Changes In Social Anxiety Research Articles

I’m Not Feeling It: Momentary Experiential Avoidance and Social Anxiety Among Individuals With Social Anxiety Disorder

Previous studies have found that social anxiety and experiential avoidance (EA) are significantly associated, but the directionality of this relationship has not been firmly established. The present study examined momentary EA and social anxiety using repeated measurements during an opposite-sex interaction. Participants were 164 individuals (50% female): 42 were diagnosed with social anxiety disorder (SAD) and the remaining 122 were non-socially-anxious individuals (NSAs). Participants formed 42 experimental dyads including 1 individual with SAD and 1 NSA individual, and 40 control dyads including 2 NSA individuals. Lower-level mediational modeling indicated that for individuals with SAD, a reciprocal relationship was observed in which changes in both EA and social anxiety mediated changes in each other. However, changes in EA explained approximately 89% of changes in social anxiety whereas changes in social anxiety explained approximately 52% of changes in EA throughout the interaction. For NSA individuals, only social anxiety predicted EA. These findings point to a deleterious cycle driven mostly by EA among individuals with SAD, but not NSA individuals. Findings are discussed within the context of previous empirical findings as well as acceptance and commitment therapy (ACT) and cognitive-behavioral models of psychopathology.

Effectiveness of Video-Feedback with Cognitive Preparation in Improving Social Performance and Anxiety through Super Skills for Life Programme Implemented in a School Setting.

Effectiveness of video-feedback with cognitive preparation to treat anxiety problems (especially social anxiety) has been scarcely explored on children. Super Skills for Life (SSL) is a CBT-based intervention to reduce anxiety and comorbid problems that, apart from social skills training and behavioural activation, integrates video-feedback with cognitive preparation. This study aimed to evaluate SSL effects, implemented in a school setting, on social performance and to test self-concept and social skills as potential mediators of pre- and post-test changes in social anxiety and generalized anxiety. Sample comprised 57 children aged 8–11 years with emotional symptoms. Children were video recorded in the first and last session to assess social performance. Anxiety and self-concept measures were completed by children pre-test and post-test. Participants reduced anxiety behaviours and improved social and communication skills after treatment. In general, girls showed better social performance than boys, but SSL impact was greater in males. Social self-concept was the only mediator of change in pre- to post-treatment social anxiety. This study provides evidence of SSL to improve children’s social performance and reduce anxiety through video-feedback with cognitive preparation. Improving social concept seems essential to reduce social anxiety. An SSL programme is an ideal prevention protocol for anxious children.

Do sudden gains predict treatment outcome in social anxiety disorder? Findings from two randomized controlled trials

ObjectiveSudden gains (SGs) have been found to occur during randomized controlled trials (RCTs) for social anxiety disorder (SAD). Evidence is mixed whether SGs relate to treatment outcome in SAD. We examined SGs in two RCTs for SAD. MethodStudy 1 (N = 68) examined SGs in individual cognitive-behavioral therapy (CBT), and Study 2 (N = 100) compared SGs in group CBT and Mindfulness-Based Stress Reduction (MBSR). Weekly ratings of social anxiety were used to calculate SGs. The Liebowitz Social Anxiety Scale-Self-Report and the Social Interaction Anxiety Scale were completed at pretreatment, posttreatment, and follow-up to assess outcome. ResultsIn Study 1, 17.6% of participants experienced a SG. Participants with SGs started and ended treatment with lower social anxiety. SGs were not associated with greater decreases in social anxiety from pre-to posttreatment or 12-month follow-up. In Study 2, SGs occurred in 27% of participants and at comparable rates in MBSR and group CBT. SGs were not associated with changes in social anxiety during treatment in either condition. ConclusionSGs occurred during treatment for SAD. In both RCTs, participants improved regardless of experiencing a SG, suggesting that SGs are not predictive of greater improvement during treatment for SAD.

The Perception of Facial Emotional Change in Social Anxiety: An ERP Study.

