Changes In Social Anxiety Symptoms Research Articles

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder

ABSTRACT Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety—depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder

BackgroundSocial anxiety disorder (SAD) places a profound burden on public health and individual wellbeing. Systemic inflammation may be important to the onset and maintenance of SAD, and anti-inflammatory treatments have shown promise in relieving symptoms of SAD. In the present study, we conducted secondary analyses on data from a randomized clinical trial to determine whether C-reactive protein (CRP) concentrations and social anxiety symptoms decreased over the course of virtual reality exposure therapy, and whether changes in social anxiety symptoms as a function of treatment varied as a function of CRP. MethodAdult participants (N = 78) with a diagnosis of SAD (59 % female) were randomized to receive exposure therapy alone, or exposure therapy supplemented with scopolamine. Social anxiety symptoms, salivary CRP, and subjective units of distress were measured across three exposure therapy sessions, at a post-treatment extinction retest, and at a 1-month follow-up. ResultsCRP decreased over the course of treatment, b = −0.03 (SE = 0.01), p =.02 95 %CI [−0.06, −0.004], as did all social anxiety symptom domains and subjective distress. Higher CRP was associated with greater decreases from pre-treatment to 1-month follow-up in fear, b = −0.45 (SE = 0.15), p =.004 95 %CI [−0.74, −0.15], and avoidance, b = −0.62 (SE = 0.19), p =.002 95 %CI [−1.01, −0.23], and in-session subjective distress from pre-treatment to post-treatment, b = −0.42 (SE = 0.21), p =.05 95 %CI [−0.83, −0.001]. However, declines in CRP were not correlated with declines in fear, r = −0.07, p =.61, or avoidance, r = −0.10, p =.49, within-persons. ConclusionsVirtual reality exposure therapy may be associated with an improvement in systemic inflammation in patients with severe SAD. Pre-treatment CRP may also be of value in predicting which patients stand to benefit the most from this treatment.

Virtual reality exposure therapy for reducing social anxiety associated with stuttering: the role of outcome expectancy, therapeutic alliance, presence and social presence

Introduction: Although several trials have demonstrated the effectiveness of Virtual Reality Exposure Therapy (VRET) for reducing social anxiety, there is little understanding about the factors that lead to symptom reduction across different treatment designs. Such factors may include outcome expectancy, therapeutic alliance, presence (perception of being in the virtual environment) and social presence (perception of interacting with others). We report on findings from a pilot trial of VRET targeting social anxiety in people who stutter, and examine the association of these four factors with treatment outcome.Methods: People who stutter reporting heightened social anxiety (n = 22) took part in the trial after being recruited via online adverts. Remotely delivered VRET was administered to participants in three sessions across three weeks. Each session targeted both performative and interactive anxiety. A virtual therapist helped participants to engage with treatment strategies, whilst also guiding them through exercises.Results: Findings showed that presence and social presence were both negatively related to changes in fear of negative evaluation between pre- and post-treatment. However, presence, outcome expectancy and therapeutic alliance were positively related to changes in social anxiety symptoms. Furthermore, outcome expectancy and therapeutic alliance were quadratically related to fear of negative evaluation change. Nevertheless, the effect of presence on social anxiety, and the effects of presence and therapeutic alliance on fear of negative evaluation must be interpreted with caution as these were not large enough to reach sufficient statistical power. Therapeutic alliance did not mediate the relationship between outcome expectancy and treatment outcome.Discussion: These findings suggest that the current VRET protocol affected social anxiety and fear of negative evaluation differently. We discuss how presence may underlie these mixed associations. We also suggest that the unexpected positive effects on social anxiety symptoms may have resulted from insufficient treatment strategies which inadvertently encouraged maladaptive learning.

