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Ye T, Elliott R, McFarquhar M, Mansell W. The impact of audience dynamics on public speaking anxiety in virtual scenarios: An online survey. J Affect Disord 2024; 363:420-429. [PMID: 39067529 DOI: 10.1016/j.jad.2024.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/29/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised. METHODS The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA. RESULTS The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores. CONCLUSIONS This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity.
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Affiliation(s)
- Tingjun Ye
- Division of Neuroscience and Experimental Psychology, Stopford Building, University of Manchester, UK.
| | - Rebecca Elliott
- Division of Neuroscience and Experimental Psychology, Stopford Building, University of Manchester, UK
| | - Martyn McFarquhar
- Division of Neuroscience and Experimental Psychology, Zochonis Building, University of Manchester, UK
| | - Warren Mansell
- Division of Psychology and Mental Health, Zochonis Building, University of Manchester, UK
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2
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McDonald MA, Meckes SJ, Shires J, Berryhill ME, Lancaster CL. Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation. J ECT 2024; 40:51-60. [PMID: 38009966 PMCID: PMC10920400 DOI: 10.1097/yct.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. METHODS Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. RESULTS Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. CONCLUSIONS The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.
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Bendezú JJ, Calhoun CD, Wadsworth ME. Within-person patterns of psychobiological stress response correspondence: links to preadolescent internalizing problems and coping behaviors. ANXIETY, STRESS, AND COPING 2022; 35:592-608. [PMID: 34632877 PMCID: PMC8994789 DOI: 10.1080/10615806.2021.1982912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Though correspondence across the affective experience and physiologic arousal levels of the stress response is thought to support efficacious coping and buffer against internalizing problems, little evidence has demonstrated such correspondence. Using a community sample of preadolescents (N=151, Mage=10.33 years, Minage=8.92, Maxage=12.00, 51.7% male), this person-centered study examined internalizing problem and coping-linked variability in psychobiological stress response correspondence. Preadolescents were exposed to the Trier Social Stress Test and self-reported negative affect (NA) and salivary cortisol (SC) levels were assessed. Multitrajectory modeling revealed four subgroups. Relative to In-Touch (i.e., Moderate NA-Moderate SC; n=65), Unmindful (i.e., Moderate NA-Low SC; n=49) were more likely to present with parent-reported but not self-reported internalizing problems; Vigilant (i.e., High NA-Low SC; n=13) were more likely to present with self- and parent-reported internalizing problems, less likely to use engagement coping, and more likely to use wishful thinking (e.g., "I wish problems would just go away."); Denial (i.e., Low NA-High SC; n=24) self-reported similarly low internalizing problems, but were also more likely to report reliance on denial (e.g., "I pretend problems don't exist."). Findings illustrate meaningful heterogeneity in preadolescent psychobiological correspondence with implications for multimodal assessment and outcome monitoring in coping-based preventative interventions.
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Affiliation(s)
- Jason José Bendezú
- Department of Psychology, S463 Elliott Hall, University of Minnesota, Minneapolis, MN 55455
| | - Casey D. Calhoun
- Department of Psychiatry, UNC School of Medicine, 101 Manning Drive, CB 7160 Chapel Hill, NC 27599
| | - Martha E. Wadsworth
- Department of Psychology, 216 Moore Building, The Pennsylvania State University, University Park, PA 16802
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Constantinou E, Georgiou D, Karekla M, Panayiotou G. Subjective distress and physiological reactivity during anxiety-evoking imagery in social anxiety. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Lipton MF, Qasmieh N, Racz SJ, Weeks JW, Reyes ADL. The Fears of Evaluation About Performance (FEAP) Task: Inducing Anxiety-Related Responses to Direct Exposure to Negative and Positive Evaluations. Behav Ther 2020; 51:843-855. [PMID: 33051028 DOI: 10.1016/j.beth.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
Fears of negative and positive evaluation (i.e., evaluative fears) manifest within performance-based situations (e.g., public speaking, group presentations), particularly among those experiencing social anxiety. Within these performance-based situations, individuals experiencing such evaluative fears frequently display a variety of impairments (e.g., avoidance, nervousness) that might manifest within and across various settings (e.g., employment, school). How do those who experience these fears react to in-the-moment feedback about their performance? We constructed the Fear of Evaluation About Performance (FEAP) task to examine ecologically valid experiences with anxiety when reacting to positive and negative feedback. During the task, participants gave a speech, and subsequent to this and in counterbalanced order, received positive and negative feedback about their speech, with continued assessment of anxiety-related arousal throughout the task. We tested the FEAP task among 127 adults, who provided self-reports of fears of positive and negative evaluation before completing the task. Fears of positive evaluation uniquely predicted arousal following receipt of positive feedback, whereas fears of negative evaluation uniquely predicted arousal following receipt of negative feedback. Relative to participants receiving positive feedback first, those receiving negative feedback first experienced elevated post-feedback arousal, followed by a steep decline in arousal post-positive feedback. Conversely, participants receiving positive feedback first experienced a buffer effect whereby arousal post-negative feedback remained low, relative to the arousal experienced post-negative feedback among those who received negative feedback first. We expect the FEAP task to inform basic science on fears of negative and positive evaluation, as well as treatment planning in applied clinical settings.
