Hybrid group art therapy for adolescents with social anxiety: a pilot study

Brief Form of the Social Phobia and Anxiety Inventory (SPAI-B) for Adolescents

Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample. The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population. A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7). Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A. In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.

Fear of negative evaluation (FNE) is a recognised diagnostic feature of Social Anxiety Disorder (SAD). Recently, the role of fear of positive evaluation (FPE) as a factor contributing to SAD has been a focus of research: there is evidence that FPE is associated with measures of social anxiety independent of measures of FNE and that measures of FPE may be sensitive to interventions for SAD. The present study examined the relationships between FPE, FNE and measures of social anxiety and depression in a sample assessed as suitable for group cognitive behaviour therapy (CBT) for social anxiety (n = 35), and the responsiveness of measures of FPE and FNE to standard group CBT for social anxiety in a subset of this group (n = 20). Measures of FNE and FPE were positively associated with each other and with measures of social interaction anxiety, general social anxiety concerns, and depression. However, the relationship between the FPE measure and measures of general social anxiety concerns and depression was not significant when FNE was statistically controlled. This is consistent with the view that FPE is specifically related to social interaction anxiety. In this sample, a measure of FPE was reduced in a sample receiving standard group CBT for social anxiety compared to a waitlisted group. The implications of these findings for the conceptualisation of SAD and for the delivery of interventions for those with SAD are considered.

Emotional and social loneliness and their unique links with social isolation, depression and anxiety

BackgroundSocial anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT.ObjectiveThis study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD.MethodsThe development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS.ResultsParticipants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation −12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation −9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS.ConclusionsThis is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.

The purpose of this study was to examine the associations between gendered racial microaggressions stress (GRMS) and gendered racial microaggressions frequency (GRMF), and Black women's social anxiety and general anxiety symptoms. We also examined the mediating roles of distress intolerance and stress in these associations. One hundred and sixty-three Black women, between the ages of 18 and 25 years old, completed a cross-sectional survey. Regression analyses were used to examine the associations between gendered racial microaggressions and social anxiety and general anxiety, and mediation analyses examined the indirect effect of gendered racial microaggressions on the outcome variables through distress intolerance and stress. GRMS was associated with greater social and general anxiety through the mechanisms of distress intolerance and stress. GRMF was associated with reduced social anxiety and was not associated with general anxiety. Intervention efforts should be aimed to prevent the experience of gendered racial microaggressions to prevent subsequent stress and mental health outcomes for Black women.

Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

Cognitive-behaviour therapy (CBT) is an evidence-based treatment for social anxiety. However, despite the high prevalence of social anxiety among autistic adults, much less is known about how autistic people experience each CBT component used in treatment. This qualitative study explores autistic adults' perspectives on a modified cognitive-behaviour therapy group programme for social anxiety, focusing on the perceived effectiveness of CBT components and the identification of needed modifications. Twenty-seven participants who completed the intervention took part in semi-structured interviews. Thematic analysis identified core themes related to therapeutic impact (application of CBT group strategies) and participant experiences (suggestions for future iterations of social groups). Overall, exposure tasks were viewed as helpful in reducing anxiety, particularly when structured and predictable. Cognitive restructuring was often experienced as effective; however, its impact was sometimes limited by persistent and deeply held core beliefs and past negative experiences. Social strategies and anxiety management skills were appreciated for their structured format and educational elements, but generalizability was sometimes raised as a limitation. Participants also recommended additional adaptations, including flexibility in content delivery and modifications to the physical environment. Findings highlight overall support of cognitive-therapy components for reducing social anxiety in adults, but also benefit to tailoring CBT approaches to theneeds of autistic adults. Results from this study offer practical guidance from autistic people to enhance the acceptability and effectiveness of future CBT interventions.Lay abstractMany autistic adults experience social anxiety, making everyday interactions feel stressful or overwhelming. To help with this, clinical researchers developed a group therapy programme based on cognitive-behaviour therapy adapted for autistic adults. While cognitive-behaviour therapy is commonly used to treat anxiety, there has been relatively little research into how autistic people experience group-based versions of this therapy. This study aimed to understand how participants felt about the programme and how it could be improved. The intervention included eight group sessions where participants learned about social anxiety and autism, social strategies and took part in guided activities to build confidence. The programme encouraged a supportive environment where autistic individuals could safely try out new ways of connecting with others without feeling pressure to hide who they are. To understand how helpful the programme was, researchers interviewed participants about their experiences. Many said the programme helped them feel more confident and less anxious in social situations. For example, they found role-playing in a safe group setting especially useful. Participants also appreciated that the therapy was adapted to suit their needs. However, the study also highlighted some areas for improvement. Some participants found parts of the programme challenging, especially unstructured activities or settings. Others suggested the programme could be more flexible, offer clearer instructions or be better prepared for people who had past negative experiences with therapy. These early findings suggest that cognitive-behaviour therapy can be effective when thoughtfully adapted for autistic adults. This work helps lay the foundation for more inclusive, autism-informed mental health services that support social confidence in a way that feels safe and empowering.

Trajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy for social anxiety disorder

The relationship between social media use and mental health remains under scrutiny by researchers, policy makers, and the general public. Recently, researchers have addressed whether Facebook use is beneficial to people with high social anxiety. The findings from such studies are mixed, partly due to differences in how variables are operationalised. A study by McCord et al (McCord, B., Rodebaugh, T. L., &amp; Levinson, C. A., 2014. Facebook: Social uses and anxiety. Computers in Human Behavior, 34, 23-27) suggested that the inclusion of a new variable, Facebook-centric social anxiety, helps explain the complex relationship between general social anxiety and frequency of usage of socially-interactive Facebook features. We undertook two studies (N=202 and N=542; majority British and non-student participants) with the aim of replicating McCord et al (2014), using the original measures (general social anxiety, Facebook-centric social anxiety, and frequency of usage of socially-interactive Facebook features). Replicating the original study, we found a significant positive association between general social anxiety and Facebook-centric social anxiety. However, unlike the original study, we did not find evidence that general social anxiety and Facebook-centric social anxiety interacted to predict frequency of usage of socially-interactive Facebook features. We discuss the implications for future research on social Facebook use.

In recent years an increased comorbidity of schizophrenic disorders with anxiety disorders has been reported. Thus, among patients with a disorder from the schizophrenia spectrum, a general anxiety disorder was found in 38.3 % of patients, with 14.9 % of these with social phobia (SP). Especially social anxiety (SA) is of particular importance because it is often associated with depression and can contribute to psychosocial disabilities in patients with psychosis.Anxiety disorders already seem to occur prior to the first psychotic manifestation in the clinical high-risk state (CHR). Therefore, the questions arise as to whether this comorbidity is also dominated by SP in this patient group and, if so, what its consequences are on early detection and prevention of psychotic disorders. To clarify these questions, the present paper provides a systematic review of all published studies on social anxiety (SA) in the CHR.A total of 124 studies were included comprising 1702 CHR individuals, 445 healthy controls, 67 relatives / siblings of patients with psychotic disorders and 95 patients with a psychosis. In the most meaningful study, anxiety disorders were generally highly significant in CHR individuals (51 %) compared to control subjects from the normal population (4 %). Among those with anxiety disorders, 14.4 % suffered from SP compared to 0.36 % in normal controls and thus SP was almost as frequent as the prevalence of this type of anxiety disorders in the schizophrenic spectrum (14.9 %). Also, the degree of SA in CHR individuals (SIAS score = 34.4, SD = 6.11) (SIAS-Score = 22.1, SD = 8.7), measured with the Social Interaction and Anxiety Scale (SIAS) in 9 studies, was almost as high as in psychotic patients (SIAS score = 35.0, SD = 9.56) and healthy controls (SIAS score = 14.,6; SD = 7,28). This degree of SA was also related to the attenuated psychotic symptomatology of the CHR individuals. However, the only study investigating the relationship between SA and a possible transition to a first psychotic manifestation did not reveal any predictive power. The feared psychosocial loss of function, which is already present in CHR, seems to be connected not only to the strong SA, but also to the similarly frequent comorbid depressive disorders.Moreover, one study has already provided some evidence that it is promising to address the SA as well as functional impairments in the CHR through newly developed specialized cognitive behavioural therapies.

