety Disord 2016; 42:95-104. [PMID: 27395806 DOI: 10.1016/j.janxdis.2016.06.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
Abstract
Cognitive models posit that social anxiety disorder (SAD) is associated with and maintained by biased attention allocation vis-à-vis social threat. However, over the last decade, there has been intense debate regarding whether AB in SAD results from preferential engagement with or difficulty in disengaging from social threat. Further, recent evidence suggests that AB may merely result from top-down attentional impairments vis-à-vis non-emotional material. Consequently, uncertainty still abounds regarding both the relative importance and the mutual interactions of these different processes and SAD symptoms. Inspired by novel network approaches to psychopathology that conceptualize symptoms as complex dynamic systems of mutually interacting variables, we computed weighted directed networks to investigate potential causal relations among laboratory measures of attentional components and symptoms of social anxiety disorder. Global and local connectivity of network structures revealed that the three most central variables were the orienting component of attention as well as both avoidance and fear of social situations. Neither preferential attention engagement with threat nor difficulty disengaging from threat exhibited high relative importance as predictors of symptoms in the network. Together, these findings suggest the value of extending the network approach beyond self-reported clinical symptoms to incorporate process-level measures from laboratory tasks to gain new insight into the mechanisms of SAD.
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Affiliation(s)
- Alexandre Heeren
- Department of Psychology, Harvard University, Cambridge, MA, USA; Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
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Ng AS, Abbott MJ. The Effect of Negative, Positive, and Neutral Self-imagery on Symptoms and Processes in Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-015-9751-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Prior K, Mills K, Ross J, Teesson M. Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug Alcohol Rev 2016; 36:317-324. [PMID: 27324816 DOI: 10.1111/dar.12419] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIMS Substance use disorders (SUDs) are common and frequently co-occur with mood and anxiety disorders. This paper provides a detailed analysis of patterns, prevalence and correlates of mood and anxiety disorders among those with a (i) pure SUD; (ii) SUD plus a mood or anxiety disorder (SUDs + 1); and (iii) SUD plus a mood and anxiety disorder (SUDs + 2). DESIGN AND METHODS Data came from the 2007 National Survey of Mental Health and Wellbeing; a nationally representative household survey of 8841 Australians aged 16-85 years. RESULTS The 12-month prevalence of SUDs was 5.1%. Of those with a 12-month SUD, 65% met the criteria for pure SUDs, 19% for SUDs + 1 and 16% for SUDs + 2. Major depression was the most common mood disorder in both comorbid groups. One-third of SUDs + 1 experienced social phobia, while over half of SUDs + 2 experienced generalised anxiety disorder. Compared with pure SUDs, SUDs + 1 experienced two times more and SUDs + 2 experienced over four times more days out of role in the preceding 30 days. Both comorbid groups were more likely to experience severe levels of impairment. SUDs + 2 were over 18 times more likely to experience suicidal thoughts in the same year. SUDs + 1 were over three times and SUDs + 2 were over 10 times more likely to have had one or more consultations with a health professional in the previous year. DISCUSSIONS AND CONCLUSIONS These findings highlight the complexities inherent with responding to and treating multiple comorbidities among substance users and emphasise the need for coordinated, cohesive responses from drug and alcohol treatment services.[Prior K, Mills K, Ross J, Teesson M. Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug Alcohol Rev 2017;36:317-324].