Integrating Cognitive-Behavioral Therapy With Compassion-Focused Therapy for the Treatment of Social Anxiety Disorder: An Evidence-Based Case Study

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for social anxiety disorder that has been found to elicit significant changes in process-based mechanisms (e.g., emotion regulation strategies), which subsequently lead to reductions in social anxiety and associated functional impairment; however, CBT may be less effective for socially anxious individuals experiencing high self-criticism and low self-compassion. Compassion-focused therapy (CFT) has been used to address these tendencies in socially anxious individuals, but research in this area is limited. The present case study examined changes in social anxiety symptoms, self-compassion, emotion regulation strategies, and functional impairment throughout the course of treatment with a young, Chinese American woman using a novel integration of CBT and CFT for social anxiety disorder. The client experienced significant reductions in social anxiety and functional impairment across treatment, which was accompanied by reductions in fear and avoidance ratings for feared social scenarios. Significant mechanistic changes were also observed, including decreases in maladaptive emotion regulation strategies (i.e., suppression, rumination) and increases in self-compassion and adaptive emotion regulation strategies (i.e., expressive engagement, cognitive reappraisal). Findings support the efficacy of integrating compassion-focused strategies with CBT for social anxiety for a young adult with prominent tendencies of self-criticism and low self-compassion.

Social anxiety in Finnish adolescents from 2013 to 2021: change from pre-COVID-19 to COVID-19 era, and mid-pandemic correlates

PurposeSocial anxiety disorder (SAD) is prevalent in adolescents. Increase in levels of general anxiety since 2010’s has been observed in young people. Little is known of time trends in symptoms of social anxiety during 2010’s, of pre- to during-COVID-19 era changes, or of associations between social anxiety symptoms and pandemic severity, distance education, and COVID-19-related experiences in young people.MethodsWe examined social anxiety symptoms, their temporal changes, and their associations with COVID-19 related factors in a sample of 450 000 13-to-20-year-old Finns in 2013–2021. Data from nationwide School Health Promotion study was used. Social anxiety symptoms were assessed with the Mini-SPIN using cut-off score ≥ 6 as indicator of high social anxiety. Multivariate logistic regression analyses were used, controlling for gender, age, family SES, and symptoms of general anxiety and depression.ResultsHigh-level social anxiety symptoms increased markedly from 2013/2015 to 2021 among both sexes. A steeper increase was found among females. In 2021, 47% of females self-reported high social anxiety, a two-fold increase relative to 2013/2015. No association between regional COVID-19 incidence and change in social anxiety symptoms was found. No clear associations between time spent in distance education and social anxiety symptoms were found. Fears of getting infected or transmitting coronavirus, and reports of not getting needed support for schoolwork during distance education were all associated with high social anxiety.ConclusionPrevalence of high social anxiety in young people aged 13–20 has increased considerably from 2013 to 2021, especially among girls. During COVID-19 pandemic, socially anxious young people report a need for educational support and suffer from infection-related fears.

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

BackgroundImproving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment. The current study explores the dynamic temporal associations between theory-driven cognitive and behavioural mechanisms of symptom change both during and following group CBT. MethodsA randomized controlled trial of imagery-enhanced CBT (n = 51) versus traditional verbal CBT (n = 54) for social anxiety was completed in a community mental health clinic setting. This study included data collected from 12-weekly sessions and a 1-month follow-up session. Mixed models were used to assess magnitude of change over the course of treatment. Cross-lagged panel models were fit to the data to examine temporal relationships between mechanisms (social-evaluative beliefs, safety behaviours) and social interaction anxiety symptoms. ResultsParticipants in both CBT groups experienced significant improvements across all cognitive, behavioural, and symptom measures, with no significant differences in the magnitude of changes between treatments. During treatment, greater social-evaluative beliefs (fear of negative evaluation, negative self-portrayals) at one time point (T) were predictive of more severe SAD symptoms and safety behaviours at T+1. Social-evaluative beliefs (fear of negative evaluation, probability and cost of social failure) and safety behaviours measured at post-treatment were positively associated with SAD symptoms at the 1-month follow-up. ConclusionsThe current study identifies social-evaluative beliefs that may be important targets for symptom and avoidance reduction during and following CBT. Assessment of these social-evaluative beliefs throughout treatment may be useful for predicting future SAD symptoms and avoidance, and for adapting treatment to promote optimal change for patients.

Remotely delivered cognitive therapy for social anxiety disorder in adolescence: Preliminary efficacy evidence based on changes throughout treatment.

