The Impact of Cognitive Restructuring on Post-Event Rumination and Its Situational Effect on Socially Anxious Adolescents

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

Alcohol use disorder and social anxiety disorder are interconnected disorders that commonly co-occur. We report the first trial to assess whether integrated treatment for social anxiety and alcohol use disorder comorbidity improves outcomes relative to standard alcohol-focussed treatment. Participants were recruited to a randomised controlled trial, and randomly allocated to one of two treatments, Integrated (n = 61) or Control (alcohol-focussed; n = 56). Assessment and treatment session were conducted at two sites in Sydney, Australia. Inclusion criteria were as follows: (1) clinical diagnosis of social anxiety disorder and (2) Diagnosis or sub-clinical symptoms of alcohol use disorder. Diagnoses were determined according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). All participants (n = 117) received 10 sessions of cognitive behavioural treatment and motivational enhancement. The Integrated treatment simultaneously targeted social anxiety disorder, alcohol use disorder and the connections between these disorders. The Control treatment focussed on alcohol use disorder only. Outcomes were assessed at 6-month follow-up, with interim assessments at post-treatment and 3 months. Primary outcomes were social anxiety disorder severity (composite Social Phobia Scale and Social Interaction Anxiety Scale), alcohol use disorder severity (standard drinks per day and Severity of Alcohol Dependence Questionnaire) and quality of life (Short-Form Health survey) was assessed to capture the combined impairment of social anxiety and alcohol use disorder comorbidity. At 6-month follow-up, both conditions showed significant reductions in social anxiety and alcohol use disorder symptoms, and improved quality of life. There was no evidence of between-condition differences for alcohol outcomes, with mean consumption reduced by 5.0 (0.8) and 5.8 (1.0) drinks per day following Alcohol and Integrated treatments, respectively. Integrated treatment achieved greater improvements in social anxiety symptoms (mean difference = -14.9, 95% confidence interval = [-28.1, -1.6], d = 0.60) and quality of life (mean difference = 7.6, 95% confidence interval = [1.2, 14.0], d = 0.80) relative to alcohol-focused treatment. These results suggest that integrated social anxiety and alcohol use disorder treatment enhances quality of life and social anxiety disorder symptom improvement, but not alcohol outcomes, compared to treatment focussed on alcohol use disorder alone.

This study reports a one-year prospective investigation of the relations between overt and relational victimization and social anxiety and phobia in a sample of adolescents. The Social Experience Questionnaire-Self Report Form (SEQ-S), Social Anxiety Scale for Adolescents (SAS-A), and Social Phobia and Anxiety Inventory for Children (SPAI-C) were administered to 144 ninth grade adolescents. A follow-up assessment with the SEQ-S, SAS-A, and SPAI-C was conducted one year later. Results indicated that relational victimization predicted symptoms of social phobia but not general social anxiety and avoidance one year later. Overt victimization was not a significant predictor of social anxiety and phobia one year later. Social anxiety and phobia did not predict peer victimization one year later. However, increases in social anxiety and social phobia symptoms (for boys) over time were positively associated with increases in relational victimization over time. Implications of these findings for peer victimization and social anxiety in the development of social phobia and negative peer experiences are discussed.

