Oxytocin and Vasopressin Levels and Related Factors in Adolescents with Social Phobia and Other Anxiety Disorders

Social anxiety disorder (SAD) is believed to be characterized by aberrant patterns of electrocortical activity during resting state and during performing social task, particularly increased slow waves activity and decreased high wave activity. The main objective of this work is to confirm whether individuals with SAD contribute to the finding of spectral power between theta and beta ratio (THBR) activity. The second objective is to compare the individual differences between resting-state brain oscillations and recovery from social performing task for SAD and healthy control (HC) groups. From 10 healthy participants (5 SAD and 5 HC), resting-state EEG during (eyes open, eyes closed) and during recovery from social performing task (self-presentation) was recorded. Social Interaction Anxiety Scale (SIAS) for SAD was administered to determine the severity level of social anxiety in all participants. As a result, findings reported here suggests that increased THBR and FMT may reflect a reduced frontal cortical activity over subcortical oscillations. In accordance with several findings, THBR was found to correlate negatively with the self-reported score of SIAS in SAD group but correlate positively with HC group. As we hypothesized, SAD individuals showed less FMT comparing to the HC group which indicates that FMT is a neurophysiological correlate on anxiety state more than anxiety trait. These results are steady with previous studies and support the concept that slow wave/ fast wave and FMT may provide a useful tool in the study of affect and the neural mechanism of emotion regulation. Together, our findings interpreted to suggest that THBR and FMT are possible neurobiological markers for SAD and can differentiate between state and trait SAD during resting state and social stressors.

Repetitive negative thinking is conceptualized to be a transdiagnostic process linked to the development and maintenance of psychopathology. Prior research distinguishes between disorder-specific exemplars (worry, rumination) and transdiagnostic measures of repetitive negative thinking with differences across disorders reported. However, establishing the measurement invariance of these measures is necessary to support meaningful comparisons across clinical groups. Bayesian structural equation modelling was used to assess the approximate invariance of the Ruminative Response Scale, Penn State Worry Questionnaire, and the Repetitive Thinking Questionnaire across individuals with a principal diagnosis of either depressive disorder, social anxiety disorder, or generalized anxiety disorder. All scales demonstrated approximate measurement invariance across the three disorder groups. The depressive disorder group reported a higher level of rumination than the generalized anxiety disorder group (Δµ = 0.25, 95% Credibility Interval [0.06, 0.45]), with no difference between the generalized anxiety disorder and social anxiety disorder groups. The depressive disorder and generalized anxiety disorder groups did not differ in their levels of trait repetitive negative thinking, but the social anxiety disorder group was markedly lower than the generalized anxiety disorder group (Δµ = -0.21 [-0.37, -0.05]). Similarly, levels of worry did not differ between the generalized anxiety disorder and depressive disorder group but were lower in the social anxiety disorder group than the generalized anxiety disorder group (Δµ = -0.23 [-0.41, -0.06]). The Ruminative Response Scale, Penn State Worry Questionnaire, and Repetitive Thinking Questionnaire are measuring trait repetitive negative thinking in a consistent manner across individuals with a principal diagnosis of depressive disorder, social anxiety disorder, or generalized anxiety disorder. This supports their use in transdiagnostic contexts and indicates that it is appropriate to directly compare the scores on these measures between diagnostic groups.

The aim of this study was to compare cognitive flexibility and executive functions in adolescents diagnosed with social anxiety disorder (SAD) who have autistic traits with those who do not, and to investigate whether there is a significant difference compared to healthy controls. The study included 36 adolescents diagnosed with SAD and 36 healthy controls. All participants completed the Cognitive Flexibility Scale (CFS), and the Liebowitz Social Anxiety Scale was administered to the SAD group. Neuropsychological tests including the Stroop Test TBAG Form, the Wisconsin Card Sorting Test (WCST), Raven’s Standard Progressive Matrices Test, and Visual-Auditory Digit Span Test-B were applied. Autistic traits were assessed using the Autism Spectrum Quotient-Adolescent’s Version (AQ-Adolescent) and the Childhood Autism Rating Scale. There was no statistically significant difference in CFS scores between the social anxiety disorder and control groups. The SAD group showed poorer performance in the subdomains of the WCST. Additionally, in all subtestes of the Stroop test, the SAD group took significantly longer to complete the test. The AQ-Adolescent scores were significantly higher in the SAD group compared to the controls. In 25% (n=9) of the cases, autistic traits were above the cutoff. There were no significant difference in neuropsychological test results between the groups who have and do not have autistic traits within the case group. A weak negative correlation was found between the Liebowitz total and avoidance subscale scores and the AQ-imagination and attention to detail scores, while no correlation was found between the Liebowitz dimensions and CFS scores. This is the among the first studies to examine autistic traits and executive functions among adolescents with SAD. While no difference was found in cognitive flexibility scale scores between the SAD and control groups, the SAD group showed poorer performance in tests measuring other executive functions. However, this difference was not significantly influenced by the presence of autistic traits.