Cognitive therapy has been established as the frontline treatment for adults with social anxiety disorder (SAD); its efficacy with socially anxious adolescents is incipient but promising. This work investigated change in social anxiety symptoms reported by adolescents and their therapist as they go through remotely delivered 10-session cognitive therapy (i.e., CT@TeenSAD). Participants were 21 adolescents (81% females; M age = 16.10) diagnosed with SAD. They reported on change on their social anxiety symptoms at the beginning of each session; their therapist reported on how their symptoms had improved at the end of each session. Results, though preliminary, show that sessions had a significant impact on self- and therapist reported change, with consistent and continuous improvement across intervention sessions. Gender did not impact on that change, but therapist did: though the same pattern of change emerged for both therapists, it was more evident for the therapist with the greatest previous clinical experience. Overall, current findings align with the cognitive therapy framework of progressive gains throughout therapy. They also add evidence on the applicability and usefulness of an online cognitive approach to adolescents diagnosed with SAD.

Risk for social anxiety in early adolescence: Longitudinal impact of pubertal development, appearance comparisons, and peer connections.

ObjectivesThe aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. MethodsFrom 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness; and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. ResultsSeparate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. ConclusionsThese results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety.

Impact of changes in social anxiety on social functioning and quality of life in outpatients with schizophrenia: A naturalistic longitudinal study

The prevalence of comorbid social anxiety disorder among patients with schizophrenia is currently attracting attention, and symptoms of social anxiety are reportedly associated with various clinical features. However, the contribution of social anxiety to social functioning and quality of life (QOL) over time remains obscure. The aim of this study was to examine the impact of changes in social anxiety symptoms on social functioning and QOL among outpatients with schizophrenia. Of the 207 outpatients who were eligible at baseline, 118 patients agreed with and completed a follow-up investigation at least 1 year (695.8 days on average) after the baseline study. Stepwise multiple regressions examining the change in social functioning using demographic data and changes in clinical variables as explanatory variables demonstrated that the changes in social anxiety and general psychopathology contributed to the change in the Social Functioning Scale, while the changes in clinical severity and negative symptoms contributed to the change in the Global Assessment of Functioning scale. Stepwise multiple regressions for the change in QOL demonstrated that the changes in social anxiety and depression contributed to the change in the World Health Organization QOL scale, Brief version, and the changes in social anxiety and positive symptoms contributed to the Subjective Well-being Under Neuroleptic Drug Treatment, Short Form. The results revealed that the changes in social anxiety symptoms were significantly associated with the change in functional outcome among patients with schizophrenia. Treatments targeting social anxiety seem to be key to achieving a full recovery in patients with schizophrenia.

A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder

To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions—an individual and a group intervention—in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms.

A coping‐oriented group intervention for students waiting to undergo secondary school transition: Effects on coping strategies, self‐esteem, and social anxiety symptoms

AbstractTo facilitate students’ transition into secondary school, a coping‐oriented group program was designed. Pre‐ and posttest data from three intervention groups conducted over the course of 5 weeks were combined for a total of 56 sixth‐grade students waiting to undergo school transition. There was also a test–retest control group (n = 26). Results indicate that completion of the intervention led to a significant decrease on scales measuring self‐reported social anxiety symptoms. There was also a significant increase in intervention participants’ self‐reported self‐esteem, likeability, adherence to social rules, and frequency of active coping strategies, compared with the control group. Furthermore, a regression analysis showed that change in the self‐reported use of active coping strategies predicted change in social anxiety symptoms for the intervention group. However, no significant change in self‐reported use of passive‐avoidant coping was observed. We conclude that facilitating effective coping with stress may provide a highly beneficial perspective toward designing transition groups, that may also lead to a significant reduction in social anxiety symptoms in adolescents waiting to undergo secondary school transition.

Attention Bias Modification Treatment for Adolescents With Social Anxiety Disorder

Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.

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.

Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder

Despite strong support for the efficacy of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), little is known about mechanisms of change in treatment. Within the context of a randomized controlled trial of CBT, this study examined patients' beliefs about the fixed versus malleable nature of anxiety—their ‘implicit theories’—as a key variable in CBT for SAD. Compared to waitlist (n = 29; 58% female), CBT (n = 24; 52% female) led to significantly lower levels of fixed beliefs about anxiety (Mbaseline = 11.70 vs. MPost = 7.08, d = 1.27). These implicit beliefs indirectly explained CBT-related changes in social anxiety symptoms (κ2 = .28, [95% CI = 0.12, 0.46]). Implicit beliefs also uniquely predicted treatment outcomes when controlling for baseline social anxiety and other kinds of maladaptive beliefs (perceived social costs, perceived social self-efficacy, and maladaptive interpersonal beliefs). Finally, implicit beliefs continued to predict social anxiety symptoms at 12 months post-treatment. These findings suggest that changes in patients' beliefs about their emotions may play an important role in CBT for SAD.

