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Martin KE, Kudryk SM, Moscovitch DA. Effects of social anxiety and self-schemas on the impact and meaningfulness of positive versus negative social autobiographical memories. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2025; 64:281-296. [PMID: 39282694 PMCID: PMC12057315 DOI: 10.1111/bjc.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 09/01/2024] [Indexed: 05/08/2025]
Abstract
OBJECTIVE Social anxiety is characterized by maladaptive self-schemas about being socially undesirable. Self-schemas are deeply held beliefs which are derived from negative autobiographical memories of painful social experiences. In contrast to the plethora of past research on negative memories in social anxiety, almost no research has investigated objectively positive social autobiographical memories. In this preregistered study, we examined the effects of social anxiety and self-schemas on the appraised impact and meaningfulness of retrieved positive versus negative social autobiographical memories. METHOD Participants recruited via Prolific (final n = 343) were randomized to one of two conditions in which they were instructed to retrieve, orally narrate, and appraise a positive or negative social autobiographical memory of a specific experience from their personal past where they felt either valued or unvalued, respectively. RESULTS Results demonstrated that participants rated their positive memories as more impactful and meaningful than negative memories overall, but this effect was reversed for participants who endorsed having either stronger negative self-schemas or greater social anxiety symptoms, for whom negative memories were more impactful. Additionally, participants who endorsed having stronger positive self-schemas rated their negative memories as significantly less impactful and their positive memories as nearly more impactful. CONCLUSION Together, these results elucidate how self-schemas and social anxiety are related to autobiographical memory appraisals, paving the way for future research on memory-based therapeutic interventions for social anxiety disorder.
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Affiliation(s)
- Katie E. Martin
- Department of Psychology and Centre for Mental Health Research and TreatmentUniversity of WaterlooWaterlooOntarioCanada
| | - Sophie M. Kudryk
- Department of Psychology and Centre for Mental Health Research and TreatmentUniversity of WaterlooWaterlooOntarioCanada
| | - David A. Moscovitch
- Department of Psychology and Centre for Mental Health Research and TreatmentUniversity of WaterlooWaterlooOntarioCanada
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Zainal NH, Tan HH, Hong RYS, Newman MG. Prescriptive Predictors of Mindfulness Ecological Momentary Intervention for Social Anxiety Disorder: Machine Learning Analysis of Randomized Controlled Trial Data. JMIR Ment Health 2025; 12:e67210. [PMID: 40359509 PMCID: PMC12117280 DOI: 10.2196/67210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 01/09/2025] [Accepted: 01/15/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Shame and stigma often prevent individuals with social anxiety disorder (SAD) from seeking and attending costly and time-intensive psychotherapies, highlighting the importance of brief, low-cost, and scalable treatments. Creating prescriptive outcome prediction models is thus crucial for identifying which clients with SAD might gain the most from a unique scalable treatment option. Nevertheless, widely used classical regression methods might not optimally capture complex nonlinear associations and interactions. OBJECTIVE Precision medicine approaches were thus harnessed to examine prescriptive predictors of optimization to a 14-day fully self-guided mindfulness ecological momentary intervention (MEMI) over a self-monitoring app (SM). METHODS This study involved 191 participants who had probable SAD. Participants were randomly assigned to MEMI (n=96) or SM (n=95). They completed self-reports of symptoms, risk factors, treatment, and sociodemographics at baseline, posttreatment, and 1-month follow-up (1MFU). Machine learning (ML) models with 17 predictors of optimization to MEMI over SM, defined as a higher probability of SAD remission from MEMI at posttreatment and 1MFU, were evaluated. The Social Phobia Diagnostic Questionnaire, structurally equivalent to the Diagnostic and Statistical Manual SAD criteria, was used to define remission. These ML models included random forest and support vector machines (radial basis function kernel) and 10-fold nested cross-validation that separated model training, minimal tuning in inner folds, and model testing in outer folds. RESULTS ML models outperformed logistic regression. The multivariable ML models using the 10 most important predictors achieved good performance, with the area under the receiver operating characteristic curve (AU-ROC) values ranging from .71 to .72 at posttreatment and 1MFU. These prerandomization and early-stage prescriptive predictors consistently identified which participants had the highest probability of optimization of MEMI over SM after 14 days and 6 weeks from baseline. Significant predictors included 4 strengths (higher trait mindfulness, lower SAD severity, presence of university education, no current psychotropic medication use), 2 weaknesses (higher generalized anxiety severity and clinician-diagnosed depression or anxiety disorder), and 1 sociodemographic variable (Chinese ethnicity). Emotion dysregulation and current psychotherapy predicted remission with inconsistent signs across time points. CONCLUSIONS The AU-ROC values indicated moderately meaningful effect sizes in identifying prescriptive predictors within multivariable models for clients with SAD. Focusing on the identified notable client strengths, weaknesses, and Chinese ethnicity may enhance our ability to predict future responses to scalable treatments. Estimating the likelihood of SAD remission with a "prescriptive predictor calculator" for each client may help clinicians and policymakers allocate scarce treatment resources effectively. Clients with high remission probability may benefit from receiving the MEMI as a vigilant waitlist strategy before intensive therapist-led psychotherapy. These efforts may aid in creating actionable treatment selection tools to optimize care for clients with SAD in routine health care settings that use stratified care principles. TRIAL REGISTRATION OSF Registries 10.17605/OSF.IO/M3KXZ; https://osf.io/m3kxz.
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Affiliation(s)
- Nur Hani Zainal
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Hui Han Tan
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Ryan Yee Shiun Hong
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Michelle Gayle Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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Garvert MM, McFadyen J, Linke S, McCloud T, Meyer SS, Sobanska S, Sharp PB, Long A, Huys QJM, Ahmadi M. Safety and Efficacy of Modular Digital Psychotherapy for Social Anxiety: Randomized Controlled Trial. J Med Internet Res 2025; 27:e64138. [PMID: 40208666 PMCID: PMC12022530 DOI: 10.2196/64138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 01/25/2025] [Accepted: 02/06/2025] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena. OBJECTIVE This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety. METHODS In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2). RESULTS In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction -9.83, SD 12.80) than in the control arm (mean SPIN score reduction -4.13, SD 11.59; t90=-2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean -12.89, SD 13.87) than in the control arm (mean -7.48, SD 12.24; t227=-3.13; false discovery rate P=.008; Cohen d=0.42). CONCLUSIONS The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2).
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Massad R, Hertz-Palmor N, Blay Y, Gur S, Schneier FR, Lazarov A. In the eye of the beholder - validating the visual social anxiety scale (VSAS) in social anxiety disorder. Cogn Behav Ther 2025:1-29. [PMID: 40202294 DOI: 10.1080/16506073.2025.2487777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 03/25/2025] [Indexed: 04/10/2025]
Abstract
The Visual Social Anxiety Scale (VSAS) is a novel picture-based self-report measure of social anxiety that shown promising psychometric properties among non-selected participants. The present study aimed to validate the VSAS among individuals with clinically diagnosed social anxiety disorder (SAD) and establish clinical cutoff scores. One-hundred-and-three adults with SAD completed the VSAS with a battery of additional self-report measures of social anxiety, depression, and general anxiety. Internal consistency, convergent and discriminant validities, were assessed. Clinical cutoff scores were established via a Receiver Operating Characteristics (ROC) analysis using a control group of individuals without any past or present psychopathology (n = 34). An Exploratory Factor Analysis (EFA) was performed to explore underlying thematic factors. The VSAS exhibited high internal consistency and adequate convergent and discriminant validities. The ROC analysis showed the area under the curve to be 0.95 and yielded an optimal cutoff score of 23.40, providing high accuracy (0.90), sensitivity (0.89), and specificity (0.91) for distinguishing SAD from non-SAD individuals. The EFA revealed a 3-factor structure representing the following themes: social interpersonal situations, formal interpersonal situations, and being the center of attention. The psychometric properties of the VSAS support its utility in assessing and identifying individuals with clinical SAD.