On the context dependency of implicit self-esteem in social anxiety disorder

Studies have shown that elevated empathic abilities and impaired theory of mind (ToM) tasks may be associated with social anxiety disorder (SAD). Adolescence is a critical period for the onset of SAD which may cause impairment in various domains of functioning. We aimed to investigate the association of ToM and empathy characteristics in adolescents diagnosed as having SAD. Forty-one drug-naive adolescents (between 12 and 18 years), who were diagnosed as having SAD without comorbidities were enrolled in the patient group. Forty adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The sample was evaluated via the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The severity of the SAD symptoms was evaluated using the Social Anxiety Scale for Adolescents. ToM was evaluated with the Reading the Mind in the Eyes Test and emotion recognition was assessed by Faces Test. The KA-SI Empathic Tendency Scale was used to assess empathic abilities. The average age was 14.36 ± 1.41 years in the SAD group and 14.30 ± 1.04 years in the control group. Twenty-eight adolescents were female in the SAD and control groups. SAD and healthy controls did not differ in terms of sociodemographic data. There were higher scores in the KA-SI cognitive and affective empathic subscales (p < .001 in all scales) in the SAD group compared with the healthy controls. Adolescents with SAD have more difficulties both in Reading the Mind in the Eyes Test and Faces Test. The results of this study may indicate that although adolescents with SAD may be impaired in decoding aspects of ToM they may evaluate themselves as more empathic in self-report tests. The discrepancy between objective tests of ToM decoding and subjective reports of empathy may play an important role in the etiology and treatment of SAD in adolescents.

Autism spectrum disorders (ASDs) and social anxiety disorder (SAD) are both characterized by social dysfunction, but no study to date has compared neural responses to social rewards in ASDs and SAD. Neural responses during social and non-social reward anticipation and outcomes were examined in individuals with ASD (n = 16), SAD (n = 15) and a control group (n = 19) via functional magnetic resonance imaging. Analyses modeling all three groups revealed increased nucleus accumbens (NAc) activation in SAD relative to ASD during monetary reward anticipation, whereas both the SAD and ASD group demonstrated decreased bilateral NAc activation relative to the control group during social reward anticipation. During reward outcomes, the SAD group did not differ significantly from the other two groups in ventromedial prefrontal cortex activation to either reward type. Analyses comparing only the ASD and SAD groups revealed greater bilateral amygdala activation to social rewards in SAD relative to ASD during both anticipation and outcome phases, and the magnitude of left amygdala hyperactivation in the SAD group during social reward anticipation was significantly correlated with the severity of trait anxiety symptoms. Results suggest reward network dysfunction to both monetary and social rewards in SAD and ASD during reward anticipation and outcomes, but that NAc hypoactivation during monetary reward anticipation differentiates ASD from SAD.

Objective: This study was to determine the relation between alexithymia and suicidal ideation and factors associ-ated with suicidal ideation in patients with social anxiety disorder (SAD). Also we determined whether alexithymia is predictor of suicidal ideation related with SAD. Methods: One hundred and sixty-four SAD (n=57), panic disorder (PD) (n=58), healthy controls (HC) (n=49) subjects (according to DSM-5) were included to study. Alexithymia was measured by Toronto Alexithymia Scale-20(TAS-20), suicidal ideation was measured by Suicidal Ideation Scale (SIS), social anxiety level were evaluated with Liebowitz Social Anxiety Scale and anxiety and depression level evaluated with Beck Depression Inventory and Beck Anxiety Inventory, State and Trait Anxiety Scales. Results: Alexithymia, the rate of was found to be 38.6% in SAD patients and 29.3% in PD patients. In SAD group, significant correlation was found between TAS 20, its factors and SIS. With path analysis, it was found that TAS 20 total scores predicted SIS scores only indirectly and via their effects on trait anxiety and subjective depressive symptoms. Conclusion: In alexithymic SAD patient’s suicidal ideation may occur when comorbid depression is present. Based upon the findings alexithymia may not be a good predictor of suicidal ideation for preventing suicidal attempts in patients with social anxiety disorder