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Taylor CT, Tsai TC, Smith TR. Examining the link between positive affectivity and anxiety reactivity to social stress in individuals with and without social anxiety disorder. J Anxiety Disord 2020; 74:102264. [PMID: 32623281 PMCID: PMC9246012 DOI: 10.1016/j.janxdis.2020.102264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Positive affect (PA) attenuates negative reactivity to stress; however, this adaptive function of PA is seldom studied in psychiatric conditions characterized by more extreme forms of affective responding. We tested distinct associations of PA and negative affect (NA) with anxiety reactivity in participants with social anxiety disorder (SAD)-a condition characterized by heightened NA and diminished PA-and non-SAD control subjects. METHOD Adults with a principal diagnosis of SAD (n = 71) and those without a psychiatric history (n = 36) rated their PA and NA during the past week, and were exposed to a laboratory stressor wherein they delivered a video-recorded speech on a controversial topic. Anxiety reactivity was assessed in terms of anticipatory anxiety prior to the speech, and observer-rated anxiety-related behavior during the speech. RESULTS Across all participants, higher PA significantly predicted lower anticipatory anxiety and less anxiety-related behavior, beyond level of NA; lower NA significantly predicted attenuated anticipatory anxiety, but not anxiety-related behavior, beyond level of PA. The association between PA and stress reactivity was diminished for individuals with especially elevated NA, as well as for individuals with SAD compared to those without. CONCLUSIONS PA may be protective against negative reactivity to social stress; however, theoretical models and clinical applications should consider possible interactive effects of PA and NA in modulating stress reactivity.
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Affiliation(s)
- Charles T. Taylor
- University of California, San Diego,Corresponding author: Charles T. Taylor, PhD, Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, Phone: 858.534.9446, FAX: 858.534.9450,
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Gallego A, McHugh L, Villatte M, Lappalainen R. Examining the relationship between public speaking anxiety, distress tolerance and psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Norberg MM, Beath AP, Kerin FJ, Martyn C, Baldwin P, Grisham JR. Trait Versus Task-Induced Emotional Reactivity and Distress Intolerance in Hoarding Disorder: Transdiagnostic Implications. Behav Ther 2020; 51:123-134. [PMID: 32005330 DOI: 10.1016/j.beth.2019.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/01/2019] [Accepted: 05/15/2019] [Indexed: 12/23/2022]
Abstract
Evidence from analogue samples suggests that deficits in emotional functioning, namely elevated emotional reactivity and distress intolerance, are implicated in the development and maintenance of hoarding disorder. We aimed to extend previous research in this area by investigating emotional reactivity and distress intolerance in a sample of individuals diagnosed with hoarding disorder (n = 24) in comparison to clinical controls (n = 21) and nonclinical community controls (n = 26) using a combination of self-report, physiological, and behavioral measures. We found that trait distress intolerance was significantly and independently associated with greater hoarding severity. The hoarding and clinical control groups reported more trait emotional reactivity and distress intolerance than the community control group, but did not differ from each other on these traits. The hoarding group reported more subjective distress before beginning a frustrating behavioral task, but did not evidence more physiological arousal. Moreover, the hoarding group experienced similar increases in distress during the task and did not differ from either group in regard to time persisting on this task. The clinical control group, however, terminated the frustrating task significantly faster than the community control group, who tended to persist until the task timed out. Lastly, trait distress intolerance evidenced a small-to-moderate but nonstatistically significant independent relationship with task persistence time. Given the desynchrony between subjective distress and physiological arousal, we encourage researchers to utilize multimodal assessment in the future. We also suggest that clinicians start to use behavioral experiments, as has been done with other psychological disorders, to improve distress intolerance among persons who experience hoarding disorder.
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Affiliation(s)
- Melissa M Norberg
- Macquarie University; Centre for Emotional Health, Macquarie University.
| | - Alissa P Beath
- Macquarie University; Centre for Emotional Health, Macquarie University
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Xing W, Lü W, Wang Z. Resting respiratory sinus arrhythmia moderates the association between social phobia symptoms and self-reported physical symptoms. Stress Health 2019; 35:525-531. [PMID: 31276300 DOI: 10.1002/smi.2885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/12/2019] [Accepted: 06/23/2019] [Indexed: 11/08/2022]
Abstract
The present study sought to investigate the association between social phobia symptoms and self-reported physical symptoms and the moderation effect of resting respiratory sinus arrhythmia (RSA) on this link. Data of 5-min resting RSA, social phobia symptoms assessed by the Social Phobia Scale, and physical symptoms assessed by the Cohen-Hoberman Inventory of Physical Symptoms were collected from 167 undergraduate students. Results indicated that higher levels of social phobia symptoms were associated with higher levels of self-reported physical symptoms. Resting RSA played the moderating role in the link between social phobia symptoms and self-reported physical symptoms, such that social phobia symptoms were positively associated with self-reported physical symptoms among individuals with low resting RSA, whereas this association was nonsignificant among individuals with high resting RSA. These findings suggest that high resting RSA as a physiological marker of better self-regulation capacity might buffer the effect of social phobia symptoms on physical health.
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Affiliation(s)
- Wanying Xing
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavioral Health, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Wei Lü
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavioral Health, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Zhenhong Wang
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavioral Health, School of Psychology, Shaanxi Normal University, Xi'an, China
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Reiss N, Warnecke I, Tibubos AN, Tolgou T, Luka-Krausgrill U, Rohrmann S. Effects of cognitive-behavioral therapy with relaxation vs. imagery rescripting on psychophysiological stress responses of students with test anxiety in a randomized controlled trial. Psychother Res 2018; 29:974-985. [DOI: 10.1080/10503307.2018.1475767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Neele Reiss
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Institut für Psychotherapie in Mainz (ipsti-mz), Mainz, Germany
| | - Irene Warnecke
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Center for Student Counseling, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ana Nanette Tibubos
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Theano Tolgou
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Sonja Rohrmann
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
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12
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Mesri B, Niles AN, Pittig A, LeBeau RT, Haik E, Craske MG. Public speaking avoidance as a treatment moderator for social anxiety disorder. J Behav Ther Exp Psychiatry 2017; 55:66-72. [PMID: 27915159 PMCID: PMC5315620 DOI: 10.1016/j.jbtep.2016.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/06/2016] [Accepted: 11/20/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient. METHODS Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life. RESULTS Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure. LIMITATIONS Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward. CONCLUSIONS Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance.