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Affiliation(s)
- Raz Massad
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Nimrod Hertz-Palmor
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Yoav Blay
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Shay Gur
- Geha Mental Health Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Franklin R Schneier
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
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Shapiro IR, Boyd JE, McCabe RE, Rowa K. Lost connection? Comparing group cohesion and treatment outcomes between videoconference and in-person cognitive behavioural group therapy for social anxiety disorder and other anxiety disorders. Behav Cogn Psychother 2025:1-15. [PMID: 40077887 DOI: 10.1017/s1352465825000013] [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: 03/14/2025]
Abstract
BACKGROUND One of the most effective treatments for social anxiety disorder (SAD) is cognitive behavioural therapy (CBT). Prior research indicates group cohesion is connected to treatment success in group CBT for SAD (CBGT). Videoconference CBGT delivery is now common following the COVID-19 pandemic; however, research investigating treatment outcomes and group cohesion in videoconference CBGT for SAD is limited. AIMS The present study aimed to compare group cohesion in videoconference CBGT for SAD to group cohesion in both in-person CBGT for SAD and videoconference CBGT for other anxiety and related disorders. A secondary aim was to compare symptom reduction across all three groups. METHOD Patients completed a 12-week CBGT program for SAD in-person (n=28), SAD via videoconference (n=46), or for another anxiety or related disorder via videoconference (n=100). At mid- and post-treatment patients completed the Group Cohesion Scale Revised (GCS-R), and at pre- and post-treatment patients completed the Social Phobia Inventory (SPIN, only in the SAD groups) and the Depression Anxiety Stress Scales (DASS-21). RESULTS Over the course of treatment, all three groups showed a significant increase in cohesion and a significant decrease in symptoms (ηp2 ranged from .156 to .562, all p<.001). Furthermore, analyses revealed no significant difference in cohesion scores between groups at both mid- and post-treatment. CONCLUSIONS These results suggest that videoconference CBGT for SAD is similarly effective in facilitating cohesion and reducing symptoms compared with in-person delivery. Limitations of the study and implications for treatment are discussed.
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Affiliation(s)
- Isabel R Shapiro
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Hamilton, Ontario, Canada
| | - Jenna E Boyd
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Lai L, Li Y, Zhao Z, Ren Z. Efficacy of a process-based, Mobile-delivered personalized CBT for anxiety disorders: Study protocol for a randomized controlled trial. Internet Interv 2025; 39:100805. [PMID: 39931044 PMCID: PMC11808676 DOI: 10.1016/j.invent.2025.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 12/15/2024] [Accepted: 01/24/2025] [Indexed: 02/13/2025] Open
Abstract
Background Internet-based Cognitive Behavioral Therapy (ICBT) is effective in treating anxiety disorders, yet there is room for improvement in treatment response and reduction in dropout rates. This study proposes a personalized, modular ICBT intervention that leverages the extended evolutionary meta-model to provide a dynamic and adaptive treatment approach, aiming to enhance usability and efficacy. Methods The trial will be conducted in two phases. Phase I involves 182 participants who will undergo a 30-day ecological momentary assessment to record functional processes and anxiety levels three times a day. The data collected will help in identifying key functional predictors of anxiety for each participant through group iterative multiple model estimation. In Phase II, participants who complete Phase I will be randomized into three groups: personalized CBT, standard CBT, and a waiting list. Outcome measures will include Brief Symptom Inventory, specific measures of anxiety, usability metrics, and dropout rates. Assessments will be conducted at baseline, immediately post-treatment, and at 1- and 3-month follow-ups. A linear mixed model will be utilized to analyze the data and determine the intervention's efficacy. Discussion Anticipated outcomes from this study include advancements in personalized CBT for anxiety disorders, contributing valuable insights into their potential benefits and addressing existing challenges in the field.
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Affiliation(s)
- Lizu Lai
- School of Humanities, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Hubei Key Research Base of Humanities and Social Sciences, Hubei Health Industry Development Research Center, Wuhan, Hubei, China
| | - Ying Li
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, Hubei, China
| | - Ziyi Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, Hubei, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, Hubei, China
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Bouwman V, Mobach L, Teachman BA, Salemink E. Return of negative interpretation bias after positive interpretation training as a dynamic predictor of treatment outcome in fear of public speaking. Behav Res Ther 2025; 185:104685. [PMID: 39799829 DOI: 10.1016/j.brat.2025.104685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 11/20/2024] [Accepted: 01/03/2025] [Indexed: 01/15/2025]
Abstract
Despite various efforts in the field, no consistent predictors of treatment outcome in anxiety disorders have been identified. Based on the Dynamic System Theory, this study proposes a novel, dynamic predictor of treatment outcome in those with public speaking anxiety. It was assessed whether speed of return to one's interpretation bias equilibrium after an experimentally-induced perturbation (i.e., interpretation training targeting negative interpretation bias as a critical maintaining factor for anxiety) predicts subsequent outcome to online exposure treatment. Women with subclinical public speaking anxiety (N = 100, M age = 23.13, SD = 3.89) were randomly allocated to a positive interpretation training (n = 50) or a neutral interpretation training (n = 50). Dynamic changes in negative interpretations were measured using Experience Sampling Method. Later, participants followed an online one-session exposure therapy for public speaking anxiety. Positive interpretation training resulted in a stronger reduction in negative interpretations compared to the neutral interpretation training. Fear of public speaking decreased from before to after the exposure therapy. Consistent with our central hypothesis, results showed that slower return to one's interpretation bias equilibrium after the positive interpretation training was associated with a greater decline in fear of public speaking after exposure treatment. These results show the potential of a dynamic approach in predicting treatment outcome in public speaking anxiety. This study contributes to the field of clinical psychology, as finding more reliable predictors of treatment outcome before the start of therapy could contribute to the efficiency of care delivery.
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Affiliation(s)
- Vera Bouwman
- Utrecht University, Department of Clinical Psychology, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
| | - Lynn Mobach
- University of Amsterdam, Department of Developmental Psychology, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands; Pro Persona Institute for Integrated Mental health Care, Wolfheze, the Netherlands
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, PO BOX 400400, Charlottesville, VA, 22904-4400, United States
| | - Elske Salemink
- Utrecht University, Department of Clinical Psychology, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
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Bakali JV, Solbakken OA, Hoffart A, Brækhus H, Kvarstein E, Johnson SU. Affect integration, metacognitions, and early maladaptive schemas as predictors of outcome in cognitive and metacognitive therapies for social anxiety disorder. Psychother Res 2024:1-13. [PMID: 39729422 DOI: 10.1080/10503307.2024.2443499] [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: 05/12/2024] [Revised: 11/22/2024] [Accepted: 12/02/2024] [Indexed: 12/29/2024] Open
Abstract
OBJECTIVE Few reliable patient characteristics have emerged as significant predictors of outcomes for Social Anxiety Disorder (SAD). This study aimed to explore whether affect integration, metacognitions, and maladaptive schemas could serve as predictors of therapeutic outcomes for patients with SAD. Relationships between these psychological constructs and baseline SAD symptomatology were also examined. METHODS Eighty-eight patients across three sites participated in Cognitive Behavioral Therapy (CBT) or Metacognitive Therapy (MCT) for SAD in inpatient or outpatient clinics. Measures of predictors and SAD symptomatology were repeatedly assessed. Statistical analyses included longitudinal, multilevel modeling. RESULTS Difficulties with affect integration, metacognitions and early maladaptive schemas clearly related to higher levels of SAD symptoms at baseline but were not generally predictive of changes in SAD symptoms during therapy. However, examining sub-domains revealed that difficulties with the integration of jealousy and tenderness, and the maladaptive schema of defectiveness/shame, predicted poorer outcomes. In contrast, initial difficulties with the integration of sadness, a greater lack of cognitive confidence, and the maladaptive schema of dependence/incompetence were associated with greater symptom improvement. CONCLUSION Identifying issues of affect integration and core self-other beliefs prior to therapy may enhance patient selection and allow for a more individualized treatment.
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Affiliation(s)
- Jan Vegard Bakali
- Centre for Mental Health and Addiction, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway
| | - Hege Brækhus
- Division for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elfrida Kvarstein
- Division for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway
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Steuber ER, Miller ML, McGuire JF. Clinical Considerations for an Evidence-Based Assessment of Anxiety Disorders in Adults. Psychiatr Clin North Am 2024; 47:623-639. [PMID: 39505445 PMCID: PMC11541043 DOI: 10.1016/j.psc.2024.04.009] [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: 11/08/2024]
Abstract
Evidence-based assessment (EBA) is critical for successful diagnosis and treatment of adult anxiety disorders. First, diagnostic interviews are reviewed with emphasis on how these tools can be used inform clinical diagnoses. Second, clinician-rated measures and self-report scales used to characterize anxiety symptom severity in adults are discussed. Third, to further inform clinical care, rating scales that illustrate clinical profiles contributing to symptom maintenance and severity-namely accommodation and avoidance behaviors-are discussed. Lastly, a summary of recommendations for using EBA for the diagnosis and treatment of anxiety disorders in adults is shared.