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Affiliation(s)
- Katrina Prior
- National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katherine Mills
- National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Joanne Ross
- National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Maree Teesson
- National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Heelan M, McAllister J, Skinner J. Stuttering, alcohol consumption and smoking. JOURNAL OF FLUENCY DISORDERS 2016; 48:27-34. [PMID: 27498892 DOI: 10.1016/j.jfludis.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Limited research has been published regarding the association between stuttering and substance use. An earlier study provided no evidence for such an association, but the authors called for further research to be conducted using a community sample. The present study used data from a community sample to investigate whether an association between stuttering and alcohol consumption or regular smoking exists in late adolescence and adulthood. METHODS Regression analyses were carried out on data from a birth cohort study, the National Child Development Study (NCDS), whose initial cohort included 18,558 participants who have since been followed up until age 55. In the analyses, the main predictor variable was parent-reported stuttering at age 16. Parental socio-economic group, cohort member's sex and childhood behavioural problems were also included. The outcome variables related to alcohol consumption and smoking habits at ages 16, 23, 33, 41, 46, 50 and 55. RESULTS No significant association was found between stuttering and alcohol consumption or stuttering and smoking at any of the ages. It was speculated that the absence of significant associations might be due to avoidance of social situations on the part of many of the participants who stutter, or adoption of alternative coping strategies. CONCLUSION Because of the association between anxiety and substance use, individuals who stutter and are anxious might be found to drink or smoke excessively, but as a group, people who stutter are not more likely than those who do not to have high levels of consumption of alcohol or nicotine.
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Torvik FA, Welander-Vatn A, Ystrom E, Knudsen GP, Czajkowski N, Kendler KS, Reichborn-Kjennerud T. Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:114-124. [PMID: 26569037 PMCID: PMC4701609 DOI: 10.1037/abn0000124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are frequently co-occurring psychiatric disorders with symptomatology related to fear of social situations. It is uncertain to what degree the 2 disorders reflect the same genetic and environmental risk factors. The current study addresses the stability and co-occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and genetic and environmental factors underlying the disorders at 2 time points. SAD and AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these approximately 10 years later. Biometric models were fitted to dimensional representations of SAD and AvPD. SAD and AvPD were moderately and approximately equally stable from young to middle adulthood, with increasing co-occurrence driven by environmental factors. At the first wave, approximately 1 in 3 individuals with AvPD had SAD, increasing to 1 in 2 at follow-up. The diagnostic criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The relationship between SAD and AvPD was best accounted for by a model with separate, although highly correlated (r = .76), and highly heritable (.66 and .71) risk factors for each disorder. Their genetic and environmental components correlated .84 and .59, respectively. The finding of partially distinct risk factors indicates qualitative differences in the etiology of SAD and AvPD. Genetic factors represented the strongest time-invariant influences, whereas environmental factors were most important at the specific points in time.
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Affiliation(s)
- Fartein Ask Torvik
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Audun Welander-Vatn
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Eivind Ystrom
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Gun Peggy Knudsen
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Nikolai Czajkowski
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
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Nagata T, Suzuki F, Teo AR. Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review. Psychiatry Clin Neurosci 2015; 69:724-40. [PMID: 26121185 DOI: 10.1111/pcn.12327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.
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Affiliation(s)
| | - Futoshi Suzuki
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Aichi, Japan
| | - Alan R Teo
- VA Portland Health Care System and Oregon Health & Science University, Oregon, USA
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The Maintaining Factors of Social Anxiety: A Three-Group Comparison of a Clinical Sample with Highly Socially Anxious Students and Non-Anxious Students. Behav Cogn Psychother 2015; 44:385-96. [PMID: 26538340 DOI: 10.1017/s1352465815000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clark and Wells' (1995) cognitive model of social anxiety (CWM) explains the maintenance of social anxiety and has been used as a guide for treatment of Social Anxiety Disorder (SAD). Few studies have examined the components of the model together across different samples. AIMS This study had two distinct aims: to test the components of CWM and to examine how the variables of CWM may differ between clinical and non-clinical samples with varying levels of social anxiety. METHOD Hypothesized relationships between three groups (i.e. a clinical sample of individuals diagnosed with SAD (ClinS), n = 40; socially anxious students (HSA), n = 40; and, non-anxious students (LSA), n = 40) were investigated. RESULTS Four out of five CWM variables tested were able to distinguish between highly socially anxious and non-anxious groups after controlling for age and depression. CONCLUSIONS CWM variables are able to distinguish between high and low levels of social anxiety and are uniquely related to social anxiety over depression.