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Affiliation(s)
- Bita Mesri
- University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States.
| | - Andrea N. Niles
- University of California, Los Angeles, Department of
Psychology, 405 Hilgard Avenue, Los Angeles, California, United States of America,
90095-1563
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, Dresden, D-01187, Germany.
| | - Richard T. LeBeau
- University of California, Los Angeles, Department of
Psychology, 405 Hilgard Avenue, Los Angeles, California, United States of America,
90095-1563
| | - Ethan Haik
- University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States.
| | - Michelle G. Craske
- University of California, Los Angeles, Department of
Psychology, 405 Hilgard Avenue, Los Angeles, California, United States of America,
90095-1563
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Rabinak CA, Mori S, Lyons M, Milad MR, Luan Phan K. Acquisition of CS-US contingencies during Pavlovian fear conditioning and extinction in social anxiety disorder and posttraumatic stress disorder. J Affect Disord 2017; 207:76-85. [PMID: 27716541 PMCID: PMC6642659 DOI: 10.1016/j.jad.2016.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/07/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fear-based disorders, like social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD), are characterized by an exaggerated fear response and avoidance to trigger cues, suggesting a transdiagnostic mechanism of psychopathology. Current theories suggest that abnormalities in conditioned fear is a primary contributor to the pathophysiology of these disorders. The primary goal of this study was to compare acquisition of conditioned stimulus (CS) and aversive unconditioned stimulus (US) contingencies during fear learning and extinction in individuals with SAD and PTSD. METHODS In a standard Pavlovian fear conditioning-extinction paradigm we measured subjective US expectancy ratings to different CSs in patients with SAD (n=16) compared to patients with PTSD (n=13) and healthy controls (n=15) RESULTS: Both patient groups (SAD, PTSD) acquired differential conditioning between a CS that predicted US (CS+) and a CS that never predicted the US (CS-), however, both groups reported an increased expectancy that the US would occur following the CS-. Additionally, the PTSD group overestimated that the US would occur in general. Neither patient group showed evidence of successful extinction of the CS+-US contingency nor differentiated their expectation of US occurrence between the CS+ and CS- during extinction learning. LIMITATIONS Group sample sizes were small and we did not include a trauma-exposed group without PTSD CONCLUSIONS: Both SAD and PTSD generalize expectations of an aversive outcome across CSs, even when a CS never signals an aversive outcome and PTSD may tend to over-expect threat. Fear learning and extinction abnormalities may be a core feature underlying shared symptoms across fear-based disorders.
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Affiliation(s)
- Christine A. Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, United States,Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, MI, United States,Pharmaceutical Sciences, Wayne State University, Detroit, MI, United States,Translational Neuroscience Program, Wayne State University, Detroit, MI, United States,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States,Correspondence to: Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2190, Detroit, MI 48201, United States. (C.A. Rabinak)
| | - Shoko Mori
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States,SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Maryssa Lyons
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Mohammed R. Milad
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - K. Luan Phan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States,Anatomy and Cell Biology and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, United States,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, United States
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Examining the Role of Implicit Emotional Judgments in Social Anxiety and Experiential Avoidance. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9583-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.
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Nowakowski ME, Antony MM, Koerner N. Modifying interpretation biases: Effects on symptomatology, behavior, and physiological reactivity in social anxiety. J Behav Ther Exp Psychiatry 2015; 49:44-52. [PMID: 25936655 DOI: 10.1016/j.jbtep.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 02/12/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The present study investigated the effects of computerized interpretation training and cognitive restructuring on symptomatology, behavior, and physiological reactivity in an analogue social anxiety sample. METHODS Seventy-two participants with elevated social anxiety scores were randomized to one session of computerized interpretation training (n = 24), cognitive restructuring (n = 24), or an active placebo control condition (n = 24). Participants completed self-report questionnaires focused on interpretation biases and social anxiety symptomatology at pre and posttraining and a speech task at posttraining during which subjective, behavioral, and physiological measures of anxiety were assessed. RESULTS Only participants in the interpretation training condition endorsed significantly more positive than negative interpretations of ambiguous social situations at posttraining. There was no evidence of generalizability of interpretation training effects to self-report measures of interpretation biases and symptomatology or the anxiety response during the posttraining speech task. Participants in the cognitive restructuring condition were rated as having higher quality speeches and showing fewer signs of anxiety during the posttraining speech task compared to participants in the interpretation training condition. LIMITATIONS The present study did not include baseline measures of speech performance or computer assessed interpretation biases. CONCLUSIONS The results of the present study bring into question the generalizability of computerized interpretation training as well as the effectiveness of a single session of cognitive restructuring in modifying the full anxiety response. Clinical and theoretical implications are discussed.
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Affiliation(s)
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
| | - Naomi Koerner
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Shikatani B, Antony MM, Cassin SE, Kuo JR. Examining the Role of Perfectionism and Intolerance of Uncertainty in Postevent Processing in Social Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9516-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pittig A, Alpers GW, Niles AN, Craske MG. Avoidant decision-making in social anxiety disorder: A laboratory task linked to in vivo anxiety and treatment outcome. Behav Res Ther 2015; 73:96-103. [PMID: 26301755 DOI: 10.1016/j.brat.2015.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/17/2015] [Accepted: 08/12/2015] [Indexed: 12/28/2022]
Abstract
Recent studies on reward-based decision-making in the presence of anxiety-related stimuli demonstrated that approach-avoidance conflicts can be assessed under controlled laboratory conditions. However, the clinical relevance of these decision conflicts has not been demonstrated. To this end, the present study investigated avoidant decisions in treatment-seeking individuals with social anxiety disorder (SAD). In a gambling task, advantageous choices to maximize gains were associated with task-irrelevant angry faces and disadvantageous choices with happy faces. The clinical relevance of avoidant decisions for in vivo anxiety in a social stress situation (public speaking) were examined (n = 44). In a subsample (n = 20), the predictive value for a reduction of avoidance following behavioral therapy was also evaluated. Results indicated a close link between more frequent avoidant decisions and elevated in vivo anxiety. Moreover, individuals who showed a deficit in the goal-directed adjustment of their decisions also showed higher and sustained distress during the social stressor and reported less decrease of avoidance following treatment. The findings highlight the importance of an avoidant decision-making style for the experience of acute distress and the maintenance of avoidance in SAD. Assessing avoidant decision-making may help to predict the response to behavioral treatments.