Social anxiety is one of the psychological symptoms that most commonly occur in social interaction. Although previous behavioral studies have investigated the neutral-angry facial emotion change in social anxiety, none of the previous studies have, however, directly investigated the angry-neutral facial emotional change. Furthermore, less is known about the neural correlates of the facial emotion changes in individuals with social anxiety. The main goal of the present study was to explore the perception of facial emotional changes in individuals with social anxiety, using high temporal resolution event-related potential techniques. Behaviorally, accuracy in the angry-neutral facial emotional change trail was lower than that in the neutral-neutral case. Neurally, we found that the N170 amplitudes in angry-neutral facial emotional change trial were larger than those in the neutral-neutral case for high social anxiety (HAS) participants, probably reflecting that they might engage in more analytical processing of different facial elements. Interestingly, HSA participants showed smaller P200 left hemisphere amplitudes in the angry-neutral facial emotional change trial when compared with the neutral-neutral case, which suggested that they might have difficulties in processing emotions when they encounter these facial emotional changes. Finally, the late positive potential amplitudes in the neutral-angry and angry-neutral facial emotional change trials were smaller than those in the neutral-neutral case, regardless of the social anxiety. These results suggest that social anxiety influences the facial emotional changes mainly at an earlier stage of processing.

Longitudinal Changes in Victimized Youth's Social Anxiety and Solitary Behavior.

This investigation's aims were to assess normative trends in social anxiety and preference for solitude by gender from early childhood to late adolescence and examine the associations among the timing and duration of peer victimization and patterns of continuity or change in social anxiety and preference for solitude across this age period. A sample of 383 children (193 girls) was followed from kindergarten (Mage = 5.50) through grade 12 (Mage = 17.89), and measures of peer victimization, social anxiety, and preference for solitude were repeatedly administered across this epoch. Five victimization trajectory subtypes emerged, capturing individual differences in victimization frequency and continuity (i.e., high-chronic, moderate-emerging, early victims, low victims, and non-victims). Results supported the conclusion that chronic victimization, a key stressor in children's peer environments, plays a different role in the development of social anxiety and preference for solitude. Whereas chronic victimization was associated with the maintenance of social anxiety, it accompanied gains in preference for solitude. The findings provide a more complete account of the overall prevalence, stability, and developmental course of victimized youths' social anxiety and preference for solitude than has been reported to date.

Emotional clarity and attention to emotions in cognitive behavioral group therapy and mindfulness-based stress reduction for social anxiety disorder

We examined (1) differences between controls and patients with social anxiety disorder (SAD) in emotional clarity and attention to emotions; (2) changes in emotional clarity and attention to emotions associated with cognitive-behavioral group therapy (CBGT), mindfulness-based stress reduction (MBSR), or a waitlist (WL) condition; and (3) whether emotional clarity and attention to emotions moderated changes in social anxiety across treatment. Participants were healthy controls (n = 37) and patients with SAD (n = 108) who were assigned to CBGT, MBSR, or WL in a randomized controlled trial. At pretreatment, posttreatment, and 12-month follow-up, patients with SAD completed measures of social anxiety, emotional clarity, and attention to emotions. Controls completed measures at baseline only. At pretreatment, patients with SAD had lower levels of emotional clarity than controls. Emotional clarity increased significantly among patients receiving CBGT, and changes were maintained at 12-month follow-up. Emotional clarity at posttreatment did not differ between CBGT and MBSR or between MBSR and WL. Changes in emotional clarity predicted changes in social anxiety, but emotional clarity did not moderate treatment outcome. Analyses of attention to emotions were not significant. Implications for the role of emotional clarity in the treatment of SAD are discussed.

Modelling the Relationship Between Changes in Social Anxiety and Rumination Before and After Treatment

Pre- and post-event rumination have been proposed to be key processes involved in the maintenance of social anxiety disorder. While the importance of addressing rumination in treatment is becoming increasingly clear, factors that mediate the relationship between changes in social anxiety and changes in rumination have yet to be investigated. Individuals with social anxiety disorder (N = 82) completed measures that assessed key cognitive and attentional processes of social anxiety, including pre- and post-event rumination, before and after cognitive behavioural treatment. Following treatment there were significant reductions in pre- and post-event rumination in addition to other cognitive and attentional aspects of social anxiety. Mediation analyses revealed that changes in state anxiety and performance and threat appraisals mediated the relationship between changes in social anxiety and pre-event rumination, while only changes in threat appraisals mediated the relationship between changes in social anxiety and post-event rumination. It appears that key cognitive and attentional processes have differing importance when anticipating feared social situations and when reflecting on it afterwards. This suggests that treatment that aims to reduce the role of pre-event rumination needs to consider multiple factors, while threat appraisals particularly need to be addressed when addressing post-event rumination.

Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social anxiety disorder into clinical practice: results from a cluster-randomised controlled trial

BackgroundDespite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD.MethodsThe manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D).ResultsRemission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = −0.605 to d = −2.937. Benefits of mSTPP were limited to single outcomes.ConclusionsFindings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00000570, registered 03. March 2011.

Social Anxiety Scale for Adolescents (SAS-A) Short Form: Longitudinal Measurement Invariance in Two Community Samples of Youth.

In this study, we examined the longitudinal measurement invariance of a 12-item short version of the Social Anxiety Scale for Adolescents (SAS-A) in two 4-year longitudinal community samples ( Nsample 1 = 815, Mage T1 = 13.38 years; Nsample 2 = 551, Mage T1 = 14.82 years). Using confirmatory factor analyses, we found strict longitudinal measurement invariance for the three-factor structure of the SAS-A across adolescence, across samples, and across gender. Some developmental changes in social anxiety were found from early to mid-adolescence, as well as gender differences across adolescence. These findings suggest that the short version of the SAS-A is a developmentally appropriate instrument that can be used effectively to examine adolescent social anxiety development.

Cognitive bias modification of interpretation in children with social anxiety disorder

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.

A Replication and Extension of the PEERS® for Young Adults Social Skills Intervention: Examining Effects on Social Skills and Social Anxiety in Young Adults with Autism Spectrum Disorder.

Young adults with ASD experience difficulties with social skills, empathy, loneliness, and social anxiety. One intervention, PEERS® for Young Adults, shows promise in addressing these challenges. The present study replicated and extended the original study by recruiting a larger sample (N = 56), employing a gold standard ASD assessment tool, and examining changes in social anxiety utilizing a randomized controlled trial design. Results indicated improvements in social responsiveness (SSIS-RS SS, p = .006 and CPB, p = .005; SRS, p = .004), PEERS® knowledge (TYASSK, p = .001), empathy (EQ, p = .044), direct interactions (QSQ-YA, p = .059), and social anxiety (LSAS-SR, p = .019). Findings demonstrate further empirical support for the intervention for individuals with ASD.

The Longitudinal Effect of Emotion Regulation Strategies on Anxiety Levels in Children and Adolescents

There is growing evidence linking emotion dysregulation to anxiety. However, few studies have examined this relationship longitudinally or developmentally. Additionally, no studies have specifically examined the predictive relevance of the emotion regulation skills taught in mindfulness- and acceptance-based therapies. We explore whether specific emotion regulation processes differentially predict specific anxiety symptoms over time among children and adolescents. Methods: Initial emotion non-awareness, nonacceptance, and difficulties with goal-directed behavior were assessed in a community sample (n = 312, age range = 8–16, mean age = 11.68, 59% female, 69% Caucasian). Social anxiety, separation anxiety, and physical anxiety symptoms were assessed every 3 months for 3 years. Hierarchical linear modeling was used to examine the concurrent and longitudinal effects of emotion dysregulation assessed at baseline or 18 months on anxiety. Results: After controlling for depression, age, and gender, all three processes concurrently predicted physical and social anxiety, and all but nonacceptance predicted separation anxiety. Only difficulties with goal-directed behavior, however, predicted longitudinal change in separation anxiety over time with covariates. Additionally, emotion non-awareness and difficulties with goal-directed behavior predicted subsequent changes in social anxiety. Conclusions: Emotion dysregulation may serve as a potential risk factor for the development of anxiety symptoms among youth. It may be beneficial to target reductions in maladaptive strategies in prevention or intervention work.

