Diagnosis Of Social Anxiety Disorder Research Articles

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.

A Case of Mis-categorization of Different Psychopathological Domain

Published on: October 2022Journal of Young Pharmacists, 2022; 14(4):447-448Case Report | doi:10.5530/jyp.2022.14.91 Authors:Anuja Bansal*, Keshvi Purohit, Anish Sehgal, Hemraj Singh RajputDepartment of Psychiatry, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Waghodia, Vadodara, Gujarat, INDIA. Abstract:Social anxiety disorder (SAD) is distinguished by excessive fear of embarrassment or rejection when disclosed to possible negative assessment by others when involved in a public performance or social interactions. Often, the diagnosis of SAD is missed due to lack of awareness and sometimes misclassified into other psychopathological domains. A 30-year-old male presented with chief complaints of fearfulness and suspiciousness in the form that whenever he sees any two individuals talking, he thinks that they are talking about him which were followed by panic like episodes and social avoidance. He consulted a psychiatrist and was prescribed Tab. Amisulpride 400mg/day, Tab. Aripiprazole 20mg/day, Tab. Olanzapine 10mg/day, Tab. Clozapine 100mg/day, Tab. Trifluoperazine 10mg/day+ Tab. Trihexyphenidyl 4mg/day, Tab. Alprazolam 1.5mg/day, Tab. Lorazepam 2mg/day, Tab. Clonazepam 0.5 mg/day and Tab. Propranolol 40mg/day. He didn’t improve on these medications but took them for 5-6 years because he was able to sleep throughout the day and avoid social interactions. He visited us and detailed evaluation was done. During history taking, it was noted that his symptoms were actually fear of going in public as he used to think that people are talking that he is inferior to them and that people might misjudge or underestimate him. On detailed Mental Status Examination (MSE), it was noted that he suffered from social anxiety with avoidant behavior. It is requisite to categorize the symptoms into clinically relevant domain by detail history taking and MSE.Keywords: Social anxiety disorder (SAD), Social avoidance, Psychopathological domains.

Rejection sensitivity and sexual minority men’s social anxiety disorder: The moderating role of sexual identity strength

ABSTRACT Although gay-related rejection sensitivity (RS) is associated with social anxiety among sexual minority men, little is known about the incremental validity of gay-related RS scores and about moderators of the association between gay-related RS and social anxiety. Study 1 (N = 114) showed that gay-related RS added to the prediction of social anxiety symptoms over and beyond personal RS. Study 2 (N = 254) showed that sexual identity strength moderated the associations between gay-related RS and the expected count of current social anxiety symptoms and the odds of social anxiety disorder diagnosis. Results lend support to the incremental validity of gay-related RS in predicting criterion variance and to the role of sexual identity strength in moderating sexual minority men’s vulnerability to the mental health correlates of gay-related RS.

Psychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder

Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD.

Measurement invariance of the Liebowitz Social Anxiety Scale-Self-Report.

The Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) is a self-report measure of social anxiety (SA), which has shown adequate psychometric properties across cultures. However, no study has systematically evaluated its measurement invariance (MI) between (a) individuals with and without a diagnosis of social anxiety disorder (SAD) and (b) males and females. The current study addresses this issue. We collected data on 257 (158 females) Italian individuals diagnosed with SAD and 356 (232 females) community-dwelling adults. We initially found support for the unidimensionality of the Italian LSAS-SR measurement model in all samples. Using the Graded Response Model, we obtained evidence of partial MI and differential item functioning between community-dwelling and SAD-diagnosed individuals and evidence of strong MI between male and female participants. The results of this study suggest that the Italian LSAS-SR measures the same trait in the same way across the symptom continuum and sexes, making it a psychometrically sound tool for assessment, screening, and research purposes.

Increasing the Efficacy of Treatment for Socially Anxious Youth Through Theoretically Derived Improvements: A Pilot Study.