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Affiliation(s)
- Andre Pittig
- Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Germany
| | - Andrea N Niles
- Department of Psychology, University of California, Los Angeles, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, USA
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Do patients with chronic pain show autonomic arousal when confronted with feared movements? An experimental investigation of the fear–avoidance model. Pain 2015; 156:547-554. [DOI: 10.1097/01.j.pain.0000460329.48633.ce] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shalom JG, Israeli H, Markovitzky O, Lipsitz JD. Social anxiety and physiological arousal during computer mediated vs. face to face communication. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.11.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Grisham JR, King BJ, Makkar SR, Felmingham KL. The contributions of arousal and self-focused attention to avoidance in social anxiety. ANXIETY STRESS AND COPING 2014; 28:303-20. [DOI: 10.1080/10615806.2014.968144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shikatani B, Antony MM, Kuo JR, Cassin SE. The impact of cognitive restructuring and mindfulness strategies on postevent processing and affect in social anxiety disorder. J Anxiety Disord 2014; 28:570-9. [PMID: 24983798 DOI: 10.1016/j.janxdis.2014.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/21/2014] [Accepted: 05/28/2014] [Indexed: 12/12/2022]
Abstract
Postevent processing (PEP; reviewing a past social event in detail) is a key maintenance factor of social anxiety disorder (SAD). The current study examined the efficacy of a single session cognitive restructuring or mindfulness strategy on decreasing PEP and its associated effects, and investigated the cognitive processes involved. Fifty-six individuals with SAD completed a speech task to elicit PEP and were taught a cognitive restructuring, mindfulness, or control strategy to manage their negative thoughts. Participants in the cognitive restructuring and mindfulness conditions reported significantly reduced PEP and improved affect as compared to the control condition. There were no significant differences between the cognitive restructuring and mindfulness conditions. Participants in the cognitive restructuring condition reported decreased probability and cost biases. Regardless of study condition, decreases in cost biases and maladaptive beliefs significantly predicted reductions in PEP. Cognitive restructuring and mindfulness appear to be promising strategies to decrease PEP and improve affect.
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Affiliation(s)
- Bethany Shikatani
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3.
| | - Janice R Kuo
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
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Siess J, Blechert J, Schmitz J. Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2014; 23:127-42. [PMID: 23812865 DOI: 10.1007/s00787-013-0443-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/12/2013] [Indexed: 01/11/2023]
Abstract
Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.
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Affiliation(s)
- Julia Siess
- Department for Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany
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McAleavey AA, Castonguay LG, Goldfried MR. Clinical experiences in conducting cognitive-behavioral therapy for social phobia. Behav Ther 2014; 45:21-35. [PMID: 24411111 DOI: 10.1016/j.beth.2013.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/16/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.
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Kerns CE, Comer JS, Pincus DB, Hofmann SG. Evaluation of the proposed social anxiety disorder specifier change for DSM-5 in a treatment-seeking sample of anxious youth. Depress Anxiety 2013; 30:709-15. [PMID: 23494954 PMCID: PMC4258526 DOI: 10.1002/da.22067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/19/2012] [Accepted: 01/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current proposal for the DSM-5 definition of social anxiety disorder (SAD) is to replace the DSM-IV generalized subtype specifier with one that specifies fears in performance situations only. Relevant evaluations to support this change in youth samples are sparse. METHODS The present study examined rates and correlates of the DSM-IV and proposed DSM-5 specifiers in a sample of treatment-seeking children and adolescents with SAD (N = 204). RESULTS When applying DSM-IV subtypes, 64.2% of the sample was classified as having a generalized subtype of SAD, with the remaining 35.2% classifying as having a nongeneralized subtype SAD. Youth with generalized SAD, relative to those with nongeneralized SAD, were older, had more clinically severe SAD, showed greater depressive symptoms, and were more likely to have a comorbid depressive disorder. No children in the current sample endorsed discrete fear in performance situations only in the absence of fear in other social situations. CONCLUSIONS The present findings call into question the meaningfulness of the proposed changes in treatment-seeking youth with SAD.
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Affiliation(s)
| | - Jonathan S. Comer
- Correspondence to: Jonathan S. Comer, Ph.D., Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02446.
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Pujol J, Giménez M, Ortiz H, Soriano-Mas C, López-Solà M, Farré M, Deus J, Merlo-Pich E, Harrison BJ, Cardoner N, Navinés R, Martín-Santos R. Neural response to the observable self in social anxiety disorder. Psychol Med 2013; 43:721-731. [PMID: 22895096 DOI: 10.1017/s0033291712001857] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping. RESULTS Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range. CONCLUSIONS Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.
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Affiliation(s)
- J Pujol
- Institut d'Alta Tecnologia-PRBB, CRC Mar, Hospital de Mar, Barcelona, Spain.