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Lampe L. Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder. Australas Psychiatry 2015; 23:343-6. [PMID: 26129819 DOI: 10.1177/1039856215592319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To outline the problems around overlap between social phobia (SAD) and avoidant personality disorder (AVPD) and provide guidelines that may assist clinicians to differentiate these conditions. CONCLUSIONS A constellation of symptoms can be identified that may distinguish AVPD from SAD, with key features being a strong and pervasively negative self-concept, a view of rejection as equating to a global evaluation of the individual as being of little worth and a sense of not fitting in socially that dates from early childhood. It is important to identify the presence of AVPD in order to anticipate potential problems with engagement and retention in therapy, to target treatment interventions and optimise outcome.
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Affiliation(s)
- Lisa Lampe
- Senior Lecturer Discipline of Psychiatry, Sydney Medical School, University of Sydney, and CADE Clinic, Department of Academic Psychiatry, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, Australia
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Weidman AC, Levinson CA. I’m still socially anxious online: Offline relationship impairment characterizing social anxiety manifests and is accurately perceived in online social networking profiles. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.12.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crome E, Grove R, Baillie AJ, Sunderland M, Teesson M, Slade T. DSM-IV and DSM-5 social anxiety disorder in the Australian community. Aust N Z J Psychiatry 2015; 49:227-35. [PMID: 25122449 PMCID: PMC4361462 DOI: 10.1177/0004867414546699] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current and accurate estimates of prevalence, correlates, comorbid concerns and treatment-seeking behaviours associated with disorders are essential for informing policy, clinical practice and research. The most recent snapshot of social anxiety disorder in Australia was published more than a decade ago, with significant changes to the accessibility of mental health treatment services and diagnostic measures occurring during this period. This paper aims to (i) update the understanding of social anxiety disorder, its associations and patterns of treatment-seeking behaviours in the Australian population, and (ii) explore the impact of revised diagnostic criteria detailed in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on prevalence estimates. METHODS The National Survey of Mental Health and Wellbeing (NSMHWB) was conducted by the Australian Bureau of Statistics in 2007, collecting information from a nationally representative random sample of 8841 Australians aged 16-85 years. The presence of social anxiety disorder diagnostic criteria and related disorders were assessed over 12 months and lifetime periods using the World Mental Health Composite International Diagnostic Interview. RESULTS Profiles of social anxiety disorder were consistent with previous estimates, with higher prevalence in females and younger age groups. Of the 8.4% of Australians meeting criteria for social anxiety disorder at some point in their lifetime (12-month prevalence 4.2%), a majority also experienced comorbid mental health concerns (70%). The revised performance-only specifier included in the DSM-5 was applicable to only 0.3% of lifetime cases. Just over 20% of people reporting social anxiety disorder as their primary concern sought treatment, most commonly through general practitioners. CONCLUSIONS Social anxiety disorder continues to be prevalent in the Australian population and highly related to other disorders, yet few people experiencing social anxiety disorder seek treatment.
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Affiliation(s)
- Erica Crome
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Centre for Emotional Health, Psychology Department, Macquarie University, Sydney, Australia
| | - Rachel Grove
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Andrew J Baillie
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Centre for Emotional Health, Psychology Department, Macquarie University, Sydney, Australia
| | - Matthew Sunderland
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
Avoidant personality disorder (AvPD) is regarded as a severe variant of social phobia (SP), consistent with a dimensional model. However, these conclusions are largely drawn from studies based on individuals with SP, with or without comorbid AvPD. The present study hypothesized that there are qualitative differences between AvPD and SP that are undermined by limiting research to participants with SP. The authors sought to test this hypothesis by comparing three groups-SP only, AvPD only, and SP+AvPD-using data extracted from an epidemiological sample of 10,641 adults aged 18 years and over. Screening questions were used in the epidemiological survey to identify ICD-10 personality disorders; from this the author developed a proxy measure for DSM-IV AvPD. Axis I diagnoses, including DSM-IV SP, were identified using the Composite International Diagnostic Interview (CIDI). In this sample, the majority of those with AvPD did not also have SP: The authors found 116 persons with AvPD only, 196 with SP only, and 69 with SP+AvPD. There was little difference between any of the groups on sex, marital status, employment, education, or impairment variables. The SP+AvPD group reported more distress and comorbidity than the SP only and AvPD only groups, which did not differentiate from each other. More feared social situations were endorsed in the SP only group compared to the AvPD only group. Although the finding of few differences between SP only and AvPD only groups among the variables measured in this epidemiological survey fails to provide support for the hypothesis of qualitative differences, the finding that the AvPD only group appears more similar to the SP only group than to the SP+AvPD group also fails to provide support for the alternative continuity hypothesis. The greater distress and additional comorbidity with depression associated with SP+AvPD may be due to the additional symptom load of a second disorder rather than simply representing a more severe variant of social phobia. The use of a proxy for AvPD is a limitation of the study. Future studies should focus on broader clinical variables that have been proposed as qualitatively different between these disorders, and on the possible genetic and environmental factors that might help explain such differences.