Cognitive behavioural therapy is the first line of treatment for social anxiety disorder; however, children with social anxiety disorder do not respond as well to generic cognitive behavioural therapy programs, compared to children with other anxiety disorders. The aim of the study was to provide a preliminary examination of the efficacy and applicability of a new disorder specific intervention for children with social anxiety disorder. Five children aged 7-13years, with a primary or secondary DSM-5 diagnosis of social anxiety disorder were provided with an adapted version of the Cool Kids anxiety program. Three out of the five children were in remission from social anxiety disorder at the end of the intervention and at 3-month follow-up. Statistically significant improvements were also noted in overall anxiety symptoms and functioning. Preliminary evidence was found for the efficacy of a social anxiety version of the Cool Kids program.

Age of onset of social anxiety disorder and psychiatric and mental health outcomes: Results from a nationally representative study

ObjectivePrior studies support that younger age of onset would be associated with poorer psychiatric and mental health outcomes for many psychiatric disorders. However, such relationship has never been examined for social anxiety disorder (SAD) in a nationally representative sample. MethodsUsing data from the second Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we have identified four groups of participants with a lifetime DSM-IV diagnosis of SAD based on the self-reported age of onset (childhood onset (<12 years, N = 658), adolescence onset (12–17 years, N = 663), early-adulthood onset (18–39 years, N = 663), and late-adulthood onset (>39 years, N = 415)), and a control group without a lifetime history of SAD (N = 32,205). We performed multinomial logistic regression models to compare lifetime DSM-IV psychiatric disorders and current mental health-related quality of life (assessed with the mental component summary score (MSC) of the SF-12) across these groups. ResultsThe lifetime prevalence rates of panic disorder, agoraphobia and post-traumatic stress disorder were significantly higher in the adulthood onset groups than in groups with an onset during childhood or adolescence (p < 0.01 for most models). MCS score was significantly higher in the childhood (46.0 (SE = 0.5)) or adolescence (46.5 (SE = 0.5)) onset groups than in the groups with an onset during adulthood (early-adulthood onset: 43.5 (SE = 0.6), and late-adulthood onset: 43.0 (SE = 0.8)). LimitationsOur results relied on retrospective self-reported data. ConclusionAmong individuals with SAD, a later age of onset was significantly associated with greater lifetime rates of psychiatric disorders and diminished quality of life.

The role of adverse childhood experiences and attachment styles in social anxiety disorder in adolescents.

Social Anxiety Disorder (SAD) is one of the most common disorders of adolescence and results in marked impairments in social and academic/occupational activities that likely to persist into adulthood. Multiple etiological factors contribute to the development of social anxiety disorder. Two critical factors in presenting with a primary diagnosis of SAD might be adverse childhood experiences (ACEs) and attachment styles. The current study examined how ACEs and attachment styles may be related to SAD in adolescents. 60 participants with ages ranging from 11 to 18 (M = 14.6; female = 36), who have a primary diagnosis of SAD and 60 control group adolescents (M = 14.6; female = 30) were included in the study. Both groups completed the Liebowitz Social Anxiety Scale (LSAS), the Childhood Trauma Questionnaire (CTQ), and the Adolescent Relationship Scales Questionnaire (A-RSQ). After controlling adolescent gender and parental education levels, childhood emotional neglect and income significantly predicted an increased risk for adolescents' SAD diagnosis. Attachment styles did not significantly contribute to predicting adolescents' SAD diagnosis after controlling childhood emotional neglect. The high predictive value of emotional neglect in childhood emphasizes its importance as a risk factor of SAD in adolescence.

Elevated social anxiety symptoms across childhood and adolescence predict adult mental disorders and cannabis use

AimWe assessed the heterogeneous development of self-reported social anxiety symptoms across childhood and adolescence (ages 10 to 18; N = 701) and examined whether these groups predicted clinically derived diagnoses of social anxiety disorder (SAD), generalized anxiety disorder (GAD), depressive episodes, panic disorder (PD), agoraphobia, obsessive compulsive disorder (OCD), and substance use in adulthood (ages 19 to 22). ResultsThree distinct social anxiety symptom trajectories were found: a high increasing group (15.5%), a moderate group (37.3%), and a low group (47.2%). The high increasing and moderate trajectory groups were differentiated from the low trajectory group on the adult mental disorders examined: SAD (high OR = 15.74; moderate OR = 11.72), GAD (high OR = 13.08; moderate OR = 8.98), depressive episode (high OR = 19.75), PD (high OR = 8.43; moderate OR = 5.90), agoraphobia (high OR = 16.39; moderate OR = 9.68), and OCD (high OR = 3.49; moderate OR = 2.98). The high and moderate groups were not differentiated on SAD, GAD, PD, or OCD but were differentiated on depressive episodes (OR = 3.24). Relative to the low and moderate trajectory groups, the high increasing social anxiety symptoms trajectory group also predicted cannabis use, but not alcohol use in adulthood. Gender, ethnicity, household income, and parental education were accounted for when predicting adult outcomes. ConclusionThese results highlight the importance of early treatment of symptoms of childhood social anxiety in the prevention of mental health problems in adulthood.