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Hook JN, Valentiner DP, Connelly J. Performance and interaction anxiety: specific relationships with other- and self-evaluation concerns. ANXIETY STRESS AND COPING 2013; 26:203-16. [DOI: 10.1080/10615806.2012.654777] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Effects of false feedback on affect, cognition, behavior, and postevent processing: the mediating role of self-focused attention. Behav Ther 2013; 44:111-24. [PMID: 23312431 DOI: 10.1016/j.beth.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/21/2022]
Abstract
Current social phobia models (e.g., Clark & Wells, 1995; Leary & Kowalski, 1995) postulate that socially anxious individuals negatively appraise their anxiety sensations (e.g., sweating, heart racing, blushing) as evidence of poor social performance, and thus fear these anxiety symptoms will be noticed and judged negatively by others. Consequently, they become self-focused and hypervigilant of these sensations and use them to judge how they appear to others. To test this model, high (N=41) and low (N=38) socially anxious participants were shown false physiological feedback regarding an increase or decrease in heart rate prior to and during an impromptu speech task. Relative to participants who observed a false heart rate decrease, those in the increase condition reported higher levels of negative affect, more negative performance appraisals, and more frequent negative ruminative thoughts, and these effects were mediated by an increase in self-focused attention. The unhelpful effects of the physiological feedback were not specific to high socially anxious participants. The results have implications for current cognitive models as well as the treatment of social phobia.
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England EL, Herbert JD, Forman EM, Rabin SJ, Juarascio A, Goldstein SP. Acceptance-based exposure therapy for public speaking anxiety. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2012. [DOI: 10.1016/j.jcbs.2012.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Admixture analysis of the diagnostic subtypes of social anxiety disorder: implications for the DSM-V. J Behav Ther Exp Psychiatry 2012; 43:752-7. [PMID: 22104656 DOI: 10.1016/j.jbtep.2011.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 10/20/2011] [Accepted: 10/28/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Much controversy exists regarding diagnostic subtypes of social anxiety disorder (SAD). The present study used admixture analysis to examine whether individuals with generalized and nongeneralized SAD belong to the same or different populations of origin. This can inform diagnostic subtyping of SAD in the forthcoming DSM-V. METHODS Treatment-seeking individuals with generalized SAD (n = 154) and nongeneralized SAD (n = 48) completed a battery of questionnaires. Based on participants' responses to the Liebowitz Social Anxiety Scale (LSAS), we estimated log likelihood and chi-square goodness-of-fit for models with 1, 2, 3, or 4 populations of origin, and compared models using forward stepwise estimation and maximum likelihood ratio tests. RESULTS Admixture analyses suggested that the two diagnostic subtypes of SAD belong to the same underlying population of origin. In addition, observable differences in depression, general anxiety, and comorbidity were no longer significant when controlling for social anxiety severity. LIMITATIONS Our sample was recruited in the U.S. and was a treatment-seeking sample. Future studies should examine whether our results generalize to different cultures, and community samples. CONCLUSIONS Support for qualitative differences between SAD subtypes was not found. Rather, our findings support the notion that the diagnostic subtypes of SAD differ quantitatively, and that SAD exists on a continuum of severity. This finding informs diagnostic subtyping of SAD in the forthcoming DSM-V.
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Abstract
We agree that conceptualisation is key in understanding the brain basis of emotion. We argue that by conflating facial emotion recognition with subjective emotion experience, Lindquist et al. understate the importance of biological predisposition in emotion. We use examples from the anxiety disorders to illustrate the distinction between these two phenomena, emphasising the importance of both emotional hardware and contextual learning.
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32
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Schutters SIJ, Viechtbauer W, Knuts IJ, Griez EJL, Schruers KRJ. 35% CO2 sensitivity in social anxiety disorder. J Psychopharmacol 2012; 26:479-86. [PMID: 22228835 DOI: 10.1177/0269881111430750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 35% carbon dioxide (CO(2)) challenge is a well-established model of panic. This study aimed to investigate 35% CO(2) sensitivity in patients with social anxiety disorder (SAD) compared with patients with panic disorder (PD) and normal controls. First, a 35% CO(2) challenge was conducted including 16 patients with generalized SAD, 16 with PD and 16 normal subjects. Outcome was assessed by a Visual Analogue Scale for Fear (VAS-F) and the Panic Symptom List (PSL). Second, meta-analyses of fear and panic scores were performed, including data from the present experiment and from previous 35% CO(2) challenge studies in patients with SAD. The present 35% CO(2) challenge found equal increases in VAS-F and PSL in patients with SAD compared with normal controls, whereas the CO(2) response in patients with PD was significantly stronger than in controls. The meta-analyses confirmed the experimental data from this study, and in addition showed an intermediate panic rate in SAD patients, in between that of normal controls and patients with PD. In conclusion, neither our experiment nor the meta-analyses found evidence for a similarly exaggerated 35% CO(2) sensitivity in SAD and PD, suggesting that the pathogenesis of SAD is different from PD, although patients with SAD may be slightly more sensitive than non-anxious controls.
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Affiliation(s)
- Sara I J Schutters
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, the Netherlands.
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33
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Schmidt LA, Santesso DL, Miskovic V, Mathewson KJ, McCabe RE, Antony MM, Moscovitch DA. Test–retest reliability of regional electroencephalogram (EEG) and cardiovascular measures in social anxiety disorder (SAD). Int J Psychophysiol 2012; 84:65-73. [DOI: 10.1016/j.ijpsycho.2012.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 01/07/2012] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
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Julian K, Beard C, Schmidt NB, Powers MB, Smits JAJ. Attention training to reduce attention bias and social stressor reactivity: an attempt to replicate and extend previous findings. Behav Res Ther 2012; 50:350-8. [PMID: 22466022 DOI: 10.1016/j.brat.2012.02.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 02/15/2012] [Accepted: 02/27/2012] [Indexed: 11/19/2022]
Abstract
Cognitive theories suggest that social anxiety is maintained, in part, by an attentional bias toward threat. Recent research shows that a single-session of attention modification training (AMP) reduces attention bias and vulnerability to a social stressor (Amir, Weber, Beard, Bomyea, & Taylor, 2008). In addition, exercise may augment the effects of attention training by its direct effects on attentional control and inhibition, thereby allowing participants receiving the AMP to more effectively disengage attention from the threatening cues and shift attention to the neutral cues. We attempted to replicate and extend previous findings by randomizing participants (N = 112) to a single-session of: a) Exercise + attention training (EX + AMP); b) Rest + attention training (REST + AMP); c) Exercise + attention control condition (EX + ACC); or d) Rest + attention control condition (REST + ACC) prior to completing a public speaking challenge. We used identical assessment and training procedures to those employed by Amir et al. (2008). Results showed there was no effect of attention training on attention bias or anxiety reactivity to the speech challenge and no interactive effects of attention training and exercise on attention bias or anxiety reactivity to the speech challenge. The failure to replicate previous findings is discussed.