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Miloyan B, Bulley A, Pachana NA, Byrne GJ. Social Phobia symptoms across the adult lifespan. J Affect Disord 2014; 168:86-90. [PMID: 25043319 DOI: 10.1016/j.jad.2014.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated symptom patterns that might distinguish between individuals with and without a diagnosis of Social Phobia (SP) across the adult lifespan. METHODS A sample of 5411 self-reported social worriers was derived from Wave 1 (2001 and 2002) of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Participants were stratified into four age groups (18-29 years, 30-44 years, 45-64 years, 65-96 years), and further divided into two diagnostic groups (self-reported social worriers with and without a SP diagnosis). RESULTS Binary logistic regression analyses revealed that a core set of symptoms was associated with SP across the adult lifespan. There were also successive reductions in the number of symptoms associated with SP in each age group, such that older adults endorsed numerically fewer SP symptoms. LIMITATIONS Though our sample size is smaller than ideal for the nature of our analyses, the NESARC represents one of the largest existing clinical datasets we know of. CONCLUSIONS Despite age-related reductions in symptom frequency, a core set of SP symptoms consistently distinguished between diagnostic groups, irrespective of age.
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Affiliation(s)
- Beyon Miloyan
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Adam Bulley
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Brisbane, Australia; Royal Brisbane & Women׳s Hospital, Brisbane, Australia
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The Impact of Self-Imagery on Affective, Cognitive, and Attentional Processes in Social Phobia: A Comprehensive Literature Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/bec.2014.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Social Phobia (SP) is a psychological disorder characterised by an excessive and persistent fear of negative evaluation in social or performance situations that interferes with daily functioning. Cognitive models of SP (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the role of negative images of the self as an important factor in the maintenance of SP. While empirical research has demonstrated the link between negative self-imagery and social anxiety, many aspects of this cognitive factor are yet to be understood. Currently, there is limited research investigating the impact of different types of self-imagery and their effects on social anxiety and performance. Further research assessing the relationships between self-imagery and other maintaining processes proposed in cognitive models is also warranted. This review assesses the literature focusing on self-imagery in social anxiety, including qualitative, empirical, and preliminary treatment studies to date. Recommendations for future research and the use of imagery-based rescripting methods in the treatment of SP are also discussed.