Gray matter abnormalities in patients with social anxiety disorder: A voxel-based morphometry study

Objective To analyze the components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorder. Methods DSM-V was used for clinical diagnosis after the initial screening with Interaction Anxiousness Scale. The subjects meet the inclusion criteria were divided into social anxiety disorder group (SAD group) and healthy control group (HC group). Koster's improved dot-probe paradigm was used in a 2 (group: SAD group, HC group)×2 (emotion categories: anger, disgust) mixed-design experiment, and the different characteristics of attentional bias between the two groups on different emotional faces were compared. Results In SAD group, under the condition of angry faces, the response times to the probe targets with the same or different positions from the negative faces were (369.7±53.0)ms and (447.2±54.3)ms, while the response times were (429.6±70.2)ms and (444.2±55.8)ms under the condition of disgust faces, and the SAD group showed attentional bias towards both anger and disgust faces (t=24.15 and 2.45, P<0.05). Under the condition of anger faces, the response time of HC group to the consistent and inconsistent position of probe target were (466.9±40.0)ms and (483.8±43.8) ms, and the HC group had an attentional bias towards anger faces(t=6.58, P<0.05). The response time under disgust faces was (493.8±43.6)ms and (498.0±46.7)ms in HC group, and did not show an attentional bias towards disgust(t=1.65, P=0.108). The scores of attentional orientation to anger faces in SAD group were significantly higher than those in the HC group(F=19.26, P<0.001), but there was no significant difference between the two groups towards disgust faces(F=0.02, P=0.897). Compared with disgust faces, the attentional orientation to anger faces was faster in both HC and SAD groups (F=101.66 and 8.00, P<0.05). Compared with the HC group, the SAD group had an impaired attentional disengagement from anger faces(F=8.66, P=0.004). Conclusion The students with social anxiety disorder have attentional bias towards both anger and disgust facial expressions, which manifested as facilitated attentional orientation and impaired attentional disengagement to anger faces. Key words: Social anxiety disorder; College students; Attentional bias; Facilitated attentional orientation; Impaired attentional disengagement

The social anxiety spectrum

Childhood trauma and current psychological functioning in adults with social anxiety disorder

Gray Matter Abnormalities in Social Anxiety Disorder: Primary, Replication, and Specificity Studies

Objective: In this study, we aimed to evaluate the properties of temperament and character in patients with social anxiety disorder(SAD) compared to healthy controls, who have similiar socio-demographic characteristics. The secondary aim of study is to investigate the relationship between temperament and character in patients with social anxiety disorder with the presence of comorbid depression and disease severity. Method: This study was conducted at the Outpatient Clinic in the Department of Psychiatry of Sisli Etfal Educating and Researching Hospital. 64 patients with social anxiety disorder whose diagnoses were made by DSM-IV and 64 healthy controls were included in this study. Control group were matched to SAD group according to age, gender and educational status. Cloninger Temperament and Character Inventory, Hamilton Depression Scale and Liebowitz Social Anxiety Scale were administered to the participants. SCID-I/CV (Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version) was used to evaluate the psychopathology in patients and control groups. Results: With or without comorbid depression, in SAD group HA(harm avoidance) scores were significantly higher compared to healthy controls and this difference was more pronounced in SAD group with comorbid depression. In addition, P(persistence) score was significantly lower in SAD group with comorbid depression compared to healthy controls while RD (reward dependence) score was significantly lower in SAD group without comorbid depression compared to healthy controls. In terms of character traits, SD(self directedness) and C(cooperativeness) scores were significantly lower in both SAD with or without comorbid depression groups compared to healthy controls. SD (self-directedness) score was significantly lower in generalized SAD group compared to non-generalized SAD group where as HA score was significantly higher in generalized SAD group compared to non-generalized SAD group. It seems that there is a linear relationship between the severity of illness and HA(harm avoidance) scores. Discussion: One of the most important findings of this study is that, HA is not only associated with depression, HA significantly rise in SAD patients without depression. Regardless of other temperament parameters HA has a significant effect on the severity of the SAD, and this supports the hypothesis that the serotonergic system plays a significant role on SAD.