Transitioning From In-Person to Telehealth Cognitive-Behavioral Therapy for Social Anxiety Disorder During the COVID-19 Pandemic: A Case Study in Flexibility in an Adverse Context.

Social anxiety disorder (SAD) is a condition in which people consistently and persistently experience significant fear and/or anxiety about one or more social situations in which they may be scrutinized and negatively evaluated. SAD has historically been found to respond well to cognitive-behavioral therapy (CBT) delivered both in-person and via telehealth; however, comparatively little information is available regarding response to treatment in the context of Coronavirus Disease 2019 (COVID-19) pandemic social and physical distancing guidelines, which have affected the way in which behavioral health services are delivered, as well as opportunities for interpersonal interactions which are either spontaneous or assigned as exposures. The current case study describes “Jennifer” (a pseudonym), a college student with a primary diagnosis of SAD, who was treated with primarily CBT interventions for 18 individual sessions over the course of approximately 6 months, which included treatment with a psychologist and a graduate student, implemented both in-person and via telehealth, both before and during the COVID-19 pandemic. Jennifer responded well to treatment, as evidenced by her self-report and decreases in symptom measure scores, engaged in CBT adapted to pandemic restrictions, and was able to utilize strategies learned during SAD treatment to address generalized anxiety and pandemic-related concerns. This case study demonstrates the feasibility of transitioning SAD care between providers and formats, as well as the robustness and flexibility of CBT strategies in the face of significant change, stress, and limitations of the external environment.

Structural and functional deficits and couplings in the cortico-striato-thalamo-cerebellar circuitry in social anxiety disorder

Although functional and structural abnormalities in brain regions involved in the neurobiology of fear and anxiety have been observed in patients with social anxiety disorder (SAD), the findings have been heterogeneous due to small sample sizes, demographic confounders, and methodological differences. Besides, multimodal neuroimaging studies on structural-functional deficits and couplings are rather scarce. Herein, we aimed to explore functional network anomalies in brain regions with structural deficits and the effects of structure-function couplings on the SAD diagnosis. High-resolution structural magnetic resonance imaging (MRI) and resting-state functional MRI images were obtained from 49 non-comorbid patients with SAD and 53 demography-matched healthy controls. Whole-brain voxel-based morphometry analysis was conducted to investigate structural alterations, which were subsequently used as seeds for the resting-state functional connectivity analysis. In addition, correlation and mediation analyses were performed to probe the potential roles of structural-functional deficits in SAD diagnosis. SAD patients had significant gray matter volume reductions in the bilateral putamen, right thalamus, and left parahippocampus. Besides, patients with SAD demonstrated widespread resting-state dysconnectivity in cortico-striato-thalamo-cerebellar circuitry. Moreover, dysconnectivity of the putamen with the cerebellum and the right thalamus with the middle temporal gyrus/supplementary motor area partially mediated the effects of putamen/thalamus atrophy on the SAD diagnosis. Our findings provide preliminary evidence for the involvement of structural and functional deficits in cortico-striato-thalamo-cerebellar circuitry in SAD, and may contribute to clarifying the underlying mechanisms of structure-function couplings for SAD. Therefore, they could offer insights into the neurobiological substrates of SAD.

Anxiety and Social Functioning: The Moderating Roles of Family Accommodation and Youth Characteristics.