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Heeren A, Lange WG, Philippot P, Wong QJJ. Biased cognitions and social anxiety: building a global framework for integrating cognitive, behavioral, and neural processes. Front Hum Neurosci 2014; 8:538. [PMID: 25100980 PMCID: PMC4105627 DOI: 10.3389/fnhum.2014.00538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandre Heeren
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université Catholique de Louvain Louvain-la-Neuve, Belgium
| | - Wolf-Gero Lange
- Behavioural Science Institute, Radboud University Nijmegen Nijmegen, Netherlands ; Department of Clinical Psychology and Psychotherapy, University of Cologne Cologne, Germany
| | - Pierre Philippot
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université Catholique de Louvain Louvain-la-Neuve, Belgium
| | - Quincy J J Wong
- Department of Psychology, Centre for Emotional Health, Macquarie University Sydney, NSW, Australia
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Crome E, Baillie A. Social anxiety disorder diagnostic criteria perform equally across age, comorbid diagnosis, and performance/interaction subtypes. ANXIETY STRESS AND COPING 2014; 28:179-91. [DOI: 10.1080/10615806.2014.930445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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López-Solà C, Fontenelle LF, Alonso P, Cuadras D, Foley DL, Pantelis C, Pujol J, Yücel M, Cardoner N, Soriano-Mas C, Menchón JM, Harrison BJ. Prevalence and heritability of obsessive-compulsive spectrum and anxiety disorder symptoms: A survey of the Australian Twin Registry. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:314-25. [PMID: 24756981 DOI: 10.1002/ajmg.b.32233] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/26/2014] [Indexed: 01/04/2023]
Abstract
While past twin studies indicate moderate levels of heritability of "obsessive-compulsive related" and anxiety disorder symptoms, no single study has reported such estimates in the same twin population nor examined potential genetic sex differences. We assessed symptoms of obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, hypochondriasis, panic disorder, social phobia and generalized anxiety disorder in 2,495 adult twins (1,468 female). Prevalence estimates for the corresponding symptom measures were determined using empirically derived cut-off scores. Twin resemblance was assessed by Pearson correlations and biometrical model-fitting analyses, incorporating sex-specific effects, using OpenMx. Prevalence estimates ranged from 1.6% in the symptoms of generalized anxiety to 16.9% for social phobia. Female twins demonstrated significantly higher prevalence rates across all domains with the exception of obsessive-compulsive symptoms. Additive genetic factors accounted for a moderate proportion of the total liability to each symptom domain. Evidence suggesting qualitative genetic sex differences (i.e., distinct genetic influences between genders) was observed for body dysmorphic concern and panic symptoms, while quantitative differences were observed for hoarding and social phobia symptoms, indicating stronger heritability in females. Novel findings in this study include the observation of probable genetic sex differences in liability towards hoarding symptoms and dysmorphic concern, as well as the lack of such differences in hypochondriasis. The trend towards qualitative sex differences in panic symptoms has some intuitive appeal with regard to biological-experimental models of panic.
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Affiliation(s)
- Clara López-Solà
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain
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Anticipatory and Post-Event Rumination in Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/bec.2014.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Social anxiety disorder (SAD) is a psychological disorder characterised by an excessive and persistent fear of social or performance situations, which interferes with daily functioning. Cognitive models of SAD (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the importance of negative pre- and post-event rumination as a maintaining factor in the cycle of SAD. While the link between negative rumination and SAD is well supported by empirical research, little is understood about this cognitively important process; thus, research investigating the predictors of negative rumination in SAD is important to consider. Within the current literature, performance appraisal appears to be the most likely unique cognitive predictor of post-event rumination. There is limited research into cognitive predictors of pre-event rumination. Treatments targeting this maintaining factor are important to consider. Suggestions for future research examining the cognitive models of SAD by experimentally manipulating perceived social standards in order to examine the impact of high and low perceived social standard on appraisal processes (i.e., threat appraisal and performance appraisal), state social anxiety, and negative pre-event and post-event rumination, are proposed. Implications for theoretical models and efficacious treatments for SAD are discussed.