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Affiliation(s)
- Elizabeth R Steuber
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michelle L Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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Castro D, Cardoso J, Araujo AS, Rodrigues AR, Ferreira F, Ferreira-Santos F, Ferreira TB. Topological properties of psychopathological networks of healthy and disordered individuals across mental disorders. J Affect Disord 2024; 366:226-233. [PMID: 39216639 DOI: 10.1016/j.jad.2024.08.168] [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: 09/18/2023] [Revised: 08/04/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
The identification of psychopathological markers has been the focus of several scientific fields. The results were inconsistent due to lack of a clear nosology. Network analysis, focusing on the interactions between symptoms, provided important insights into the nosology of mental disorders. These interactions originate several topological properties that could constitute markers of psychopathology. One of these properties is network connectivity, which has been explored in recent years. However, the results have been inconsistent, and the topological properties of psychopathological networks remain largely unexplored and unknown. We compared several topological properties (i.e., connectivity, average path length, assortativity, average degree, modularity, global clustering) of psychopathological networks of healthy and disordered participants across depression (N = 2830), generalized anxiety (N = 13,463), social anxiety (N = 12,814), and obsessive-compulsive disorder (N = 16,426). Networks were estimated using Bayesian Gaussian Graphical Models. The Janson-Shannon measure of divergence was used to identify differences between the network properties. Network connectivity distinguished healthy and disordered participants' networks in all disorders. However, in depression and generalized anxiety, network connectivity was higher in healthy participants. The presence and number of motifs also distinguished the networks of healthy and disordered participants. Other topological properties (i.e., modularity, clustering, average path length and average degree) seem to be disorder-specific. The psychopathological significance of network connectivity must be clarified. Some topological properties of psychopathological networks are promising markers of psychopathology and may contribute to clarifying the nosology of mental disorders.
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Affiliation(s)
- Daniel Castro
- University of Maia, Maia, Portugal; Center for Psychology at University of Porto, Porto, Portugal.
| | - Joana Cardoso
- University of Maia, Maia, Portugal; Center for Psychology at University of Porto, Porto, Portugal
| | - Ana Sofia Araujo
- University of Maia, Maia, Portugal; Center for Psychology at University of Porto, Porto, Portugal
| | - Ana Rita Rodrigues
- University of Maia, Maia, Portugal; Center for Psychology at University of Porto, Porto, Portugal
| | | | - Fernando Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - Tiago Bento Ferreira
- University of Maia, Maia, Portugal; Center for Psychology at University of Porto, Porto, Portugal
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11
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Premkumar P, Heym N, Myers JAC, Formby P, Battersby S, Sumich AL, Brown DJ. Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial. Front Psychiatry 2024; 15:1467141. [PMID: 39600795 PMCID: PMC11589380 DOI: 10.3389/fpsyt.2024.1467141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 10/14/2024] [Indexed: 11/29/2024] Open
Abstract
Introduction We previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced heartrate. Elevated heartrate characterises social anxiety and the self-guided VRET seemed to reduce heartrate. Thus, receiving continuous biofeedback about physiological arousal during the VRET could help socially anxious individuals to manage their anxiety. The present study aimed to determine whether biofeedback enhances the responsiveness of VRET. Methods Seventy-two individuals with high self-reported social anxiety were randomly allocated to VRET-plus-biofeedback (n=38; 25 completers) or VRET alone (n=35; 25 completers). Three hour-long VRET sessions were delivered over three consecutive weeks. During each session, participants delivered a 20-minute public speech in front of a virtual audience. Participants in the VRET-plus-biofeedback group received biofeedback on heartrate and frontal alpha asymmetry (FAA) within the virtual environment and were asked to lower their arousal accordingly. Participants in both groups completed psychometric assessments of social anxiety after each session and at one-month follow-up. Results PSA improved by the end of treatment and overall social anxiety improved one month after the VRET across both groups. The VRET-plus-biofeedback group showed a steadier reduction in FAA in the first VRET session and a greater reduction in self-reported arousal across the three sessions than the VRET-alone group. Conclusion Biofeedback can steady physiological arousal and lower perceived arousal during exposure. The benefits of self-guided VRET for social anxiety are sustained one month after therapy.
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Affiliation(s)
- Preethi Premkumar
- Division of Psychology, London South Bank University, London, United Kingdom
| | - Nadja Heym
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - James A. C. Myers
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Phoebe Formby
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | | | | | - David Joseph Brown
- Department of Computer Science, Nottingham Trent University, Nottingham, United Kingdom
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Swift MC, Depasquale M, Chen J. Cognitive processing biases of social anxiety in adults who do and do not stutter. JOURNAL OF COMMUNICATION DISORDERS 2024; 112:106472. [PMID: 39454539 DOI: 10.1016/j.jcomdis.2024.106472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 09/02/2024] [Accepted: 10/05/2024] [Indexed: 10/28/2024]
Abstract
PURPOSE Adults who stutter are at risk of developing high levels of social anxiety, leading to negative outcomes and contributing towards stuttering relapse post treatment. To ensure that psychological treatments for social anxiety in stuttering adults are relevant and effective, a broader empirical understanding of the mechanisms of social anxiety in stuttering populations is required. Four key cognitive processing biases identified as maintenance factors in cognitive behavioral models of social anxiety were examined: self-focused attention, safety behavior use, negative self-imagery, and interpretation bias. METHODS Adults who stutter and non-stuttering adults (N = 186) were assessed via an online survey. Participants were categorised into two groups based on stuttering: formally diagnosed stuttering and non-stuttering. Within those groups, participants were further categorised as having low or high levels of social anxiety. Cognitive processing bias was assessed in response to two hypothetical social scenarios (i.e., social interaction and social performance). RESULTS As predicted, in both adults who stutter and who are non-stuttering, high social anxiety was related to greater self-focused attention, safety behavior use and negative self-imagery compared to low social anxiety. No significant effect of social anxiety or stuttering was found in relation to interpretation bias. A significant effect of social anxiety upon negative self-imagery was observed in formally-diagnosed adults who stutter compared to non-stuttering adults. CONCLUSION The results support the use of cognitive behavioral models of social anxiety as a framework for research and treatment development within stuttering populations.
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Affiliation(s)
- Michelle C Swift
- Speech Pathology, UniSA Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
| | - Martha Depasquale
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Junwen Chen
- School of Medicine and Psychology, 39 Science Road, The Australian National University, Canberra ACT 2601, Australia.
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13
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Shechter Strulov T, Aderka IM. Dating in social anxiety disorder: A daily diary study. J Anxiety Disord 2024; 107:102927. [PMID: 39270372 DOI: 10.1016/j.janxdis.2024.102927] [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: 05/20/2024] [Revised: 07/24/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024]
Abstract
Romantic relationships are vital for health, well-being and quality of life, and an increasing percentage of romantic relations begin via use of dating apps and subsequently progress to dates. In the present study we examined dating application use and dates among individuals with SAD (n = 54) and without SAD (n = 54). Our sample included young adults (age range 18 to 33) who were not in a romantic relationship at the time of the study. For both individuals with SAD and without SAD, half of the participants were men, and half were women. We used a daily diary measurement in which participants reported on their dating application use and dates, as well as on concomitant emotions and perceptions for 21 consecutive days. We found that individuals with and without SAD did not differ in the frequency/duration of application use nor in the number of dates attended. However, individuals with SAD experienced dates as more negative compared to individuals without SAD (Cohen's d = 0.65). Interestingly, individuals with SAD did not significantly differ in their experience of dates as positive compared to individuals without SAD. Moreover, use of dating applications/going on dates were associated with increases in shame (Cohen's d = 0.59) and embarrassment (Cohen's d = 0.45) and this was found to a greater extent among individuals with SAD compared to individuals without SAD (Cohen's d = 0.50, 0.39 for shame and embarrassment respectively). Findings are discussed in the context of cognitive behavioral models of SAD and implications for treatment are considered.