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Affiliation(s)
- Kristin Julian
- Department of Psychology, Southern Methodist University, Dedman College, Dallas, TX 75275, USA
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Schmitz J, Krämer M, Tuschen-Caffier B, Heinrichs N, Blechert J. Restricted autonomic flexibility in children with social phobia. J Child Psychol Psychiatry 2011; 52:1203-11. [PMID: 21615735 DOI: 10.1111/j.1469-7610.2011.02417.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychophysiological hyperresponsiveness to social-evaluative stress plays a key role in current theories of social phobia (SP). Owing to the early onset of this disorder, the study of children with SP can help to improve etiological models. However, research to date has failed to clarify whether children with SP are physiologically hyperresponsive to stress or not. In addition, the existence of elevated pre-stressor baseline group differences complicates the interpretation of acute stress responses and therefore poses a challenge for this line of research. Drawing on current models of autonomic control to explain the relationship between baseline and stress responding in SP children and healthy controls (HC), we acquired a broad set of autonomic measures in our study. METHOD To index baseline and stress reactivity and to assess autonomic flexibility, we assessed a comprehensive array of sympathetic and parasympathetic measures in SP children (aged 8 to 12 years; n = 30) and healthy control children (HC, n = 26), while exposing them to the Trier Social Stress Test for Children (TSST-C). RESULTS At baseline, the SP children showed higher levels of sympathetic (heart rate, electrodermal activity) and lower levels of parasympathetic (respiratory sinus arrhythmia, RSA) activation when compared to the HC children. During the TSST-C, the SP children showed similar HR responses but a limited RSA reactivity and a slower HR recovery relative to the HC children. CONCLUSION Our study extends previous research by showing elevated baseline arousal and comparable stress responding in SP children relative to HC children. In addition, based on the autonomic flexibility model, we provide a potential explanation for the null findings of previous studies during stress. The pattern of elevated baseline heart rates and reduced RSA point to restricted autonomic flexibility in children with SP.
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Affiliation(s)
- Julian Schmitz
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany.
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Krämer M, Seefeldt WL, Heinrichs N, Tuschen-Caffier B, Schmitz J, Wolf OT, Blechert J. Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 40:95-104. [DOI: 10.1007/s10802-011-9548-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cornwell BR, Heller R, Biggs A, Pine DS, Grillon C. Becoming the center of attention in social anxiety disorder: startle reactivity to a virtual audience during speech anticipation. J Clin Psychiatry 2011; 72:942-8. [PMID: 21034683 PMCID: PMC3462648 DOI: 10.4088/jcp.09m05731blu] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A detailed understanding of how individuals diagnosed with social anxiety disorder (SAD) respond physiologically under social-evaluative threat is lacking. Our aim was to isolate the specific components of public speaking that trigger fear in vulnerable individuals and best discriminate between SAD and healthy individuals. METHOD Sixteen individuals diagnosed with SAD (DSM-IV-TR criteria) and 16 healthy individuals were enrolled in the study from December 2005 to March 2008. Subjects were asked to prepare and deliver a short speech in a virtual reality (VR) environment. The VR environment simulated standing center stage before a live audience and allowed us to gradually introduce social cues during speech anticipation. Startle eye-blink responses were elicited periodically by white noise bursts presented during anticipation, speech delivery, and recovery in VR, as well as outside VR during an initial habituation phase, and startle reactivity was measured by electromyography. Subjects rated their distress at 4 timepoints in VR using a 0-10 scale, with anchors being "not distressed" to "highly distressed." State anxiety was measured before and after VR with the Spielberger State-Trait Anxiety Inventory. RESULTS Individuals with SAD reported greater distress and state anxiety than healthy individuals across the entire procedure (P values < .005). Analyses of startle reactivity revealed a robust group difference during speech anticipation in VR, specifically as audience members directed their eye gaze and turned their attention toward participants (P < .05, Bonferroni-corrected). CONCLUSIONS The VR environment is sufficiently realistic to provoke fear and anxiety in individuals highly vulnerable to socially threatening situations. Individuals with SAD showed potentiated startle, indicative of a strong phasic fear response, specifically when they perceived themselves as occupying the focus of others' attention as speech time approached. Potentiated startle under social-evaluative threat indexes SAD-related fear of negative evaluation.
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Affiliation(s)
- Brian R Cornwell
- Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Dr, MSC 2670, Bethesda, MD 20892, USA.