Moderators of Change in Social Anxiety during CBT in a Transdiagnostic, Naturalistic Treatment-Seeking Sample

Background There are a number of hypothesized underlying factors that, while present across a range of anxiety and fear-based disorders, are proposed to be specifically influential in the maintenance of social anxiety (SA) symptoms. Aims This study examined the influence of specific constructs (i.e., anxiety sensitivity, ruminative thinking, and depressive symptoms) on reduction of SA symptoms during a course of cognitive behavioral therapy (CBT). To better model potential causal relationships between observed moderators and social anxiety, time-lagged analyses between SA and significant moderators were also explored. Methods Participants (N = 107) were patients seeking treatment in a fee-for-service clinic specializing in CBT for anxiety disorders, OCD and PTSD. Participants were repeatedly assessed for a variety of symptoms and potential moderators throughout treatment. Results Even though anxiety sensitivity regarding social concerns, rumination, reflection, and depression showed significant within-and between-person relationships with SA symptoms, only rumination was found to uniquely moderate change in SA symptoms over the course of treatment. Specifically, those with higher average levels of ruminative thinking tended to improve greater on SA symptoms than those with lower levels throughout treatment. Further, this observed moderation effect was not found to significantly influence OCD, generalized anxiety, or PTSD symptoms. Finally, a bi-directional relationship was found between rumination and SA with rumination predicting subsequent changes in SA and vice versa. Conclusions High levels of ruminative thinking do not appear to be an impediment to improvement in SA symptoms in a naturalistic, treatment-seeking sample of individuals with anxiety disorders.

Is middle childhood attachment related to social functioning in young adulthood?

The aim of the present study (N = 69) was to examine whether middle childhood attachment, measured using the Separation Anxiety Test (Slough, Goyette & Greenberg, 1988), predicts aspects of social functioning (social initiative, prosocial orientation, social anxiety, loneliness) in young adulthood. Insecurity-avoidance at age 8.5 years was, as expected, negatively related to social initiative and prosocial orientation, and was also positively related to social anxiety and loneliness at age 21 years. In addition, insecurity-avoidance contributed to developmental change in social anxiety from middle childhood to young adulthood. Contrary to our expectations, the two security scales were generally unrelated to future social functioning. Taken together, these results extend previous research by showing that insecurity-avoidance is related to social functioning also beyond childhood and adolescence, and that it contributes to developmental change in social functioning over time. The scarcity of prospective links for the attachment security scales points to the need for future studies addressing when and why attachment does not contribute to future social functioning.

Mindfulness and acceptance-based group therapy and traditional cognitive behavioral group therapy for social anxiety disorder: Mechanisms of change

The present study investigated mechanisms of change for two group treatments for social anxiety disorder (SAD): cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). Participants were treatment completers (n = 37 for MAGT, n = 32 for CBGT) from a randomized clinical trial. Cognitive reappraisal was the hypothesized mechanism of change for CBGT. Mindfulness and acceptance were hypothesized mechanisms of change for MAGT. Latent difference score (LDS) analysis results demonstrate that cognitive reappraisal coupling (in which cognitive reappraisal is negatively associated with the subsequent rate of change in social anxiety) had a greater impact on social anxiety for CBGT than MAGT. The LDS bidirectional mindfulness model (mindfulness predicts subsequent change in social anxiety; social anxiety predicts subsequent change in mindfulness) was supported for both treatments. Results for acceptance were less clear. Cognitive reappraisal may be a more important mechanism of change for CBGT than MAGT, whereas mindfulness may be an important mechanism of change for both treatments.

Is self-critical perfectionism an antecedent of or a consequence of social anxiety, or both? A 12-month, three-wave longitudinal study

Cross-sectional research suggests a relationship between perfectionism and social anxiety. However, research has not examined the direction of this relationship using a longitudinal design. Perfectionism may be an antecedent or consequence of social anxiety, or both. Our study tested reciprocal relations between self-critical perfectionism (i.e., intense self-rebuke, negative reactions to perceived failures, and nagging self-doubt about actions) and social anxiety. We hypothesized that self-critical perfectionism would be both an antecedent and a consequence of social anxiety. A 3-wave, 12-month longitudinal design was used to test the hypotheses. Waves were spaced 6months apart. Participants (N=301 undergraduates) completed measures in the lab at Wave 1. Online questionnaires were administered for Waves 2 and 3. Self-critical perfectionism and social anxiety both displayed strong rank-order inter-individual stability. Social anxiety predicted increases in self-critical perfectionism. However, self-critical perfectionism did not predict change in social anxiety. Self-critical perfectionism was a consequence of, but not an antecedent of, social anxiety. Results suggest treatments that reduce social anxiety may also reduce self-critical perfectionism.