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Affiliation(s)
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel.
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14
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Moscovitch DA, White K, Hudd T. Hooking the Self Onto the Past: How Positive Autobiographical Memory Retrieval Benefits People With Social Anxiety. Clin Psychol Sci 2024; 12:882-902. [PMID: 39309219 PMCID: PMC11415290 DOI: 10.1177/21677026231195792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/19/2023] [Indexed: 09/25/2024]
Abstract
Do people with social anxiety (SA) benefit from positive memory retrieval that heightens self-relevant meaning? In this preregistered study, an analog sample of 255 participants with self-reported clinically significant symptoms of SA were randomly assigned to retrieve and process a positive social-autobiographical memory by focusing on either its self-relevant meaning (deep processing) or its perceptual features (superficial processing). Participants were then socially excluded and instructed to reimagine their positive memory. Analyses revealed that participants assigned to the deep processing condition experienced significantly greater improvements than participants in the superficial processing condition in positive affect, social safeness, and positive beliefs about others during initial memory retrieval and in negative and positive beliefs about the self following memory reactivation during recovery from exclusion. These novel findings highlight the potential utility of memory-based interventions for SA that work by "hooking" self-meaning onto recollections of positive interpersonal experiences that elicit feelings of social acceptance.
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Affiliation(s)
- David A. Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo
| | - Kendra White
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo
| | - Taylor Hudd
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo
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15
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Zainal NH, Tan HH, Hong RY, Newman MG. Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial. J Anxiety Disord 2024; 104:102858. [PMID: 38657408 PMCID: PMC11411489 DOI: 10.1016/j.janxdis.2024.102858] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024]
Abstract
Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = -0.10-0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (-0.13-0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (-4.62-0.67). A significant reduction in depression severity occurred in MEMI (-0.63--0.60) but not SM (-0.31--0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School (HMS), Department of Health Care Policy, USA; National University of Singapore (NUS), Department of Psychology, USA.
| | - Hui Han Tan
- National University of Singapore (NUS), Department of Psychology, USA
| | - Ryan Y Hong
- National University of Singapore (NUS), Department of Psychology, USA
| | - Michelle G Newman
- The Pennsylvania State University (PSU), Department of Psychology, USA
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16
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Zainal NH, Tan HH, Hong RYS, Newman MG. Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e53712. [PMID: 38640015 PMCID: PMC11069101 DOI: 10.2196/53712] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted. OBJECTIVE In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD). METHODS Participants with SAD (defined as having a prerandomization cut-off score ≥20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes. RESULTS Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal-directed behavior difficulties (between-group Cohen d=-0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal-directed behavior difficulties: Cohen d=-0.73 vs -0.29, lack of emotional clarity: Cohen d=-0.39 vs -0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=-0.29 vs -0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=-0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98). CONCLUSIONS Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD. TRIAL REGISTRATION Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz.
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Affiliation(s)
- Nur Hani Zainal
- Department of Psychology, National University of Singapore, Singapore, Singapore
- Department of Health Policy, Harvard Medical School, Boston, MA, United States
| | - Hui Han Tan
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Ryan Yee Shiun Hong
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Michelle Gayle Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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17
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Musella KE, DiFonte MC, Michel R, Stamates A, Flannery-Schroeder E. Emotion regulation as a mediator in the relationship between childhood maltreatment and symptoms of social anxiety among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38466343 DOI: 10.1080/07448481.2024.2325926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The current study explored emotion regulation strategies (ie, suppression, cognitive reappraisal, experiential avoidance) as mediators in the relationship between childhood maltreatment and social anxiety. PARTICIPANTS One hundred and ninety-three undergraduate students (Mage = 19.5 years; 83.9% female) were recruited from a public university in the northeastern United States. METHODS Participants completed measures assessing childhood maltreatment, emotion regulation strategies, and social anxiety. RESULTS Structural equation modeling was used to examine the mediation paths. Childhood maltreatment was negatively associated with cognitive reappraisal and experiential avoidance, and positively associated with suppression. Higher suppression was associated with higher social anxiety, and higher experiential avoidance was associated with lower social anxiety. The association between childhood maltreatment and symptoms of social anxiety was mediated by suppression and experiential avoidance, but not cognitive reappraisal. All other paths were nonsignificant. CONCLUSIONS Findings suggest that treatments for childhood maltreatment should aim to bolster experiential avoidance and minimize suppression to address social anxiety symptoms.
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Affiliation(s)
- Katharine E Musella
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Maria C DiFonte
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut, USA
| | - Rebecca Michel
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Amy Stamates
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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18
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Shatz H, Oren-Yagoda R, Aderka IM. Nonverbal synchrony in diagnostic interviews of individuals with social anxiety disorder. J Anxiety Disord 2024; 101:102803. [PMID: 38101251 DOI: 10.1016/j.janxdis.2023.102803] [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: 03/11/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
The present study examined nonverbal synchrony (i.e., synchrony between individuals' movement) during diagnostic interviews of individuals with and without social anxiety disorder (SAD). Specifically, 42 individuals with SAD and 42 individuals without SAD underwent a structured clinical interview, and videos of clinical interviews were analysed using Motion Energy Analysis (an objective machine-based video analysis) to quantify each individuals' movement as well as dyadic synchrony. Results indicated that interviews of individuals with SAD had significantly lower levels of nonverbal synchrony compared to interviews of individuals without SAD. In addition, interviews of individuals with SAD had lower levels of pacing compared to interviews of individuals without SAD (pacing refers to synchrony in which the interviewer initiates movement to which the participant responds). Analyses with social anxiety represented as a continuum of severity (vs. a diagnostic dichotomy) resulted in similar findings. Thus, individuals with SAD synchronized with interviewers' movement to a lesser extent compared to individuals without SAD, and social anxiety was associated with diminished synchrony. Implications for psychopathology and diagnosis of SAD are discussed.
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Affiliation(s)
- Hallel Shatz
- School of Psychological Sciences, University of Haifa, Israel
| | | | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel.
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19
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Schneider RL, Arch JJ. Values- versus monetary reward-enhanced exposure therapy for the treatment of social anxiety in emerging adulthood. J Anxiety Disord 2023; 100:102788. [PMID: 37866085 DOI: 10.1016/j.janxdis.2023.102788] [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: 01/28/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
Exposure therapy represents the gold-standard treatment for social anxiety, yet evidence indicates the need for improvement. One promising avenue involves linking exposures to a motivator. The current study examined the impact of intrinsically-rewarding, personal values-enhanced versus extrinsically-rewarding, monetary-enhanced exposure on short-term social anxiety fear and avoidance outcomes, and evaluated impacted initial treatment motivation and exposure generalization. METHODS Sixty emerging adults ages 17-26 with significantly elevated social and public speaking anxiety were randomized to receive values-enhanced exposure, monetary reward-enhanced exposure, or exposure alone. They completed a laboratory session with a brief intervention and speech exposure, one-week follow-up with novel exposure, and online follow-up two weeks later. Subjective and behavioral anxiety measures were collected. RESULTS Linking exposures to values decreased self-reported anxiety following the speech exposure retest, which generalized to anticipatory anxiety prior to a novel speech task. Linking exposures to money temporarily increased speech length, but this difference did not remain during the novel task. Conditions showed similar improvements on other outcomes. CONCLUSION Extrinsic motivators can temporarily motivate exposure engagement, whereas a brief values intervention can enhance exposure learning and decrease subjective anxiety across feared situations compared to monetary enhancement. If replicated, this has pragmatic implications for exposure framing within social anxiety treatment.
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Affiliation(s)
- Rebecca L Schneider
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80302, USA.