Research suggests that those experiencing Social Anxiety (SA) symptoms are more likely to engage in repetitive thought (RT), including upward counterfactual thinking (U-CFT). Findings indicate that these cognitive patterns may lead to deleterious thoughts and emotions, particularly when U-CFT focuses on non-repeatable, uncontrollable situations and negative self-appraisals. The present dissertation consisted of two complementary studies. Study 1 attempted to 1) validate new measures of state and trait U-CFT, 2) examine the relationship between U-CFT and established measures of RT and mood, and 3) explore the relationship between SA symptoms and counterfactual thinking within a student population. Results indicated that the U-CFT-S (trait measure of U-CFT) and the Counterfactual Likelihood scales (state measure of U-CFT) evidenced sound psychometrics in terms of internal consistency, factor structure, and relationships with related questionnaires. Factor analyses revealed that the Maladaptive U-CFT-S scale clustered with negative mood, rumination, and learned helplessness, while the Adaptive U-CFT subscale clustered with measures of positive mood and self-efficacy. Finally, symptoms of SA correlated positively with state and trait U-CFT generation. Study 2 1) compared patterns of U-CFT and emotions such as guilt and self-blame between a diagnosed Social Anxiety Disorder (SAD) group and a Healthy Control (HC) group 2) determined if disorder-specific content impacts U-CFT generation, and 3) piloted a brief, CBT-based, video intervention targeting maladaptive U-CFT. Results indicated that the SAD group evidenced higher amounts of U-CFT in response to the socially-based scenarios than the HC group and in response to social than non-social scenarios. The SAD group evidenced higher levels of unhelpful emotions (e.g., guilt) both pre- and post-CFT generation than HC participants. Finally, the CBT intervention was generally unsuccessful at reducing maladaptive U-CFT, but was more likely to be effective among SAD than HC participants. Implications of this dissertation include: 1) the benefit of including state- and trait-based measures of U-CFT in future research, 2) the importance of conceptualizing U-CFT as a multifaceted construct, 3) addressing that those with SAD are engaging in maladaptive U-CFT and experiencing consequent guilt and self-blame, and 4) the direction of creating more comprehensive, brief interventions aimed at targeting maladaptive U-CFT.

Research suggests that those experiencing Social Anxiety (SA) symptoms are more likely to engage in repetitive thought (RT), including upward counterfactual thinking (U-CFT). Findings indicate that these cognitive patterns may lead to deleterious thoughts and emotions, particularly when U-CFT focuses on non-repeatable, uncontrollable situations and negative self-appraisals. The present dissertation consisted of two complementary studies. Study 1 attempted to 1) validate new measures of state and trait U-CFT, 2) examine the relationship between U-CFT and established measures of RT and mood, and 3) explore the relationship between SA symptoms and counterfactual thinking within a student population. Results indicated that the U-CFT-S (trait measure of U-CFT) and the Counterfactual Likelihood scales (state measure of U-CFT) evidenced sound psychometrics in terms of internal consistency, factor structure, and relationships with related questionnaires. Factor analyses revealed that the Maladaptive U-CFT-S scale clustered with negative mood, rumination, and learned helplessness, while the Adaptive U-CFT subscale clustered with measures of positive mood and self-efficacy. Finally, symptoms of SA correlated positively with state and trait U-CFT generation. Study 2 1) compared patterns of U-CFT and emotions such as guilt and self-blame between a diagnosed Social Anxiety Disorder (SAD) group and a Healthy Control (HC) group 2) determined if disorder-specific content impacts U-CFT generation, and 3) piloted a brief, CBT-based, video intervention targeting maladaptive U-CFT. Results indicated that the SAD group evidenced higher amounts of U-CFT in response to the socially-based scenarios than the HC group and in response to social than non-social scenarios. The SAD group evidenced higher levels of unhelpful emotions (e.g., guilt) both pre- and post-CFT generation than HC participants. Finally, the CBT intervention was generally unsuccessful at reducing maladaptive U-CFT, but was more likely to be effective among SAD than HC participants. Implications of this dissertation include: 1) the benefit of including state- and trait-based measures of U-CFT in future research, 2) the importance of conceptualizing U-CFT as a multifaceted construct, 3) addressing that those with SAD are engaging in maladaptive U-CFT and experiencing consequent guilt and self-blame, and 4) the direction of creating more comprehensive, brief interventions aimed at targeting maladaptive U-CFT.