Moderation and mediation of the effect of attention training in social anxiety disorder

While attention modification programs (AMP) have shown promise as laboratory-based treatments for social anxiety disorder, trials of internet-delivered AMP have not yielded significant differences between active and control conditions. To address these inconsistencies, we examined the moderational and mediational role of attention bias in the efficacy of attention training. We compared data reported by Carlbring et al. (2012) to an identical AMP condition, with the exception that participants were instructed to activate social anxiety fears prior to each attention training session (AMP + FACT; n = 39). We also compared all attention training groups to an internet-delivered cognitive-behavioral therapy (iCBT) condition (n = 40). Participants in the AMP + FACT group experienced greater reductions in social anxiety symptoms than both active (n = 40) and control (n = 39) groups reported by Carlbring et al., and did not differ in symptom reductions from the iCBT group. Higher attention bias predicted greater symptom reductions for participants who completed AMP, but not for the control group. Moreover, change in attention bias mediated the relationship between AMP group (active condition reported by Carlbring et al. versus AMP + FACT) and change in social anxiety symptoms. These results suggest the importance of interpreting findings related to symptom change in attention training studies in the context of bias effects.Trial registration: ISRCTN01715124

Cognitive processes as mediators of the relation between mindfulness and change in social anxiety symptoms following cognitive behavioral treatment

The present study examined whether pretreatment mindfulness exerts an indirect effect on outcomes following cognitive-behavioral therapy (CBT). Cognitive processes of probability and cost bias (i.e., overestimations of the likelihood that negative social events will occur, and that these events will have negative consequences when they do occur) were explored as potential mediators of the relation between mindfulness and social anxiety symptom change. People with higher levels of mindfulness may be better able to benefit from treatments that reduce biases because mindfulness may aid in regulation of attention. Sixty-seven individuals with a primary diagnosis of social phobia identifying public speaking as their greatest fear received eight sessions of one of two types of exposure-based CBT delivered according to treatment manuals. Participants completed self-report measures of mindfulness, probability bias, cost bias, and social anxiety symptoms. Mediation hypotheses were assessed by a bootstrapped regression using treatment outcome data. Pretreatment mindfulness was not related to change in social anxiety symptoms from pre- to posttreatment. However, mindfulness had an indirect effect on treatment outcome via its association with probability bias, but not cost bias, at midtreatment. These findings were consistent across three metrics of social anxiety symptoms. Mindfulness may play a role in response to CBT among individuals with social phobia through its relation with probability bias – even when the treatment does not target mindfulness.

Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts

Cognitive models state that cognitions are organized hierarchically, so that the underlying schemas affect behavior via more automatic, superficial cognitive processes. This study aimed to demonstrate that early maladaptive schemas predict anxious automatic thoughts, and to show that such automatic thoughts act as mediators between schemas and prospective changes in social anxiety symptoms. The study also examined an alternative reverse model in which schemas acted as mediators between automatic thoughts and social anxiety. A total of 1052 adolescents (499 girls and 553 boys; Mage=13.43; SDage=1.29) completed measures of early maladaptive schemas, socially anxious automatic thoughts, and social anxiety symptoms at Times 1, 2, and 3. The results revealed bidirectional longitudinal relationships among schemas and automatic thoughts that were consistent in content (e.g., the disconnection/rejection schemas and automatic thoughts of negative self-concept). Furthermore, the automatic thoughts of anticipatory negative evaluation by others at Time 2 mediated the relationship between the other-directedness schemas at Time 1 and social anxiety symptoms at Time 3. These findings are consistent with hierarchical cognitive models of social anxiety given that deeper schemas predict more surface-level thoughts. They also support that these more surface-level thoughts contribute to perpetuating schemas. Finally, results show that early maladaptive schemas of the other-directedness domain play a relevant role in the development and maintenance of social anxiety.