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Reduced anterior temporal and hippocampal functional connectivity during face processing discriminates individuals with social anxiety disorder from healthy controls and panic disorder, and increases following treatment. Neuropsychopharmacology 2014; 39:425-34. [PMID: 24084831 PMCID: PMC3870777 DOI: 10.1038/npp.2013.211] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 01/28/2023]
Abstract
Group functional magnetic resonance imaging (fMRI) studies suggest that anxiety disorders are associated with anomalous brain activation and functional connectivity (FC). However, brain-based features sensitive enough to discriminate individual subjects with a specific anxiety disorder and that track symptom severity longitudinally, desirable qualities for putative disorder-specific biomarkers, remain to be identified. Blood oxygen level-dependent (BOLD) fMRI during emotional face perceptual tasks and a new, large-scale and condition-dependent FC and machine learning approach were used to identify features (pair-wise correlations) that discriminated patients with social anxiety disorder (SAD, N=16) from controls (N=19). We assessed whether these features discriminated SAD from panic disorder (PD, N=16), and SAD from controls in an independent replication sample that performed a similar task at baseline (N: SAD=15, controls=17) and following 8-weeks paroxetine treatment (N: SAD=12, untreated controls=7). High SAD vs HCs discrimination (area under the ROC curve, AUC, arithmetic mean of sensitivity and specificity) was achieved with two FC features during unattended neutral face perception (AUC=0.88, P<0.05 corrected). These features also discriminated SAD vs PD (AUC=0.82, P=0.0001) and SAD vs HCs in the independent replication sample (FC during unattended angry face perception, AUC=0.71, P=0.01). The most informative FC was left hippocampus-left temporal pole, which was reduced in both SAD samples (replication sample P=0.027), and this FC increased following the treatment (post>pre, t(11)=2.9, P=0.007). In conclusion, SAD is associated with reduced FC between left temporal pole and left hippocampus during face perception, and results suggest promise for emerging FC-based biomarkers for SAD diagnosis and treatment effects.
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Kashdan TB, Ferssizidis P, Farmer AS, Adams LM, McKnight PE. Failure to capitalize on sharing good news with romantic partners: Exploring positivity deficits of socially anxious people with self-reports, partner-reports, and behavioral observations. Behav Res Ther 2013; 51:656-68. [PMID: 23916635 PMCID: PMC3776926 DOI: 10.1016/j.brat.2013.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/30/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Abstract
Extending prior work on social anxiety and positivity deficits, we examined whether individual differences in social anxiety alter the ability to share and respond to the good news of romantic partners (i.e., capitalization support) and how this influences romantic relationship satisfaction and commitment. In this study of 174 heterosexual couples (average age of 21.5 with 58.3% identifying as Caucasian), greater social anxiety was associated with the provision and receipt of less supportive responses to shared positive events as measured by trait questionnaires, partner reports, and behavioral observations in the laboratory. In longitudinal analyses, individuals in romantic relationships with socially anxious partners who experienced inadequate capitalization support were more likely to terminate their relationship and report a decline in relationship quality six months later. As evidence of construct specificity, social anxiety effects were independent of depressive symptoms. Taken together, social anxiety influenced a person's ability to receive and provide support for shared positive events; these deficits had adverse romantic consequences. Researchers and clinicians may better understand social anxiety by exploring a wider range of interpersonal contexts and positive constructs. The addition of capitalization support to the social anxiety literature offers new insights into interpersonal approaches and treatments. With romantic partners, socially anxious people provided and received less supportive responses to shared positive events. Independent observers viewed socially anxious individuals as unenthusiastic and non-expressive of positive emotions. Over 6-months, social anxiety moderated the influence of capitalization support on relationship stability and quality.
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42
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MacKenzie MB, Fowler KF. Social anxiety disorder in the Canadian population: exploring gender differences in sociodemographic profile. J Anxiety Disord 2013; 27:427-34. [PMID: 23768484 DOI: 10.1016/j.janxdis.2013.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 04/25/2013] [Accepted: 05/10/2013] [Indexed: 01/14/2023]
Abstract
The present study examined the prevalence and sociodemographic profile of Canadians with social anxiety disorder using data from the Canadian Community Health Survey Cycle 1.2 (N = 36,984). Social anxiety disorder was assessed using the World Mental Health Composite International Diagnostic Interview and sociodemographic variables were explored by gender. Results suggested significant gender differences for prevalence, comorbid depression, marital status, living arrangements, employment status in the past 12 months, and self-reported mental health status. These observations suggest that individuals with social anxiety disorder experience life disruption, and that of all socially anxious respondents, females may be experiencing more distress than males.