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80302, USA
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20
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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21
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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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22
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Schittenhelm JM, von Borell C, Clément C, Schüller J, Stangier U, Hoyer J. Evaluation of a smartphone application for self-help for patients with social anxiety disorder: a randomized controlled study-SMASH. Trials 2023; 24:154. [PMID: 36855058 PMCID: PMC9974392 DOI: 10.1186/s13063-023-07168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND There is growing evidence that Internet-based cognitive behavioral therapy (ICBT) is as effective as a stand-alone treatment and helps facilitating access to treatment. Given the complexity of the treatment, we argue that the effect of ICBT could be even greater if guided by a therapist, as this could increase treatment adherence. We modified an established and well-evaluated treatment approach and developed a mobile application for treating social anxiety disorder (SAD). In the present study, we compare the efficacy of app use alone (APP) with video-based, therapist-guided app use (TG-APP) and with a wait-list control group (WLC) in terms of symptom reduction, and various secondary outcomes such as increase in quality of life or decrease of general psychological distress. METHODS/DESIGN A within-between interaction design with randomization to one of three conditions will be used. In the APP condition, patients receive only the app without any additional contact with therapists, while in the TG-APP condition, therapists provide 8 sessions of video-based treatment in addition to using the app. The study will be conducted in two university outpatient treatment centers with reliably diagnosed SAD patients. The primary outcome will be defined as change in SAD symptoms, as measured by the Liebowitz Social Anxiety Scale (expert rating). Furthermore, a wide range of self-reports and clinician ratings for other symptoms (depression, general psychopathology) or quality of life will be used. A simulation-based power analysis for a 3 × 2 interaction effect (group × time) on the primary outcome in a linear mixed model resulted in a total sample size of N = 165. DISCUSSION The present study will be one of the first to examine the additional benefit of therapist-guided video sessions regarding the use of an app treating SAD. Study results are pivotal to future treatment application in SAD.
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Affiliation(s)
- Jan Marius Schittenhelm
- Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt, Germany.
| | - Christoph von Borell
- grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Celina Clément
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Johanna Schüller
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Ulrich Stangier
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Juergen Hoyer
- grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
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23
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Wilson GA, Malivoire BL, Cassin SE, Antony MM. A mixed methods investigation of reasons underlying fear of positive evaluation. Clin Psychol Psychother 2022; 30:473-485. [PMID: 36523260 DOI: 10.1002/cpp.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/15/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Fear of negative evaluation (FNE) is a hallmark feature of social anxiety disorder (SAD). There is also evidence that people with SAD fear receiving positive evaluation and that fear of positive evaluation (FPE) is distinct from FNE. However, researchers have speculated that concerns related to negative evaluation may actually underlie FPE. This study sought to advance our understanding of FPE by employing both quantitative and qualitative methods to assess the reasons underlying participants' endorsement of FPE on the Fear of Positive Evaluation Scale and the extent to which these reasons reflect FNE versus FPE in a sample of individuals with SAD (n = 47) and a nonclinical comparison group (n = 49). Results indicated that responses to the FPES items primarily reflected an underlying FNE. Consistent with contemporary cognitive-behavioural theories of SAD, fear of proximal or eventual negative judgement emerged as the most common reason for participants' responses on the FPES. However, participants reported other reasons that did not reflect FNE, such as fear of hurting people's feelings and uncertainty associated with positive evaluation. All of the reasons underlying participants' ratings on the FPES were reported by both the SAD group and the nonclinical comparison group; however, individuals with SAD endorsed each of the reasons to a greater extent. These findings suggest that the FPES does not exclusively assess FPE as intended; however, the emergence and endorsement of reasons other than FNE suggest that FPE exists as a distinct construct.
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Affiliation(s)
- Gillian A Wilson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Bailee L Malivoire
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Stephanie E Cassin
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Martin M Antony
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
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24
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Singh P, Samantaray NN. Brief Cognitive Behavioral Group Therapy and Verbal-Exposure-Augmented Cognitive Behavioral Therapy for Social Anxiety Disorder in University Students: A Randomized Controlled Feasibility Trial. Indian J Psychol Med 2022; 44:552-557. [PMID: 36339696 PMCID: PMC9615442 DOI: 10.1177/02537176211026250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Considering the need for developing and examining evidenced-based programs using a brief group format for management of social anxiety disorder (SAD) at the community level, we studied the efficacy of two brief versions of cognitive-behavioral therapy (CBT) programs, brief cognitive-behavioral group therapy (bCBGT), and verbal exposure augmented cognitive behavioral therapy (VE-CBT), on social anxiety among university students. Methods A single-center, randomized, parallel-group design was adopted. We delivered six weekly two-hour group sessions, bCBGT and VE-CBT, to 41 university students diagnosed with SAD. An independent rater assessed participants using the Liebowitz Social Anxiety Scale (LSAS) and Clinical Global Impression scale-Severity (CGI-S) at baseline, postintervention, and two-month follow-up. A patient-rated measure, Social Phobia Inventory (SPIN), was assessed at the same time-points. Results There was a significant improvement in severity of social anxiety from baseline to posttreatment and baseline to two-month follow-up in both groups. However, the treatment effects in bCBGT were statistically superior to VE-CBT at postintervention (SPIN, P = 0.038; LSAS, P = 0.028; CGI-S, P = 0.036) and follow-up (SPIN, P = 0.006; LSAS, P = 0.01; CGI-S, P = 0.04). Conclusions Brief CBT treatments, both bCBGT and VE-CBT, are efficacious for SAD among university students. They have the potential to address barriers associated with SAD management. However, we recommend a longer follow-up and replications in diverse settings.Clinical trial registration number: CTRI/2019/11/021954.
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Affiliation(s)
- Preeti Singh
- Dept. of Psychiatry, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
| | - Narendra Nath Samantaray
- Dept. of Clinical Psychology, School of Medical and Paramedical Science, Mizoram University (A Central University), Aizawl, India
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25
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Effects of safety behavior fading on social anxiety and emotional disclosure. Behav Res Ther 2022; 157:104165. [PMID: 36029642 DOI: 10.1016/j.brat.2022.104165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022]
Abstract
Individuals with social anxiety disorder commonly engage in safety behaviors (SBs), which are behavioral and cognitive strategies employed in an effort to avoid or decrease the likelihood of a feared threat outcome and decrease anxiety in social situations. These behaviors are thought to be dysfunctional and play a key role in contemporary models of the disorder. The current experimental study sought to expand upon existing research by examining the role of SBs in social anxiety and self-disclosure. Participants with elevated social anxiety symptoms (N = 115) were randomized to either a two-week SB fading manipulation or a no-instruction control. Self-report measures were administered pre- and post-manipulation, and participants completed an in-vivo speech task at post. SB fading led to lower social anxiety symptoms at post relative to the control. SB fading also led to greater self-reported openness to general self-disclosure and emotional disclosure compared to the control, though these effects were modest. No condition effect on emotional reactivity to a speech task was observed. SB fading led to greater observer-rated disclosure on the speech task than control, though this was only found among those high in dispositional self-disclosure at baseline. The present study provides further evidence for the importance of SBs in social anxiety and suggests SB fading might lead to greater comfort with self-disclosure. Limitations and directions for future research are discussed.
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Massad R, Hertz-Palmor N, Schneier FR, Lazarov A. Development and initial validation of the Visual Social Anxiety Scale (VSAS): Could a picture be worth a thousand words? J Anxiety Disord 2022; 89:102589. [PMID: 35689849 DOI: 10.1016/j.janxdis.2022.102589] [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: 08/23/2021] [Revised: 03/13/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
Accurate assessment is crucial for determining appropriate therapeutic interventions for social anxiety and conducting sound clinical research. While self-report measures of social anxiety are widely used in both research and clinical settings, they have several drawbacks inherent to their textual nature. Here, we describe the development and initial validation of the Visual Social Anxiety Scale (VSAS), a novel picture-based self-report measure of social anxiety, based on the well-established widely-used Liebowitz Social Anxiety Scale (LSAS). Specifically, the 24 items of the LSAS were used as the basis for social situations to be included in the VSAS. First, pictures to serve as VSAS items were selected using a rigorous two-phase process (four pilot studies; n = 225). Next, reliability (internal consistency, test-retest) and validity (convergent, discriminant) were explored with new participants (n = 304) who completed the VSAS and a battery of additional self-report questionnaires, delivered in a random order. The VSAS was completed again a month later (n = 260/304). The VSAS showed high internal consistency and test-retest reliability, and good convergent and discriminant validities. VSAS correlations with convergent measures were significantly greater than its correlations with discriminant measures. Thus, the VSAS shows initial promise as a novel picture-based self-report measure of social anxiety.
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Affiliation(s)
- Raz Massad
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | | | - Franklin R Schneier
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel.