It is well established that anxiety can contribute to social functioning difficulties during childhood and adolescence. It is less clear which anxious youth are most likely to struggle socially, and what types of difficulties they are likely to experience, limiting the extent of identification and intervention efforts. In this study, we aim to improve specification of the linkages between youth anxiety severity and social functioning by examining several potential moderators of these associations. Specifically, we examine whether family accommodation of youth anxiety, in addition to youth age, sex, and the presence of a social anxiety disorder diagnosis, influence associations between anxiety severity and social functioning among youth with anxiety disorders. Youth (N = 158, Mage = 9.99years, SD = 2.74) and their mothers completed diagnostic interviews and questionnaires assessing anxiety and depression symptoms, family accommodation, and a range of social functioning variables. In a series of hierarchical linear regressions, we found that youth anxiety severity was most strongly associated with social impairment at high levels of family accommodation for adolescents and for youth without social anxiety disorder (mother-report). We also found several direct effects of anxiety severity, family accommodation, and youth age, sex, and diagnosis on different facets of youth social functioning (youth- and/or mother-report). We discuss clinical implications and future research directions focused on specifying the nature of associations between youth anxiety and their social functioning.

Complexity Analysis of EEG in Patients With Social Anxiety Disorder Using Fuzzy Entropy and Machine Learning Techniques

The diagnosis of social anxiety disorder (SAD) is of great consequence not only due to its impacts on the individual and society but also the expenditures to the national health systems. There is yet a deficiency of objective neurophysiological information to assist the present clinical SAD diagnosis. The main objective of this study is to analyze the electroencephalogram (EEG) complexity of 88 SAD subjects, subdivided into 4 balanced groups (22 severe, 22 moderate, 22 mild, and 22 healthy controls (HCs) using Fuzzy Entropy measure (FE) and machine learning algorithms. In addition, this study aimed at designing a computer-aided diagnosis system to identify the severity of SAD (severe, moderate, mild, and HC) in different EEG frequency bands (delta, theta, alpha, and beta). The experimental results showed that among the HC and the three considered levels of SAD, SAD patients in fast-waves exhibited significantly less FE values in resting-state compared with HCs (p <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\leq0.05$ </tex-math></inline-formula> ). The EEG complexity analysis showed a discriminatory neuronal activity over the frontoparietal and occipital regions between SAD patients and HCs. Additionally, the FE values measured in the resting-state were positively correlated with Social Interaction Anxiety Scale (SIAS) scores in fast-waves (beta and alpha), indicating that the regional FE measures are putative biomarkers in assessing the clinical symptoms of SAD. Also, the classification results demonstrated that the proposed method outperformed the state of the art methods with an accuracy of 86.93 %, sensitivity of 92.46%, and specificity of 95.32% with the Naive Bayes (NB) classifier. This study emphasizes the viability of quantitative FE measures and the specific combinations involving the chosen classifiers could be considered as an alternative biomarker for future clinical SAD recognition.

Screening Social Anxiety in Adolescents Through the Eyes of Their Carers.

Despite the availability of efficacious treatment and screening protocols, social anxiety disorder (SAD) in adolescents is considerably under-detected and undertreated. Our main study objective was to examine a brief, valid, and reliable social anxiety measure already tested to serve as self-report child measure but administered via Internet aimed at listening to the ability of his or her parent to identify social anxiety symptomatology in his or her child. This parent version could be used as a complementary measure to avoid his or her overestimation of children of social anxiety symptomatology using traditional self-reported measures. We examined the psychometric properties of brief and valid social anxiety measure in their parent format and administered via the Internet. The sample included 179 parents/legal guardians of adolescents (67% girls) with a clinical diagnosis of SAD (mean age: 14.27; SD = 1.33). Findings revealed good factor structure, internal consistency, and construct validity. Data support a single, strength-based factor on the SPAIB-P, being structure largely invariant across age and gender. The limited number of adolescents with a performance-only specifier prevented examining the utility of scale to screen for this recently established specifier. It is crucial to evaluate if these results generalize to different cultures and community samples. The findings suggest that the SPAIB-P evidences performance comparable with child-reported measure. Parents can be reliable reports of the social anxiety symptomatology of the adolescent. The SPAIB-P may be useful for identifying clinically disturbed socially anxious adolescents.

Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures

• Process research aiming to identify mediators of therapy can aid in making therapy more efficient and optimal. • Repeated measurement, at the start of each session of potential mediators of CBT and Exposure Therapy for social anxiety was carried out. • Both CBT and Exposure Therapy were found to have common mediational pathways and were equally effective in the treatment of SAD. • Perceived social self-efficacy and estimated social cost was found to be mediators of CBT and Exposure Therapy. Process research aims to identify mediators of therapy which can help increase the efficacy and optimization of therapy. The present study examined the role of estimated social cost, perceived social self-efficacy and perceived emotional control as potential mediators in Cognitive Behaviour Therapy (CBT) and Exposure Therapy (EXP) in individuals with social anxiety disorder. Fifty adults with a primary diagnosis of social anxiety disorder (SAD) were recruited from a tertiary treatment center and randomly assigned to receive either CBT (N=25) or EXP (N=25).Levels of social anxiety, estimated social cost, perceived social self-efficacy, and perceived emotional control were assessed at the beginning of each session. Multilevel modeling was used to estimate the effects of the above variables on social anxiety and examine differences between the two groups. Changes in perceived social self-efficacy and estimated social cost predicted changes in social anxiety. Perceived emotional control was not a significant predictor of changes in social anxiety. There were no significant differences between the two groups. The study has a small sample size, and there is a lack of adequate follow-up data. A single therapist delivered both interventions, which could limit external validity. Perceived social self-efficacy and estimated social cost emerged as mediators of both CBT and EXP. The two interventions had common meditational pathways, and there was an interactive bi-directional relationship between social anxiety and the studied mediators.

The role of shame and guilt in social anxiety disorder

• Shame plays an important role in the understanding of social anxiety disorders. • Shame contributes significantly to the variation in social anxiety disorders over and above depression. • Guilt does not seem to have a notable association with social anxiety disorder, at least not contextual-legitimate guilt. For maladaptive forms of guilt, further research is required. Research suggests that shame and guilt may play a role in anxiety disorders. For social anxiety disorder (SAD), however, only a few studies investigated patients with the primary diagnosis of SAD. Thus, further research on shame and guilt in SAD is required. A secondary analysis of Data from the SOPHO-NET multicenter treatment study was performed. In a large sample of N = 495 patients with the primary diagnosis of SAD the relationship between shame and guilt with symptoms of social anxiety, depression, and interpersonal problems was examined by means of correlation analysis and additionally, a hierarchical linear regression analysis. To assess SAD, the German version of the Structured Clinical Interview for DSM-IV was used. Shame and guilt were assessed by the Test of Self-Conscious Affect. Results showed significant associations between internal shame and SAD symptoms, depression, and interpersonal problems. Internal shame contributed significantly to the variation in SAD symptoms over and above depression. Contextual-legitimate guilt was neither correlated with SAD symptoms nor with interpersonal problems. For depression, a significant but very small correlation with SAD symptoms was found that did not persist after controlling for internal shame by partial correlation. Internal shame but not contextual-legitimate guilt plays a role in SAD. It seems to be not only associated with symptoms of social anxiety but also with depression and interpersonal problems. Future studies should examine whether a focus on internal shame may be useful in treating SAD.

Feasibility of an Intensive, Disorder-Specific, Group-Based Cognitive Behavioural Therapy Intervention for Adolescents with Social Anxiety Disorder.

This study examined the preliminary acceptability and efficacy of an intensive, group-based, disorder-specific cognitive behavioural therapy (CBT) intervention for adolescents with social anxiety disorder (SAD). Fourteen Australian adolescents with SAD (78.6% female, M age = 13.93 years) and their parents completed the program plus measures of treatment satisfaction, and provided feedback. Clinical interviews and surveys were administered pre-treatment, post-treatment, and at 6-month follow-up to determine diagnostic status and assess related variables. Post-treatment satisfaction scores were very high for adolescents and parents. Post-treatment, 32.3% of participants no longer met criteria for SAD diagnosis, increasing to 42.9% at follow-up. Participants showed sizeable reductions in comorbid diagnoses, significant improvements in global functioning, social anxiety symptoms, and internalising symptoms from pre- to post-treatment (maintained at follow-up), and significant improvements in social skills and social competence from pre-treatment to follow-up. This study supports the use of an intensive CBT program for adolescents with SAD.