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43
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Boettcher J, Carlbring P, Renneberg B, Berger T. Internet-Based Interventions for Social Anxiety Disorder - an Overview. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000354747] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Essau CA, Sasagawa S, Ishikawa SI, Okajima I, O'Callaghan J, Bray D. A Japanese form of social anxiety (taijin kyofusho): frequency and correlates in two generations of the same family. Int J Soc Psychiatry 2012; 58:635-42. [PMID: 21911434 DOI: 10.1177/0020764011421099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND One specific type of social anxiety, occurring primarily in Japanese culture, is called taijin kyofusho. Taijin kyofusho is characterized by an intense fear that one's body parts or functions displease, embarrass or are offensive to others. AIM The main aim of the present study was to compare the frequency and correlates of taijin kyofusho symptoms (TKS) in Japanese adolescents and their parents. METHOD The sample included 351 adolescents, aged 12 to 17 years, and one of their parents/guardians. These adolescents were recruited from secondary schools in Miyazaki, Japan. All participants completed a set of questionnaires that were used to measure TKS, DSM-IV anxiety disorder symptoms, general difficulties and positive attributes, self-construals and social support. RESULTS Adolescents reported significantly more TKS than their parent/guardians. In each generational sample high TKS was significantly associated with high levels of anxiety symptoms, the strongest correlation being with social phobia. The pattern of the relationship between self-construal and TKS differed across the two generations. Among adolescents, independent self-construal was associated with lower TKS, whereas among parents, interdependent self-construal was associated with lower evaluative concerns from others. CONCLUSION The present study illustrates the importance of the diverse roles that self-construals play in TKS across different generations of the same family constellation in contemporary Japanese culture.
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Affiliation(s)
- Cecilia A Essau
- Department of Psychology, Roehampton University, London, UK.
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Crome E, Baillie A, Taylor A. Are male and female responses to social phobia diagnostic criteria comparable? Int J Methods Psychiatr Res 2012; 21:222-31. [PMID: 22887822 PMCID: PMC6878434 DOI: 10.1002/mpr.1363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 04/11/2011] [Accepted: 05/18/2011] [Indexed: 11/08/2022] Open
Abstract
Females typically report higher social phobia levels than males in community samples, and this may be due to sex bias in assessment measures. This study aims to establish whether patterns of responding to social phobia diagnostic criteria in the Composite International Diagnostic Interview (CIDI) are comparable across males and females. A subsample of participants in the Australian National Survey of Mental Health and Wellbeing (1997) reporting at least one social fear were selected (n = 1755). Analyses were conducted using a series of multi-group confirmatory factor analyses for categorical data, with unique steps to model invariance of residual variances. Partial, but not full, invariance was established, as males and females differed in their responses to items assessing physical anxiety symptoms at low levels of social fear. Whilst these differences were statistically significant, they are likely not to affect clinical practice or rates of social phobia diagnosis. This supports differences on this measure being interpreted as genuine, and strengthens findings females are more vulnerable to social phobia than males.
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Affiliation(s)
- Erica Crome
- Centre for Emotional Health, Psychology Department, Macquarie University, NSW, Australia.
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Clarke PJF, Hickie IB, Scott E, Guastella AJ. Clinical staging model applied to young people presenting with social anxiety. Early Interv Psychiatry 2012; 6:256-64. [PMID: 22691271 DOI: 10.1111/j.1751-7893.2012.00364.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Although the use of illness-staging models in clinical medicine has proved particularly useful, the concept has not been widely applied in mental health. Here, we apply a clinical staging framework to a population of help-seeking young people presenting with social anxiety. The goal was to provide a detailed description of common clinical stage of those presenting for treatment of social anxiety, and to delineate the associations between symptom type, severity and clinical stage. METHODS The results of a structured clinical interview along with background clinical information formed the basis for consensus-derived decisions regarding clinical stage. Subjects also completed self-report measures to assess anxiety and depressive symptoms. Comparisons were conducted largely between those subjects who were considered to have reached a critical clinical threshold for discrete or progressive disorders (i.e., those staged at two and beyond) and those with 'attenuated syndromes' (stage 1b - 69% of subjects). RESULTS One hundred forty-three subjects (63% male, mean age = 22.1 years) were clinically assessed prior to entry into active treatment programmes. Subjects assigned to stage two or above reported more psychological distress, higher depression scores and more alcohol use. However, these subjects did not report more severe anxiety symptoms. A higher incidence of substance misuse was a significant feature of those in later clinical stages. CONCLUSIONS The study suggests that those who present with social anxiety are characterized by a broad range of symptom severity, with a small, though significant proportion representing individuals whose mental health problems have already progressed to a stage characterized by greater co-morbidity and risk of chronicity. Our data specifically suggest that depressive symptoms and substance abuse/dependence may differentiate those in earlier and later clinical stages.