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Milosevic I, Cameron DH, Milanovic M, McCabe RE, Rowa K. Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:391-402. [PMID: 34159838 PMCID: PMC9065489 DOI: 10.1177/07067437211027319] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. METHOD Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. RESULTS Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. CONCLUSIONS Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
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Affiliation(s)
- Irena Milosevic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Melissa Milanovic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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A follow-up study on treatment effects of cognitive-behavioral therapy on social anxiety disorder: Impact of COVID-19 fear during post-lockdown period. Psychiatry Res 2022; 310:114439. [PMID: 35180611 PMCID: PMC8840826 DOI: 10.1016/j.psychres.2022.114439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
There is a paucity of research on the role of COVID-19 related fear and lockdown on social anxiety disorder (SAD). In a follow-up study during post-lockdown period, we compared social anxiety of individuals with SAD who received cognitive-behavioral therapy (CBT) versus psychoeducational-supportive therapy (PST) before the COVID-19 pandemic, and the impact of COVID-19 related fear. Social anxiety severity was rated by the Social Phobia Inventory (SPIN) at pre-intervention, post-intervention, and post-lockdown periods. Fear of COVID-19 was assessed during the post-lockdown period. The treatment effects in the CBT group (n = 33) were significantly better than the PST group (n = 32) at post-intervention; this was maintained at 14-months following intervention despite COVID-related lockdown. In the PST group, there was no change following the intervention; and the social phobia increased after lockdown. The CBT group had significantly less COVID-19 related fear than the PST group. Social anxiety was positively correlated with fear of COVID-19; and individuals with comorbidities had significantly more fear. Using the hierarchical multiple regression, SPIN post-intervention, COVID-19 fear, and duration of SAD predicted social anxiety severity during the post-lockdown period. In conclusion, the effect of CBT for SAD was maintained through lockdown and was associated with significantly less COVID-19 related fear.
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Smith M, Sharpe B, Arumuham A, Birch P. Examining the Predictors of Mental Ill Health in Esport Competitors. Healthcare (Basel) 2022; 10:healthcare10040626. [PMID: 35455804 PMCID: PMC9027719 DOI: 10.3390/healthcare10040626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
Few research studies have examined the predictors of mental ill health in esports. This study addresses that gap by investigating stressors, sleep, burnout, social phobia anxiety and mental ill health in esport athletes. An online survey was disseminated to competitive student esport athletes (n = 313) residing in the UK. The survey included measures of stressors resulting from competing in esports, sleep quality, burnout, and social phobia, as well as outcome measures of mental ill health. Hierarchical regression analyses examined these relationships. All the hypotheses were supported, with stressors significantly predicting sleep quality, burnout, and social phobia anxiety, and stressors, sleep quality, burnout, and social phobia anxiety were all significant positive predictors of mental ill health. The strength of these predictions varied, for example, the daytime dysfunction subscale of sleep was a strong predictor of all outcome variables; two subscales of burnout, reduced sense of accomplishment and exhaustion significantly predicted each of the three mental ill health outcome variables, and two subscales of social phobia anxiety, fear and avoidance, significantly predicted mental ill health. Our study has important implications for player health in esports, highlighting interventions that could target specific aspects of stress, sleep, burnout, and social phobia anxiety to improve the mental health of those who compete in esports.
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Affiliation(s)
- Matthew Smith
- School of Sport, Health and Community, Faculty of Health and Wellbeing, University of Winchester, Winchester SO22 4NR, UK
- Correspondence:
| | - Benjamin Sharpe
- Institute of Education, Social and Life Sciences, University of Chichester, Chichester PO19 6PE, UK;
| | - Atheeshaan Arumuham
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Phil Birch
- Institute of Sport, Nursing and Allied Health, University of Chichester, Chichester PO19 6PE, UK;
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31
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Positive Beliefs about Post-Event Processing in Social Anxiety Disorder. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.25] [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
Abstract
Background: Post-event processing (PEP) is an important maintenance factor of social anxiety disorder (SAD). This study examined psychometric properties of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ; Fisak & Hammond, 2013), which measures metacognitive beliefs about PEP. Method: Participants receiving treatment for SAD (n = 71) and other anxiety and related disorders (n = 266) completed self-report questionnaires at several timepoints. Results: Confirmatory factor analysis did not support the PB-PEPQ's proposed unidimensional model. Subsequent exploratory factor analysis yielded a three-factor structure consisting of engaging in PEP to (1) review negative events (Negative scale), (2) review positive events (Positive scale), and (3) better understand one's social anxiety (Understand scale). Within the SAD subsample, PB-PEPQ scales demonstrated good internal consistency (α = 0.83–0.85) and test–retest reliability (r = 0.65–0.78). Convergent and criterion validity of the PB-PEPQ Negative scale were supported. PB-PEPQ scale scores were significantly higher within the SAD group, as compared with the other groups (generalised anxiety disorder, panic disorder and agoraphobia, posttraumatic stress disorder, and obsessive-compulsive disorder), supporting the scales’ discriminative validity. Conclusion: Findings support the reliability and validity of the PB-PEPQ in a clinical sample and reveal the measure's multifactorial structure.
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32
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O'Brien K, Sukovieff A, Johnson EA. Evidence of Delayed, Recursive Benefits of Self-Affirmation on Anxiety in Socially Anxious University Students. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.6.534] [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: Persons with social anxiety disorder (SAD) often experience social interactions as threatening and commonly avoid them or perform poorly in them (Asher et al., 2017). Self-affirmation is an intervention shown to help individuals engage effectively in situations they perceive as threatening (Sherman & Hartson, 2011). We hypothesized that self-affirmation would allow socially anxious individuals to participate in more social activities, do so more effectively, and with less stress and anxiety. Methods: Following completion of baseline measures, 75 socially anxious university students were randomly assigned to complete a self-affirming or control writing task. They subsequently completed the Trier Social Stress Test for Groups (TSST-G), and received SAD psychoeducation designed to promote social engagement over the coming month, after which they were reassessed on baseline measures of social anxiety. Results Self-affirmation demonstrated no benefit at the time of engagement in the TSST-G. However, at follow-up, self-affirmed students reported significantly less discomfort, anxiety, and distress related to a variety of social behaviors as well as more engagement in those behaviors, relative to baseline, compared with non-affirmed students. Moreover, significantly more affirmed than non-affirmed participants reported clinically significant reductions in symptoms of SAD at follow-up. Discussion These results help to broaden our conceptualization of self-affirmation and provide support for its potential utility in treatment for those with SAD.
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33
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Constantin K, Penney AM, Pope CJ, Miedema VC, Tett RP, Mazmanian D. Negative repetitive thoughts clarify the link between trait emotional intelligence and emotional distress. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A Preliminary Examination of the Acceptability, Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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35
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Rozen N, Aderka IM. The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis. Cogn Behav Ther 2021; 51:185-216. [PMID: 34617874 DOI: 10.1080/16506073.2021.1966089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.
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Affiliation(s)
- Naama Rozen
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Haifa, Israel
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36
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Broman- Fulks JJ, Hall CA, Kelso KC, Kundert C. Incremental validity of the AAQ-II for anxiety disorder symptomology. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cardace F, Rubel J, Altmann U, Merkler M, Schwartz B, Deisenhofer AK, Paulick J, Schoenherr D, Strauß B, Lutz W. [Convergence of Scales to Measure Social Anxiety: An IRT Linking Approach]. Psychother Psychosom Med Psychol 2021; 72:59-67. [PMID: 34517422 DOI: 10.1055/a-1519-7259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The Liebowitz Social Anxiety Scale (LSAS) and the Social Phobia Inventory (SPIN) are established measures in the investigation of social anxiety. Furthermore, the subscale Interpersonal Sensitivity of the Brief Symptom Inventory (BSI-53) is frequently used to screen social anxiety. All three scales claim to capture the same construct, which raises the question of the convergence of these scales. To make research findings comparable by a cross-questionnaire factor (common factor), an item response theory (IRT) linking approach is used in the present study. METHODS 64 German-speaking psychiatric patients and 295 healthy subjects completed the three questionnaires. Different IRT models, including Graded Response Models (GRM), were constructed, and their model fit compared. Regression analyses were performed based on the best-fit model. The common factor was predicted from the questionnaire total values. RESULTS The relationship between the different scales was best explained by a bifactor GRM with one common factor and three domain-specific factors (RMSEA=0.036, CFI=0.977, WRMR=1.061). Based on the results of the regression analyses, three equations were derived for the transformation of questionnaire's total values. CONCLUSION The IRT linking approach allows the derivation of a general factor of social anxiety, taking into account commonalities and differences between the instruments used. This has advantages for both research and practice. A replication of this study as well as the implementation of further instruments are recommended to verify the validity of this approach and to generalize the results.