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Taylor CT, Bomyea J, Amir N. Malleability of attentional bias for positive emotional information and anxiety vulnerability. Emotion 2011; 11:127-138. [PMID: 21401232 PMCID: PMC3208375 DOI: 10.1037/a0021301] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent research supports a causal link between attentional bias for negative emotional information and anxiety vulnerability. However, little is known about the role of positive emotional processing in modulating anxiety reactivity to stress. In the current study, we used an attentional training paradigm designed to experimentally manipulate the processing of positive emotional cues. Participants were randomly assigned to complete a computerized probe detection task designed to induce selective processing of positive stimuli or to a sham condition. Following training, participants were exposed to a laboratory stressor (i.e., videotaped speech), and state anxiety and positive affect in response to the stressor were assessed. Results revealed that individual variability in the capacity to develop an attentional bias for positive information following training predicted subsequent emotional responses to the stressor. Moreover, individual differences in social anxiety, but not depression, moderated the effects of the attentional manipulation, such that, higher levels of social anxiety were associated with diminished attentional allocation toward positive cues. The current findings point to the potential value of considering the role of positive emotional processing in anxiety vulnerability.
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Affiliation(s)
- Charles T. Taylor
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
| | - Jessica Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
| | - Nader Amir
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
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Knappe S, Beesdo-Baum K, Fehm L, Stein MB, Lieb R, Wittchen HU. Social fear and social phobia types among community youth: differential clinical features and vulnerability factors. J Psychiatr Res 2011; 45:111-20. [PMID: 20684833 DOI: 10.1016/j.jpsychires.2010.05.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/30/2010] [Accepted: 05/05/2010] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare different social fears and social phobia subtypes with regard to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability factors (behavioural inhibition (BI), parental psychopathology and parental rearing) among community youth. METHODS Fears of 6 social situations and Social Phobia (SP), along with their clinical features, were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N = 3021 14-24 year olds that were followed up for 10 years. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings' family history reports. RESULTS In the total sample, 20.0%, 11.6%, 11.7% reported fear of 1, 2, 3 or more social situations, respectively; rates were 24.2%, 18.7%, and 57.1% in SP-cases (6.6% of the total sample). Exploring the factorial structure indicated rather unidimensionality of social fears than mutual distinction of social fears by interaction vs. performance situations. Except for fear of taking tests and public speaking, social fears rarely occurred in isolation. Social fears of both interaction and performance situations were associated with severe avoidance (vs. fear of either situation; Odds Ratios, OR = 1.5, 95%CI: 1.1-1.9) and impairment (OR = 3.6, 95%CI: 2.6-4.9), and more comorbid anxiety and depressive disorders (OR range 3.2-5.8, p > .001). Fear of interaction situations was associated with higher BI (vs. performance-related fears, OR range 1.2-2.1, p < .05). Associations with parental psychopathology and unfavourable parental rearing were less consistent, albeit stronger for fear of interaction situations (vs. performance-related fears). Interactions with time indicated an earlier onset of SP for higher BI, but not for parental psychopathology or unfavourable parental rearing. CONCLUSIONS Interaction-related social fears differ in their clinical and vulnerability factors from performance-related social fears. The current DSM-IV specifier of "generalized" SP may fall short of adequately denoting these differences. Fear of taking tests appears to be conceptually and, possibly, etiologically distinct from other social fears, and may be better placed in another category (e.g., as a type of specific phobia).
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
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Shimizu M, Seery MD, Weisbuch M, Lupien SP. Trait Social Anxiety and Physiological Activation: Cardiovascular Threat During Social Interaction. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2010; 37:94-106. [DOI: 10.1177/0146167210391674] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiological activation is thought to be a part of the constellation of responses that accompany social anxiety, but evidence regarding the nature of such activation is mixed. In two studies, the relationship between trait social anxiety and responses during social interaction was explored using on-line cardiovascular indexes of threat. Across Studies 1 and 2, women higher in trait social anxiety exhibited cardiovascular responses consistent with greater threat during the social interaction than those lower in social anxiety. Retrospective self-reports (Studies 1 and 2), as well as partner ratings and interaction behavior (Study 2), also revealed consistent differences as a function of trait social anxiety. Study 2 added male participants, among whom a divergence emerged between results for physiological measures and other responses. These findings have implications for understanding physiological as well as psychological processes among people with social anxiety during social interaction.
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Affiliation(s)
| | - Mark D. Seery
- University at Buffalo, State University of New York, Buffalo, NY, USA,
| | | | - Shannon P. Lupien
- University at Buffalo, State University of New York, Buffalo, NY, USA
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Houtepen LC, Peterse DP, Westphal KGC, Olivier B, Vinkers CH. The autonomic stress-induced hyperthermia response is not enhanced by several anxiogenic drugs. Physiol Behav 2010; 102:105-9. [PMID: 20828578 DOI: 10.1016/j.physbeh.2010.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 07/25/2010] [Accepted: 09/01/2010] [Indexed: 12/22/2022]
Abstract
While anxiety models are often based on locomotor activity responses, the stress-induced hyperthermia (SIH) paradigm uses the autonomic stress response by measuring body temperature. The effects of putative anxiogenic compounds in the SIH paradigm are inconclusive in mice and have not been examined in rats. Furthermore, it has been suggested that drug-induced effects on body temperature could be dependent on locomotor activity levels. Therefore, the effects of three anxiogenic substances, yohimbine (an α(2) receptor antagonist), mCPP (a 5HT(2C) receptor agonist) and FG-7142 (a GABA(A) receptor inverse agonist acting at the benzodiazepine site) on the stress-induced body temperature and locomotor activity response were studied in rats using novel cage stress. All anxiogenic compounds resulted in hypothermia. In contrast, FG-7142 and yohimbine increased locomotor activity levels, whereas mCPP reduced locomotor activity levels. The lack of an increased body temperature response of anxiogenic compounds indicates that the anxiogenic capacity of a drug does not necessarily yield increased autonomic stress responsivity. Moreover, the present study shows that a drug-induced decreased body temperature can be accompanied by increased locomotor activity, suggesting that both parameters represent independent parameters of the stress response.