Involuntary subordination and its relation to personality, mood, and submissive behavior.

According to social rank theory, involuntary subordination may be adaptive in species that compete for resources as a mechanism to switch off fighting behaviors when loss is imminent (thus saving an organism from injury). In humans, major depression is thought to occur when involuntary subordination becomes prolonged. The present study sought to operationalize involuntary subordination. Study 1 involved a reanalysis of a Gilbert and Allan (1998) study, with the hypothesis that social comparison (i.e., perceived status), submissive behavior, feelings of defeat, and entrapment would load on a common factor (interpreted as involuntary subordination). Exploratory and confirmatory factor analysis supported this model. In Study 2 measures of these same variables were administered to a group of undergraduate students. Eight items were selected from each measure (on the basis of item-total correlations) to form the Involuntary Subordination Questionnaire (ISQ). In Study 3 scores on the ISQ showed high levels of internal consistency and test-retest reliability in a sample of undergraduate students. Scores on the ISQ were significantly positively correlated with various neurotic personality styles and negatively correlated with variables indicating dominance or mastery. Involuntary subordination scores also significantly predicted change in social anxiety symptoms over 9 weeks. In Study 4 scores on the ISQ were examined in relation to nonverbal behaviors. In men, the ISQ was correlated with behaviors indicating a lack of confidence and submissiveness. Involuntary subordination appears to be a relatively stable trait with implications for personality, mood, and real-world behavior.

A Randomized Controlled Trial of Atomoxetine in Generalized Social Anxiety Disorder

The current mainstays of social anxiety disorder pharmacotherapy are serotonergic agents, with less known about the efficacy of more noradrenergic drugs. Atomoxetine (ATM), a highly selective norepinephrine reuptake inhibitor, is currently approved for the treatment of attention-deficit/hyperactivity disorder (ADHD). We describe the first controlled trial of ATM with respect to efficacy and tolerability in adults with the generalized subtype of social anxiety disorder (GSAD) without comorbid ADHD. Twenty-seven outpatients with clinically prevailing diagnoses of GSAD by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were randomized in a 1:1 ratio to 10 weeks of double-blind flexible-dose treatment with either ATM 40-100 mg per day (n = 14) or placebo (n = 13). Primary efficacy outcome was score at end point on the Liebowitz Social Anxiety Scale in the intention-to-treat sample. There were no significant group differences in patients completing the study (ATM, 79%; placebo, 77%). Whereas ATM was well tolerated, there were no significant differences in clinical efficacy between ATM and placebo for GSAD. There were few responders overall (ATM, 21%; placebo, 33%), but proportions were similar in each group (chi [1, 26] = 0.47; P = 0.67). Analysis of variance with repeated measures on the Liebowitz Social Anxiety Scale was performed to detect any differential change in social anxiety symptoms between groups. A significant time effect was found (F = 8.71; P = 0.007), but the time-by-treatment interaction was nonsignificant (F = 0.013; P = 0.91). Although the small sample size limits confidence in the reported results, the comparable, and low, response rates for ATM and placebo suggest that in the absence of comorbid ADHD, ATM is unlikely to be an effective agent for the treatment of GSAD.

Fear responding to 35% CO 2 challenge as a vulnerability marker for later social anxiety symptoms

The majority of biological challenge studies have focused on panic disorder though there is a small literature suggesting that patients with social anxiety disorder (SAD) show comparable responding. These cross-sectional studies suggest that CO 2 reactivity may be a marker of vulnerability to social anxiety. However, the nature of this association is unclear due to design limitations in this literature. The present report prospectively evaluated whether response to a 20% CO 2 challenge was predictive of later changes in social anxiety symptoms. A large non-clinical sample of young adults ( N = 404) screened for axis I disorders completed a 20% CO 2 challenge and were followed for approximately 18 months. Consistent with the vulnerability hypothesis, those showing greater reactivity to the CO 2 challenge showed increased social anxiety symptoms over time. This significant association was maintained after controlling for gender and trait anxiety. These data provide novel evidence suggesting that CO 2 sensitivity is predictive of the development of social anxiety symptoms.