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Affiliation(s)
- Patrick J F Clarke
- Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Helgadóttir FD, Menzies RG, Onslow M, Packman A, O'Brian S. Online CBT II: A Phase I Trial of a Standalone, Online CBT Treatment Program for Social Anxiety in Stuttering. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.26.4.254] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AbstractThis paper introduces a novel approach to internet treatment for social anxiety. The goal of this treatment was to address key limitations of current standalone treatments (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2009). The ‘computer psychologist’ designed for this study used fully automated, prewritten individualised sample answers in order to simulate a human–human interaction through a human–computer interface. Two males who sought treatment for stuttering and met the diagnosis for social phobia according to the DSM-IV and ICD-10 criteria were selected for this study. After receiving the treatment, both users no longer met criteria for social phobia. Also, significant improvements were observed on other psychometric tests, including measures of unhelpful cognitions, behavioural avoidance, quality of life, and low mood. The quality of the interaction appeared to be similar to face-to-face therapy, indicating that the ‘computer psychologist’ established an effective therapeutic relationship, and the automated techniques used were sufficiently engaging to prompt users to log on regularly and complete the treatment program.
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Chagas MHN, Nardi AE, Manfro GG, Hetem LAB, Andrada NC, Levitan MN, Salum GA, Isolan L, Ferrari MCF, Crippa JAS. [Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder]. ACTA ACUST UNITED AC 2011; 32:444-52. [PMID: 21308267 DOI: 10.1590/s1516-44462010005000029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/14/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.
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Affiliation(s)
- Marcos Hortes N Chagas
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, and Hospital das Clínicas-Terceiro Andar, Ribeirão Preto, SP, Brazil
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Rapee RM. Family Factors in the Development and Management of Anxiety Disorders. Clin Child Fam Psychol Rev 2011; 15:69-80. [DOI: 10.1007/s10567-011-0106-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Relationship between social phobia and depression differs between boys and girls in mid-adolescence. J Affect Disord 2011; 133:97-104. [PMID: 21497912 DOI: 10.1016/j.jad.2011.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/25/2011] [Accepted: 03/22/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Earlier studies suggest that social phobia (SP) and depression (DEP) often have their onset in adolescence, and are highly comorbid, with SP mainly preceding depression. There is a lack of population-based prospective studies among adolescents vulnerable to both disorders, taking into account possible gender differences in the relationship between the two. METHODS This study is part of a prospective Adolescent Mental Health Cohort (AMHC) study. Subjects are 9th grade pupils (mean age 15.5 years (sd 0.39)) responding to a survey conducted 2002-2003 (T1) and a 2-year follow-up 2004-2005 (T2) (N=2038). Social phobia was measured by the Social Phobia Inventory (SPIN) and depression by the 13-item Beck Depression Inventory (BDI-13). RESULTS Risk for depression at T2 by SP at T1 was elevated only among boys (OR 3.6, 95% C.I. 1.507-8.579, p=0.004), whereas among girls, risk for SP at T2 by DEP at T1 was elevated (OR 7.8, 95% CI 4.529-13.391, p<0.001). The course of both disorders was unstable and recovery was common. LIMITATIONS Lack of diagnostic interviews and fairly high drop-out rate (36.9%) in follow-up. CONCLUSIONS The relationship between SP and depression in adolescence seems different for boys and girls. Further studies are needed to explore factors explaining the different course of these disorders among boys and girls. Clinicians need to be alert to comorbidity when examining an adolescent with SP or depression.
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