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Affiliation(s)
- Lotte C Houtepen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Sorbonnelaan 16, 3584CA Utrecht, The Netherlands
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42
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Beard C, Amir N. Negative Interpretation Bias Mediates the Effect of Social Anxiety on State Anxiety. COGNITIVE THERAPY AND RESEARCH 2010; 34:292-296. [PMID: 20495620 PMCID: PMC2872495 DOI: 10.1007/s10608-009-9258-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive models of social anxiety predict that interpretation bias mediates the relationship between level of social anxiety and state anxiety in response to social-evaluative threat. We tested this prediction in 67 socially anxious undergraduates. Participants completed self-report measures of social anxiety and interpretation bias, and two days later they completed an impromptu speech. Mediational analyses supported the hypothesis that interpretation bias mediates the effect of social anxiety on state anxiety in response to the speech. This relationship was specific to negative interpretation of ambiguous social scenarios. The current findings support cognitive models of social phobia and add to the empirical base supporting the role of interpretation bias in social anxiety.
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Affiliation(s)
- Courtney Beard
- Department of Psychology University of Georgia Athens, GA 30602
| | - Nader Amir
- Department of Psychology University of Georgia Athens, GA 30602
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Carter SA, Wu KD. Symptoms of specific and generalized social phobia: an examination of discriminant validity and structural relations with mood and anxiety symptoms. Behav Ther 2010; 41:254-65. [PMID: 20412890 DOI: 10.1016/j.beth.2009.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/17/2009] [Accepted: 04/18/2009] [Indexed: 01/24/2023]
Abstract
Current models divide social phobia into specific (SSP) and generalized (GSP) subtypes and suggest strong overlap between GSP and avoidant personality disorder (APD). Meanwhile, other research suggests reclassifying anxiety and mood disorders as fear and distress disorders. To unify these separate lines of research, this study was designed to test the hypothesis that SSP is more related to fear disorders (e.g., panic and phobias), whereas GSP and APD are more related to distress disorders (e.g., depression and generalized anxiety). Confirmatory factor analysis suggested the best-fitting model had symptoms of GSP, APD, and depression loading on one factor, and symptoms of SSP, panic, and specific phobias loading on a second factor. Key components of this model were (a) the inclusion of GAD symptoms reduced model fit and (b) GSP and APD symptoms significantly predicted SSP symptoms; this is consistent with conceptualizations of individuals with both GSP and SSP reporting performance anxiety.
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Taylor CT, Bomyea J, Amir N. Attentional bias away from positive social information mediates the link between social anxiety and anxiety vulnerability to a social stressor. J Anxiety Disord 2010; 24:403-8. [PMID: 20207102 PMCID: PMC4005423 DOI: 10.1016/j.janxdis.2010.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 02/09/2010] [Accepted: 02/10/2010] [Indexed: 11/25/2022]
Abstract
Accumulating evidence suggests that social anxiety is associated with biased processing of positive social information. However, it remains to be determined whether those biases are simply correlates of, or play a role in maintaining social anxiety. The current study examined whether diminished attentional allocation for positive social cues mediates the link between social anxiety and anxiety reactivity to a social-evaluative task. Forty-three undergraduate students ranging in severity of social anxiety symptoms completed a baseline measure of attentional bias for positive social cues (i.e., modified probe detection task) and subsequently delivered an impromptu videotaped speech. Mediation analyses revealed that the tendency to allocate attention away from positive social stimuli mediated the effect of social anxiety on change in state anxiety in response to the stressor. The current findings add to a nascent empirical literature suggesting that aberrant processing of positive social information may contribute to the persistence of excessive social anxiety.
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Affiliation(s)
- Charles T. Taylor
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
| | - Jessica Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
| | - Nader Amir
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University
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Carter SA, Wu KD. Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression. Behav Ther 2010; 41:2-13. [PMID: 20171323 DOI: 10.1016/j.beth.2008.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/17/2008] [Accepted: 10/19/2008] [Indexed: 11/19/2022]
Abstract
This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia.
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Affiliation(s)
- Shawn A Carter
- Department of Psychology, Northern Illinois University, DeKalb, IL 60115, USA
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Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010; 27:168-89. [PMID: 20143427 DOI: 10.1002/da.20670] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. METHOD A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. RESULTS/CONCLUSIONS Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
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Affiliation(s)
- Susan M Bögels
- Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.
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Does the form or the amount of exposure make a difference in the cognitive-behavioral therapy treatment of social phobia? J Nerv Ment Dis 2009; 197:507-13. [PMID: 19597358 DOI: 10.1097/nmd.0b013e3181aacc08] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exposure is considered to be an essential ingredient of cognitive-behavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure.
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48
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Heiser NA, Turner SM, Beidel DC, Roberson-Nay R. Differentiating social phobia from shyness. J Anxiety Disord 2009; 23:469-76. [PMID: 19028075 PMCID: PMC2692184 DOI: 10.1016/j.janxdis.2008.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 01/06/2023]
Abstract
To clarify the relationship between social phobia and shyness, this study examined the characteristics of highly shy persons with social phobia, highly shy persons without social phobia, and non-shy persons. Those with social phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without social phobia. About one-third of the highly shy without social phobia reported no social fears, highlighting heterogeneity of the shy. The social phobia group reported similar levels of anxiety as the shy without social phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The social phobia group performed less effectively across tasks than those without social phobia. All groups' perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of social phobia.
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Affiliation(s)
- Nancy A. Heiser
- Corresponding author. Present address: 3000 Connecticut Avenue, NW, Suite 202, Washington, DC 20008, USA. Tel.: +1 202 234 1393. E-mail address: (N.A. Heiser)
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Voncken MJ, Bögels SM. Physiological blushing in social anxiety disorder patients with and without blushing complaints: Two subtypes? Biol Psychol 2009; 81:86-94. [DOI: 10.1016/j.biopsycho.2009.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 01/18/2009] [Accepted: 02/13/2009] [Indexed: 11/17/2022]
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50
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