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Affiliation(s)
- Fabio Cardace
- Klinische Psychologie und Psychotherapie, Universität Trier,Trier, Deutschland
| | - Julian Rubel
- Abteilung für Psychotherapieforschung, Justus Liebig Universitat Giessen, Giessen, Deutschland
| | - Uwe Altmann
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Universitätsklinikum Jena, Jena, Deutschland
| | - Martin Merkler
- Klinische Psychologie und Psychotherapie, Universität Trier,Trier, Deutschland
| | - Brian Schwartz
- Klinische Psychologie und Psychotherapie, Universität Trier,Trier, Deutschland
| | | | - Jane Paulick
- Klinische Psychologie und Psychotherapie, Universität Trier,Trier, Deutschland
| | - Desiree Schoenherr
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Universitätsklinikum Jena, Jena, Deutschland
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Universitätsklinikum Jena, Jena, Deutschland
| | - Wolfgang Lutz
- FB I - Psychologie, Klinische Psychologie und Psychotherapie, Universität Trier, Trier, Deutschland
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Sarfan LD, Magee JC, Clerkin EM. Evaluating Mechanisms: Mapping Weekly Dynamics between Experiential Avoidance and SAD Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractWidely-used, empirically-supported treatments focus on reducing experiential avoidance (EA) as a mechanism of social anxiety disorder (SAD) symptom change. However, little is known about how EA and SAD symptoms bidirectionally interrelate from session to session, or throughout the course of an intervention—a gap that raises significant theoretical and clinical questions about the mechanistic role of EA. Participants (N = 78) with elevated EA and SAD symptoms completed a 3-session pilot intervention (Approach-Avoidance Task training plus psychoeducation) designed to target EA. Bivariate latent change score modeling was then used to map the bidirectional, temporal interrelationships between EA and SAD symptoms from session to session. Analyses accounted for the overall trajectory of change in both variables (i.e., EA and SAD) and both variables’ preceding measurement. Findings suggested that changes in SAD symptoms preceded and predicted changes in EA from session to session. Contrary to hypotheses, this effect was not bidirectional, as changes in EA did not precede and predict changes in SAD symptoms from session to session. The use of a relatively small analogue sample limit the external validity of the present findings. Nevertheless, these novel findings advance our understanding of the dynamic interrelationships between EA and SAD symptoms throughout treatment. Moreover, given that many leading treatments target EA, this study highlights a need for future work to continue evaluating whether EA is indeed a mechanism of SAD symptom change.
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Lervik LV, Hoffart A, Knapstad M, Smith ORF. Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder. Psychother Res 2021; 32:195-208. [PMID: 34142636 DOI: 10.1080/10503307.2021.1930243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES In cognitive behavioral therapy (CBT) for social anxiety disorder (SAD), avoidance behavior (AB) and cognitions (COG) are two important targets of intervention, but so far no studies have directly examined their relative importance. By means of cross-lagged panel models (CLPM), we examined their temporal associations and impacts on outcome in clients with symptoms of SAD while addressing typical methodological challenges. METHOD We used data from the first six therapy sessions in a sample of 428 primary care clients (mean [SD] age = 34.6 [12.2], 34.3% men), participating in the Prompt Mental Health Care trial. Session-by-session data was collected on AB, COG, depression and general anxiety. Competing multiple indicator CLPMs were tested. RESULTS The Random Intercept-CLPM provided best fit, and indicated that AB predicted COG at subsequent time points (.39 ≤ β ≤ .42 for T2-T5, p < .05), but not vice versa. In addition, AB, but not COG, predicted clients' general anxiety score at subsequent time points. Results were both robust to the inclusion of depressive symptoms as a within-level covariate, and sensitivity tests for stationarity and missing data assumptions. CONCLUSION Targeting avoidance behavior for primary care clients with symptoms of SAD may be more vital for the optimal effect of CBT than targeting cognitions. Methodological considerations and limitations of the study are discussed.Trial registration: ClinicalTrials.gov identifier: NCT03238872.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Asle Hoffart
- Modum Bad Psychiatric Center, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Otto R F Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
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40
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Seon Q, Hum S, Tuineag M, Pavlova B, Beaulieu S, Linnaranta O. Properties of common anxiety scales among patients with bipolar disorder. J Affect Disord 2021; 281:972-979. [PMID: 33229021 DOI: 10.1016/j.jad.2020.09.139] [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: 05/02/2020] [Revised: 08/19/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Almost half of the patients with a bipolar disorder (BD) have anxiety disorder(s) (AD) during their lifetime, but feasible measures for all AD are few. Furthermore, cognitive impairments can compromise reliability of existing scales, since many are needed for full coverage. Thus, we investigated how reliably patients responded to anxiety scales and any symptom overlap to propose future improvements to anxiety assessments. METHODS We collected 152 observations in patients with BD with the Clinically Useful Anxiety Outcome Scale, Social Phobia Inventory, Panic Disorder Severity Measurement, and Trauma Screening Questionnaire (in total, 57 items). The scales were analyzed as a set in a Rasch model. RESULTS During our analyses, we found indication that BD outpatients had difficulty differentiating response options to 70% (40/57) of items which were rescored or deleted. Only one case was misfitting (-2.65±.41). In total, 22 items were locally dependent and one indicated misfit. The final model included 25-items and fit the Rasch model (χ2=35.92, DF=50, p=.93). The model was unidimensional, without losing appropriate associations with depression (r = 0.62), suicidality (r = 0.37), and hypomania (r= -0.01). LIMITATIONS Bolstering the size of less frequent subgroups should be accomplished in future work. CONCLUSION A unidimensional rather than categorical approach to severity of anxiety might be both useful and feasible in this population. Further development of screens is necessary to enable systematic screening and measurement of anxiety in BD.
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Affiliation(s)
- Quinta Seon
- Department of Psychology, McGill University, Quebec, Canada
| | - Stanley Hum
- Montreal Neurological Institute, Quebec, Canada
| | - Maria Tuineag
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada
| | - Barbara Pavlova
- Dalhousie University, Nova Scotia, Canada; Nova Scotia Health Authority, Nova Scotia, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada.
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Interpersonal motivations in social anxiety: Weakened approach and intensified avoidance motivations for affiliation and social-rank. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sauter M, Braun T, Mack W. Social Context and Gaming Motives Predict Mental Health Better Than Time Played: An Exploratory Regression Analysis with over 13,000 Video Game Players. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:94-100. [DOI: 10.1089/cyber.2020.0234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Marian Sauter
- Institute for Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Tina Braun
- Institute for Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Wolfgang Mack
- Institute for Psychology, Bundeswehr University Munich, Neubiberg, Germany
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Samantaray NN, Nath B, Behera N, Mishra A, Singh P, Sudhir P. Brief cognitive behavior group therapy for social anxiety among medical students: A randomized placebo-controlled trial. Asian J Psychiatr 2021; 55:102526. [PMID: 33360708 DOI: 10.1016/j.ajp.2020.102526] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare brief cognitive behavior group therapy (bCBGT) for social anxiety disorder (SAD) to a credible placebo, psychoeducational-supportive therapy (PST), in a sample of medical students. METHOD This was a single-center, rater-blind, randomized, attention placebo-controlled, parallel-group study. Participants were 50 consenting undergraduate medical students of a state government medical college in Cuttack, India having a primary diagnosis of SAD, who recieved 6 weekly 2-h group sessions. Assessments were carried out at baseline, post intervention and at two-month follow. Independent raters assessed the participants on the Liebowitz Social Anxiety Scale and Clinical Global Impression- Improvement scale (CGI-I). Social Phobia Inventory (SPIN), a self-rated measure, was administered in the same periods. RESULTS bCBGT group improved significantly across periods from pre-treatment to post-treatment and from pre-treatment to two-month follow-up. bCBGT was statistically superior to PST at the post-treatment and follow-up assessments and showed large effect sizes at both post-treatment and follow-up. CONCLUSIONS A 6-session bCBGT is an efficacious treatment for SAD among medical students. A longer follow-up and replication in other groups, and clinical settings are necessary for generalization to a broader SAD population.