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

Cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD) may decrease social anxiety by training emotion regulation skills. This randomized controlled trial of CBT for SAD examined changes in weekly frequency and success of cognitive reappraisal and expressive suppression, as well as weekly intensity of social anxiety among patients receiving 16 weekly sessions of individual CBT. We expected these variables to (1) differ from pre-to-post-CBT vs. Waitlist, (2) have differential trajectories during CBT, and (3) covary during CBT. We also expected that weekly changes in emotion regulation would predict (4) subsequent weekly changes in social anxiety, and (5) changes in social anxiety both during and post-CBT. Compared to Waitlist, CBT increased cognitive reappraisal frequency and success, decreased social anxiety, but had no impact on expressive suppression. During CBT, weekly cognitive reappraisal frequency and success increased, whereas weekly expressive suppression frequency and social anxiety decreased. Weekly decreases in social anxiety were associated with concurrent increases in reappraisal success and decreases in suppression frequency. Granger causality analysis showed that only reappraisal success increases predicted decreases in subsequent social anxiety during CBT. Reappraisal success increases pre-to-post-CBT predicted reductions in social anxiety symptom severity post-CBT. The trajectory of weekly changes in emotion regulation strategies may help clinicians understand whether CBT is effective and predict decreases in social anxiety. ClinicalTrials.gov identifierNCT00380731; http://www.clinicaltrials.gov/ct2/show/NCT00380731?term=social+anxiety+cognitive+behavioral+therapy+Stanford&rank=1

Patient Expectations in Internet-Based Self-Help for Social Anxiety

A number of controlled trials have demonstrated the efficacy of Internet-based cognitive-behaviour therapy for treating social anxiety disorder (SAD). However, little is known about what makes those interventions work. The current trial focuses on patient expectations as one common mechanism of change. The study examines whether patients' expectancy predicts outcome, adherence, and dropout in an unguided Internet-based self-help programme for SAD. Data of 109 participants in a 10-week self-help programme for SAD were analysed. Social anxiety measures were administered prior to the intervention, at week 2, and after the intervention. Expectancy was assessed at week 2. Patient expectations were a significant predictor of change in social anxiety (β = − .35 to − .40, all p < .003). Patient expectations also predicted treatment adherence (β = .27, p = .02). Patients with higher expectations showed more adherence and better outcome. Dropout was not predicted by expectations. The effect of positive expectations on outcome was mediated by early symptom change (from week 0 to week 2). Results suggest that positive outcome expectations have a beneficial effect on outcome in Internet-based self-help for SAD. Furthermore, patient expectations as early process predictors could be used to inform therapeutic decisions such as stepping up patients to guided or face-to-face treatment options.

Pre-treatment shyness mindset predicts less reduction of social anxiety during exposure therapy

This study examined the moderating role of shyness mindset on the reduction of social anxiety during exposure-based treatment. Participants (N=60) in an intensive outpatient program for anxiety disorders were assessed at pre- and post-treatment. Social performance anxiety decreased dramatically during treatment, but the amount of decrease differed as a function of pre-treatment shyness mindset. At one standard deviation above the mean on both the social performance anxiety and shyness mindset measures, an average reduction of 15 points on the social performance anxiety measure was observed. At one standard deviation above the mean on the social performance anxiety measure and one standard deviation below the mean on the shyness mindset measure, an average reduction of 27 points on the social performance anxiety measure was observed. These results suggest that targeting shyness mindset during exposure-based treatments for social anxiety disorder might increase the effectiveness of treatment for individuals with a high shyness mindset.

Evaluation of a group-based social skills training for children with problem behavior

This study evaluated a group-based training program in social skills targeting reduction of problem behaviors in N = 161 children between 7 and 13 years of age. The effects of the intervention were tested in a quasi-experimental study, with a follow-up assessment 12 months after an optional continuation camp. At the post-test, both the experimental and control group showed less social problems and internalizing problems, whereas only the experimental group showed a small and positive change in social anxiety. After a 12 month follow-up, a subsample of the experimental group (children who followed a continuation camp) showed large positive changes for all outcome measures, except for externalizing problems, showing a small effect.