Social anxiety disorder (SAD) is a prevalent condition among adolescents, characterized by an intense and persistent fear of social situations or performance, which results in significant distress and impairment in daily activities. Adolescents with SAD often avoid social interactions, which can negatively affect their academic, social and emotional development. Cognitive-behavioral therapy (CBT) has been widely recognized as an effective approach to treating SAD, offering practical strategies to reduce anxiety symptoms and improve social functioning. This abstract will explore the effectiveness of CBT in adolescents with social anxiety disorder, highlighting the main techniques used and the clinical outcomes observed. The aim of this paper is to review and evaluate the effectiveness of cognitive-behavioral therapy in the treatment of adolescents with social anxiety disorder. The aim is to analyze the main techniques of CBT, the mechanisms by which it promotes anxiety reduction and the results of clinical studies that show its effectiveness. In addition, the challenges and specific considerations in applying CBT to this age group will be discussed. This literature review aims to analyze the effectiveness of Cognitive-Behavioral Therapy (CBT) in the treatment of social anxiety in adolescents. To this end, references from relevant studies and meta-analyses were selected and reviewed, covering various approaches and results related to the topic. The selection of references was based on the relevance and impact of the publications in the field of psychotherapy and social anxiety. CBT is a form of psychotherapy based on identifying and modifying dysfunctional patterns of thought and behavior. In the context of SAD in adolescents, CBT aims to help patients recognize and restructure irrational beliefs about themselves and social situations, develop appropriate social skills and reduce avoidance of social interactions. With this in mind, the main CBT techniques include cognitive restructuring, gradual exposure and social skills training. Cognitive restructuring involves helping adolescents to identify negative automatic thoughts and replace them with more realistic and balanced interpretations. Gradual exposure consists of exposing adolescents, in a controlled and progressive way, to feared social situations, allowing them to face their fears and reduce the associated anxiety response. Social skills training focuses on developing social competencies, such as initiating and maintaining conversations, asking and answering questions, and dealing with criticism and rejection in an assertive manner. Clinical studies have demonstrated the effectiveness of CBT in reducing SAD symptoms in adolescents. Research indicates that adolescents who receive CBT show a significant decrease in levels of social anxiety, improved quality of life and greater participation in social and school activities. For example, a study conducted by Masia Warner et al. (2005) showed that adolescents who participated in a group CBT program had a notable reduction in social anxiety symptoms compared to a control group. Another study by Beidel, Turner and Morris (2000) showed that individual CBT resulted in substantial improvements in adolescents’ social anxiety and social functioning. Despite the promising results, the application of CBT to adolescents with SAD presents specific challenges. Adherence to treatment can be hampered by adolescents’ resistance to engaging in therapy sessions and facing feared social situations. In addition, parental involvement and coordination with schools are important components for successful treatment, as social and environmental support is crucial for the generalization of therapeutic gains. Therefore, cognitive-behavioral therapy has proven to be an effective approach for treating adolescents with social anxiety disorder. Cognitive restructuring techniques, gradual exposure and social skills training are key to helping adolescents overcome their fears and improve their social functioning. Clinical studies provide robust evidence that CBT can significantly reduce SAD symptoms and improve quality of life for adolescents. However, it is essential to consider the challenges specific to this age group, including resistance to treatment and the need for support from parents and schools. With a careful and collaborative approach, CBT can provide lasting benefits for adolescents with social anxiety disorder, promoting their emotional and social well-being.

Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.

Emotionality and Emotion Regulation as Risk Markers for Social Anxiety: Considering Development, Multiple Dimensions, and Social Threat

Cognitive models of social anxiety disorder have conveyed the implication that self-focused attention (SFA) and post-event rumination (PER) are significant predictors in maintaining the symptoms of social anxiety (SA); however, their relationships have been scarcely studied in adolescents, including Chinese samples. The primary purpose of the current study was to examine the role of PER as a potential mediator between SFA and SA among Chinese adolescents; moreover, the moderation effect of gender was investigated. A total of 2,755 Chinese adolescents ranging in age from 11 to 19 years old with an average age of 14.18 were recruited from six urban public schools. Participants were asked to complete questionnaires measuring SFA, PER, SA, and depression. Structural equation modeling results showed that PER displayed as a plausible mediator in the relationship between SFA and SA, even after controlling for depression. In addition, gender was revealed to be a significant moderator, with a stronger relationship between PER and SA for girls than for boys. The current study provided evidence for Clark and Wells’ proposition about the associations among SFA, PER, and SA, contributing to the field of adolescents’ mental health and supporting the cultural applicability of the model.

The ability to interpret facial expressions accurately is important to adaptive social functioning. Social anxiety disorder is associated with a biased interpretation of facial emotions. This study aimed to demonstrate the effects of feedback training on modifying interpretation bias in individuals with high social anxiety. A total of 451 university students were screened, and 69 participants with high social anxiety were randomly assigned to either a training (n = 37) or a control (n = 32) group. Participants completed pre-questionnaires on social anxiety and depression symptoms, then performed a single session of experiment, followed by post-questionnaires on social anxiety symptoms. In the experiment, participants viewed an ambiguous facial expression and rated the intensity on a continuous scale. The training group received feedback that presented their ratings alongside the actual intensity, allowing them to accurately assess their emotional perception bias through trial-by-trial feedback. The control group received no feedback. The training group showed a significant reduction in interpretation bias for happy and angry faces after the experiment, while the control group did not. However, although the training group's social anxiety symptoms decreased post-experiment, the difference was not statistically significant compared to the control group. These findings provide preliminary evidence that the feedback training targeting dimensional ratings of emotions may be a promising option for correcting interpretation bias in individuals with high social anxiety. Future research could implement multiple sessions of training to potentially reduce both interpretation bias and social anxiety symptoms and verify the long-term effects.