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Affiliation(s)
- Narendra Nath Samantaray
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack, 753007, India; Dept. of Clinical Psychology, Institute of Psychiatry & Human Behaviour, Bambolim, Goa, 403202, India.
| | - Bijaylaxmi Nath
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack, 753007, India.
| | - Nirupama Behera
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack, 753007, India.
| | - Abinash Mishra
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack, 753007, India.
| | - Preeti Singh
- Dept. of Psychiatry, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, 492001, India.
| | - Paulomi Sudhir
- Consultant Behavioural Medicine Unit, Department of Clinical Psychology, M.V.Govindaswamy Building, NIMHANS, Bengaluru, 560029, India.
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Khatri DK, Choudhary M, Sood A, Singh SB. Anxiety: An ignored aspect of Parkinson’s disease lacking attention. Biomed Pharmacother 2020; 131:110776. [DOI: 10.1016/j.biopha.2020.110776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
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Shaw PV, Wilson GA, Antony MM. Examination of emotional contagion and social anxiety using novel video stimuli. ANXIETY STRESS AND COPING 2020; 34:215-227. [PMID: 33124470 DOI: 10.1080/10615806.2020.1839729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Socially anxious individuals often exhibit signs of anxiety that might elicit discomfort in others and negatively influence their interactions, due in part to emotional contagion. However, there is limited research examining the phenomenon of emotional contagion in social anxiety, which is the topic of the current study. DESIGN AND METHODS An experimental design was used in which undergraduate psychology students (N = 128) were assigned to either an experimental condition (watching a video of a socially anxious presenter) or a control condition (watching a video of a nonanxious presenter). Various measures were administered to assess social anxiety, emotional contagion, state anxiety, and related constructs. RESULTS After controlling for baseline anxiety levels, participants in the experimental condition reported significantly higher levels of anxiety during and immediately after watching the video compared to individuals in the control condition (multivariate analysis of covariance, analysis of variance). Similar results were found across both conditions in participants with higher levels of trait social anxiety and higher public speaking anxiety (moderated regression analyses). CONCLUSIONS The findings suggest that social anxiety may be emotionally contagious, and provides insight into the role that emotional contagion may play in the association between social anxiety and interpersonal functioning.
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Affiliation(s)
- Pam V Shaw
- Department of Psychology, Ryerson University, Toronto, Canada
| | | | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, Canada
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Lenton-Brym AP, Monson CM, Antony MM. Responses to perceived intimate partner rejection among individuals with social anxiety disorder and healthy controls. J Anxiety Disord 2020; 75:102281. [PMID: 32777600 DOI: 10.1016/j.janxdis.2020.102281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
Individuals with social anxiety disorder (SAD) demonstrate impaired functioning in intimate relationships, yet little is known about how socially anxious individuals respond to perceived intimate partner rejection. In the present study, individuals with SAD (n = 30) and healthy controls (HCs; n = 33) who were involved in current intimate relationships completed daily diaries each evening for 14 days. Daily diaries assessed the extent to which participants experienced feelings of rejection in their intimate relationships, as well as the extent to which they responded to feelings of rejection by using behaviors characterized by withdrawal ("withdrawal" processes) versus efforts to reaffiliate with their partners ("approach" processes). Results revealed that overall, individuals with SAD exhibited greater use of withdrawal-focused processes, whereas HC participants exhibited greater use of approach-focused processes. However, on days following intimate partner rejection, only individuals with SAD restricted their use of withdrawal-focused processes. These findings provide insight into the nature of rejection concerns and responses to rejection among individuals with SAD as compared with HC participants.
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Abend R, Naim R, Pergamin-Hight L, Fox NA, Pine DS, Bar-Haim Y. Age Moderates Link Between Training Effects and Treatment Response to Attention Bias Modification Treatment for Social Anxiety Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:881-894. [PMID: 30426323 DOI: 10.1007/s10802-018-0494-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Attention bias modification treatment (ABMT) aims to reduce anxiety symptoms via practice on computerized attention training tasks. Despite evidence of efficacy, clinical effects appear heterogeneous. More research on ABMT mechanisms and moderators of treatment response is needed. Age is one potentially important moderator, as developmental differences in training effects may impact response. We examined developmental links between ABMT training effects and response in social anxiety disorder (SAD). We pooled data from two randomized controlled trials in treatment-seeking youths and adults with SAD (N = 99) that used identical ABMT methods. We first characterized learning effects associated with the eight-session ABMT training protocol. We then tested whether learning magnitude predicted the clinical (change in SAD symptoms) and cognitive (change in attention bias) responses to treatment. Finally, we tested whether age moderated the association between ABMT learning and treatment response. Results indicate that ABMT was associated with an incremental learning curve during the protocol, and that learning improved with age. Age further moderated the association between learning gains during the ABMT protocol and subsequent reduction in self-reported SAD symptoms, such that this association was stronger with age. These effects were not evident in bias scores or clinician ratings. Finally, pre-treatment SAD symptoms and bias scores predicted ABMT learning gains. This study highlights the links among age, learning processes, and clinical response to ABMT. These insights may inform attempts to increase the clinical efficacy of ABMT for anxiety.
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Affiliation(s)
- Rany Abend
- Section on Development and Affective Neuroscience, National Institute of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892, USA.
| | - Reut Naim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, 3404D Benjamin Building, College Park, MD, USA
| | - Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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Erliksson OJ, Lindner P, Mörtberg E. Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users: A psychometric evaluation and cross-sectional study. Scand J Psychol 2020; 61:819-826. [PMID: 32713014 DOI: 10.1111/sjop.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/24/2020] [Indexed: 01/07/2023]
Abstract
Research on the association between social anxiety and social media usage remains inconclusive: despite the preference for computer-mediated communication there is currently no clear empirical support for social anxiety being associated with longer duration of social media use. Self-report measures for social anxiety that are adapted for the context of social media could facilitate further research. The current study aimed to develop a Swedish version of the recently developed Social Anxiety Scale for Social Media Users (SAS-SMU), evaluate its psychometric properties, and explore associations between different uses of social media and social anxiety. Three factors were retained for SAS-SMU with excellent internal consistency. SAS-SMU evidenced convergent validity with measures of social anxiety, negative convergent validity with satisfaction with life, and divergent validity with measures of obsessive-compulsive disorder, depression and generalized anxiety disorder. Results indicated that higher levels of social anxiety were associated with passive and active use as well as longer duration of social media use in general, which is at odds with a previous study where passive use remained the only significant predictor for social anxiety.
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Affiliation(s)
| | - Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ewa Mörtberg
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Attridge MD, Morfitt RC, Roseborough DJ, Jones ER. Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study. JMIR Form Res 2020; 4:e17712. [PMID: 32706662 PMCID: PMC7413280 DOI: 10.2196/17712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers.
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Romano M, Moscovitch DA, Saini P, Huppert JD. The effects of positive interpretation bias on cognitive reappraisal and social performance: Implications for social anxiety disorder. Behav Res Ther 2020; 131:103651. [PMID: 32504886 DOI: 10.1016/j.brat.2020.103651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022]
Abstract
People with social anxiety disorder (SAD) lack non-socially anxious individuals' tendency to interpret ambiguous social information in a positively biased manner. To gain a better understanding of the specific in-vivo social consequences of positive interpretation bias, we recruited 38 individuals with SAD and 31 healthy controls (HC) to participate in an in-vivo social task. We tested whether a positive interpretation bias, measured using a sentence completion task, might confer benefits for the adaptive emotion regulation strategy of cognitive reappraisal, and whether such benefits depended on participants' emotional states. We also examined whether positive interpretation bias might confer additional benefits such as improved self-perceived and observer-rated social performance. In support of prior research, HC participants exhibited a positive interpretation bias on the sentence completion task, whereas participants with SAD did not. Regression analyses revealed that positive interpretation bias predicted greater cognitive reappraisal during social stress, particularly when state positive affect was low. Moreover, positive interpretation bias predicted more positive self-perception of social performance and reduced underestimations of performance relative to observer ratings. These results suggest that positive interpretations of ambiguous social information may be related to increased use of cognitive reappraisal and more positive self-perceptions of social performance.
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Affiliation(s)
- Mia Romano
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada
| | - David A Moscovitch
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada.
| | - Prabhjot Saini
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada
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