Social Anxiety in Patients With Parkinson's Disease

Objective To analyze the internet-based cognitive behavior therapy (ICBT) intervent medical university students' social anxiety, and provide experiences and theoretical basis for future social anxiety interventions. Methods 45 medical students of social anxiety were voluntarily divided into the one-to-one intervention group, one-to-five intervention group and control group. The control group did not intervene, one-to-one intervention group and one-to-five intervention group were interfered single person or team by cognitive behavioral therapy, respectively. The level and symptom of social anxiety of the 3 groups were assessed before and after the intervention by social phobia inventory(SPIN) and Social anxiety symptoms interview inventory. Results After the intervention, the scores of SPIN and the 3 subscales within it (fear, avoidance and physiological) of one-to-one ICBT group and one-to-five ICBT group were lower than those of the control group (SPIN scores: one-to-one ICBT group 15.60±7.87, one-to-five ICBT group 14.87±8.83, control group 20.20±11.46). Variance analysis showed that, in addition to physiological subscale(F=0.641, P>0.05), the scores of SPIN, fear and avoidance subscales had significant differences among the 3 groups (F=3.764, P=0.018; F=3.606, P=0.021; F=5.444, P=0.005). In the analysis of participants' social anxiety symptoms, after treatment, in one-to-one ICBT group, there was 1 participant changed into subthreshold social anxiety and 1 participant into normal in the 2 threshold social anxiety participants. All the 3 subthreshold social anxiety participants changed into normal. In one-to-five ICBT group, there was 1 threshold social anxiety participant lapsed to subthreshold social anxiety, 1 subthreshold social anxiety participants still remained in subthreshold social anxiety, 2 symptomatic social anxiety participants changed into normal. But there were no significant changes in control group. Conclusions All the two methods of intervention have a certain effect.The effect of one-to-one intervention therapy is most significant. Key words: Medical students; Social anxiety; Internet-based cognitive behavior therapy

ABSTRACTCamouflaging has been defined as the masking or compensation of autistic traits during social interactions, often as a response to the stigma associated with autism and social expectations. Social anxiety has been closely linked to camouflaging, as autistic individuals may adopt camouflaging strategies to navigate social expectations and to reduce the risk of being negatively evaluated. Understanding the relationship between social anxiety and camouflaging in autism is essential for developing effective clinical interventions. This study investigated the effects of a modified Cognitive Behavioral Therapy (CBT) group intervention, the Engage Program, on camouflaging and social anxiety. Specifically, the objective was to determine whether the CBT program would reduce social anxiety symptoms and if this reduction would also be associated with improvements in camouflaging behaviours. Seventy‐one autistic adults participated in an 8‐week modified CBT group intervention for social anxiety. Camouflaging behaviors were assessed using the CAT‐Q scale, and social anxiety levels were measured using three established and validated self‐report measures. Pre‐ and post‐intervention scores were analyzed to determine change following treatment, and correlations between social anxiety and camouflaging measures were explored. As expected, the CBT intervention program significantly reduced social anxiety symptoms across all measures, showing moderate effect sizes from pre‐ to post‐treatment. However, no significant changes in camouflaging behaviors were observed from pre‐ to post‐treatment. Despite this, reductions in social anxiety symptoms were correlated with decreases in camouflaging behaviours, particularly for the compensation and assimilation subscales. Autistic participants who showed the most benefit from therapy on social anxiety measures also showed the greatest reduction in their camouflaging scores from pre‐ to post‐treatment. These findings suggest that improvements in social anxiety symptoms from CBT are also associated with reductions in camouflaging. Importantly, CBT did not lead to an increase in camouflaging behaviors in autistic adults. This study supports the overall benefits of CBT for autistic adults and suggests a need for more randomized controlled studies.