Adults with autism spectrum disorder (ASD) are at elevated risk for social anxiety disorder (SAD). Limited information exists on the reliability of social anxiety instruments with these adults and their performance when compared to individuals with SAD without ASD. This study examines psychometric properties of self-report social anxiety instruments in autistic adults without intellectual disability, compared to adults with SAD. Additionally, we compared instrument scores between a subgroup of autistic adults with a dual diagnosis of SAD (ASD + SAD) and adults with SAD only. Adults diagnosed with SAD (N=316) or ASD (N=102) were recruited from the Brain and Mind Centre in New South Wales, Australia. Sixty autistic participants also received a diagnosis of SAD (ASD + SAD). Participants completed the Liebowitz Social Anxiety Scale-self-report, the Social Interaction Anxiety Scale, the Social Phobia Scale, and the Brief Fear of Negative Evaluation Scale. All instruments showed excellent internal consistency in autistic adults. The instruments showed evidence of convergent validity, and the strength of relationships between measures were equivalent between ASD and SAD groups. For all instruments, performance of these instruments in autistic adults with a SAD diagnosis was very similar to performance in adults diagnosed with SAD but without ASD. Findings support the use of these instruments for identifying social anxiety symptoms in autistic adults without intellectual disability and have utility for mental health clinical services. LAY SUMMARY: Autistic adults often experience social anxiety. We examined the use of four social anxiety questionnaires in autistic adults, compared to adults with SAD. We found similar results between autistic adults and adults with SAD, suggesting that these questionnaires can be useful for measuring social anxiety symptoms in autistic adults. These findings have implications for clinical services, as they show that these instruments are reliable when used with autistic adults.

ABSTRACTBackground: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.Design: Cross-sectional, quantitative surveys.Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.Results: In Study 1 (N = 447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N = 325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.

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

Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035.

Asthma and Social Anxiety in Adolescents

BackgroundUnderstanding the role of self-imagery in the development of social anxiety in adolescence holds promise for improving intervention. Cross-sectional studies indicate that imagery characteristics are associated with social anxiety symptoms, however, prospective studies are lacking. The current study examined concurrent and prospective associations between two image characteristics, namely observer-perspective and vividness, with social anxiety symptoms in a community adolescent sample (N = 616; 53% girls; aged 11–15 years). In addition, we examined common themes in the negative social anxiety-related images.MethodsNegative self-imagery and social anxiety symptoms were assessed using questionnaires at baseline and at 4–6-month follow-up. A series of multiple linear regression analyses were performed to see if each image characteristic predicts concurrent and prospective social anxiety symptoms. Topic modelling was performed to infer key topics from verbal data.ResultsObserver-perspective and vividness significantly predicted concurrent social anxiety symptoms beyond the influence of age and gender. Observer-perspective significantly predicted prospective levels of social anxiety symptoms beyond the influence of age, gender, and baseline social anxiety and depression symptoms. Negative self-images clustered into two themes: the fear of appearing anxious and the fear of being judged or viewed as unacceptable.ConclusionsSpecific characteristics and contents of negative self-images may be particularly relevant to the development of adolescent social anxiety.

BackgroundRecognition of symptoms of Social anxiety (SA) may be difficult among individuals with Autism Spectrum Disorders (ASD) because of overlap between social anxiety and autistic symptomatology. The main aim of our study was thus to explore the association between symptoms of social anxiety and clinical characteristics of ASD in order to identify individuals experiencing concomitant ASD and social anxiety disorder. We also described the prevalence of SA in a sample of children and adolescents with ASD.Method79 children and adolescents with ASD (with and without intellectual disability) and 28-matched control participants were recruited in two French Expert Centers for ASD, coordinated by the Fundation FondaMental. Psychiatric comorbidities, anxiety disorders and depression were screened with standard tools (Liebowitz social anxiety scale, Hamilton Depression and Anxiety Rating Scale) and correlated to autistic features and social skills assessed with the social responsiveness scale 2 (SRS-2) and the repetitive behavior scale (RBS-R). We performed bivariate analysis between the social anxiety level and the scores measured with different clinical scales. We then adjusted the observed relationships with the alterations of SRS-2 and RBS-R scores.ResultsAfter adjustment, the level of social anxiety appeared as significantly associated with alterations in social reciprocity and particularly with the SRS-2 “social communication” and “social motivation” sub-scores, but not with RBS-R score.ConclusionsWe confirm previous reports showing that individuals with ASD are at high risk for specific anxiety disorders. In particular, high levels of impairments in social motivation and social communication (SRS-2) are indicative of comorbid disorders namely, social anxiety and ASD. Our findings clearly inform diagnostic assessment in ASD and stress the need to take comorbid anxiety disorders into consideration to improve treatment of ASD. To further clarify the impact of social anxiety on social competences and socio-adaptive handicap, longitudinal studies and cluster analysis will be needed in the future.