Epidemiology of social phobia in Andalusia

IntroductionPopulation studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample. Material and methodsWe used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression. ResultsEstimated prevalence for SAD was 1.1% (95% CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse. ConclusionsAmong this large Andalusian population sample, the prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had previously reported such a strong association with paranoia.

50.1 Additional, Alternative Avoidant Cluster Symptoms for the Diagnosis of PTSD in Children

This study sought to explore developmentally sensitive avoidant cluster symptoms for children. Abused children (N = 119; mean age = 9.96 years; SD = 1.67) were recruited in a southern state; 65.5% were female, 68.9% were White, and 31.1% were Black. Data were collected in an NIMH study (5-RO1MH49784-04). Informed consent and assent were completed by parents and children. The Abuse Dimensions Inventory (ADI) measures severity of physical and sexual abuse. Data collection for this NIMH study began prior to the release of the DSM-IV, so the Diagnostic Interview for Children and Adolescents—Revised (DICA-R) was utilized for the assessment of PTSD and social anxiety disorder (SAD). The Child Dissociative Checklist (CDC) is a screening measure to access dissociative symptoms based on ratings by caregivers. The CDC mean was 6.93 (SD = 6.54). For the creation of developmentally sensitive, avoidant symptoms, using the DICA-R, if a parent endorsed symptoms that met the criteria for SAD, then the diagnosis of SAD was counted as one avoidant symptom. For dissociation, the CDC was used with a cutoff greater than 12 to establish an alternative avoidant symptom. Of the 119 children, the percentage meeting the threshold set by DSM-III-R was identified for each cluster based on child and parent interviews: Reexperiencing (child: 84.9%; parent: 67.2%); Arousal (child: 84.9%; parent: 66.3%); Avoidance (child: 76.5%; parent: 58.1%); and Positive Diagnosis (child: 62.2%; parent: 31.1%). The percentage of children meeting the threshold of 3, but using the 2 additional symptoms (SAD and CDC) as developmental equivalents for avoidance, was identified based on child and parent interviews: Child PTSD (child: 66.7%; parent: 43.9%); Child PTSD + SAD (child: 78.2%; parent: 53.6%); Child PTSD + CDC (child: 78.0%; parent: 56.0%); Child PTSD + SAD + CDC (child: 89.5%; parent: 75.7%). The developmentally sensitive avoidant criteria resulted in higher rates of PTSD. It is plausible that clinging to a safe parent served the function of reducing distress (reexperiencing and arousal). Similarly, dissociative symptoms may reduce distress. The study limitations included: 1) it was a retrospective analysis of study data that used DSM-III-R criteria; 2) it was conducted in one southern state; and 3) variables used for alternative SAD and dissociative symptoms were available in a subset (N = 66) of the sample.

A pilot study of intensive 7-day internet-based cognitive behavioral therapy for social anxiety disorder

Accessible, affordable cognitive behavioral therapy (CBT) options for Social Anxiety Disorder (SAD) that allow for rapid symptom improvement are needed. The present study investigated the first intensive, 7-day internet-based CBT for SAD. An open pilot trial was conducted to test the acceptability, feasibility and preliminary outcomes of the program in a sample of 16 participants (9 females, M age = 40.34, SD = 10.55) with a DSM-5 diagnosis of SAD. Participants were enrolled into the 6-lesson online program, and completed the Social Phobia Scale [SPS], Social Interaction Anxiety Scale [SIAS], Patient Health Questionnaire-9 (PHQ-9), and Work and Social Adjustment Scale (WSAS) at baseline, post and one month follow-up. We found support for the feasibility and acceptability of the program; 15 participants (93.8%) completed the program, and all participants reported the program was satisfactory. Large, significant reductions in social anxiety severity on both the SPS and SIAS (Hedges’ gs = 1.26–1.9) and functional impairment (WSAS; gs = 0.88–0.98) were found at post-treatment and follow-up. Medium, significant reductions in depressive symptom severity were also found (gs = 0.88–0.98 at post and follow-up, respectively). A third of participants scored below the clinical cut-off on both the SPS and SIAS at post-treatment and follow-up. A randomized controlled trial with longer follow-up is needed to evaluate the efficacy of this intensive internet-based treatment for SAD. Implications and future research directions are discussed.