Elevated Social Anxiety Symptoms Research Articles

Resting state functional connectivity differences following working memory training with massed exposure in individuals with public speaking anxiety

Exposure-based cognitive behavioral therapy (CBT) is a gold standard treatment for Social Anxiety Disorder (SAD), but many patients do not gain complete symptom relief. Since fear extinction is central to the effectiveness of exposure within CBT, adjunctive treatments that target neurocognitive systems underlying fear extinction could increase the effectiveness of CBT. Successful fear extinction and cognitive tasks like working memory share neurocognitive substrates. The present study evaluates the neural impact of working memory training (WMT) as an adjunctive CBT treatment by exploring changes in intrinsic network connectivity associated with combining WMT with exposure exercises. The sample included twenty-four adults (Mean Age = 27.42(9.75), 62.5% female) with elevated social anxiety symptoms. Participants completed either a WMT or sham training (ST) condition, followed by a speech-based massed exposure session (WMT+Exp versus ST+Exp). Compared to ST+Exp, WMT+Exp participants exhibited lower connectivity between the default and visual networks and visual and dorsal networks. Lower connectivity between these networks was associated with lower subjective distress at the end of the massed exposure across the whole sample. WMT+Exp completers exhibited unique functional connectivity between the frontoparietal and dorsal attention networks. WM+Exp was associated with a neural connectivity profile involving networks critical to working memory, fear learning, and emotion regulation, as well as emotional and sensory processing functions. Data provisionally point to combined working memory training and exposure facilitating improvement in neural connections useful for benefitting from CBT for SAD.

Perceived psychological control relates to coping-related drinking motives via social anxiety among adolescents: A cross-sectional mediation analysis

Accumulating evidence suggests that particular parenting behaviors (e.g., elevated psychological control) may increase risk for both problematic social anxiety and alcohol use among youth; however, no work has yet examined these factors together in a single model. Building developmentally sensitive models of problematic alcohol use trajectories is key to developing effective prevention and intervention strategies. The present study includes 94 adolescents (ages 14–17 years; 53.3% girls; 89.2% White) entering a treatment facility for a variety of internalizing and externalizing forms of psychological distress. Levels of perceived parental psychological control, social anxiety, and coping-related drinking motives were assessed. Higher levels of perceived psychological control were associated with a greater endorsement of coping-related drinking motives; however, a significant proportion of that association was accounted for by elevated social anxiety symptoms. These data extend the existing literature and lay groundwork for more sophisticated experimental and longitudinal designs to corroborate the findings. Moreover, personality-targeted drinking interventions for adolescents may benefit from identifying elevated perceived psychological control as a developmentally relevant risk factor for social anxiety and problematic drinking motives and administering relevant interventions (e.g., personality-targeted coping skills training, parent-involved care) before drinking patterns are established.

Social Anxiety Across Sexual and Gender Identity Subpopulations

Recent research indicates that gay/lesbian identified sexual minority individuals report lower social anxiety than their counterparts who identify as bisexual or indicate an emerging identity label (e.g., queer, pansexual, or asexual). The current study advances the knowledge base by comparing levels of social anxiety across both sexualandgender identity subpopulations in a sexual minority sample residing in the Republic of Ireland. Six hundred two sexual minority adults participated in an online survey in which they completed measures of sociodemographic variables (including sexual and gender identity) and social anxiety. Across gender identity subpopulations, transgender/non-binary individuals were more likely to report elevated social anxiety symptoms than both cisgender men and cisgender women; further, cisgender women were more likely to report elevated social anxiety symptoms than cisgender men. Within each of these gender identity groups, there was no significant difference in odds of elevated social anxiety symptoms across sexual identity subgroups (gay/lesbian, bisexual, and emerging identity) when adjusted for sociodemographic variables. Results highlight the necessity to represent the mental health experiences of diverse sexual minority subpopulations, especially in population-based studies of sexual minority mental health. Additionally, future studies should aim to explore the potentially distinctive and complex social stressors encountered by the diverse groups within the sexual and gender minority population.

What Works in Preventing Emerging Social Anxiety: Exposure, Cognitive Restructuring, or a Combination?

Programs that aim to reduce symptoms of social anxiety in children generally include multiple components, such as exposure and cognitive restructuring. It is unknown if separate components yield positive intervention effects in children or whether a combination of components is required. We investigated the effectiveness of exposure, cognitive restructuring, and a combination of both components in reducing social anxiety symptoms and anxiety-related social-emotional outcomes in an indicated-prevention setting. To this end, we conducted a cluster-randomized microtrial using a sample of 191 children aged 8 to 13 years (M = 10.48, SD = 1.10). Children with elevated social anxiety symptoms participated in one of three group interventions, each lasting four weeks, and completed a questionnaire on four measurement occasions. Latent change models demonstrated that the intervention with either exposure or cognitive restructuring reduced social anxiety symptoms and anxiety-related outcomes. The analyses showed that both of these intervention components were effective, with more favorable effects for exposure. Combining exposure and cognitive restructuring techniques did not yield greater benefit than either component alone. Future research should investigate whether specific components may be more effective for particular subgroups (e.g., based on sex or level of behavioral inhibition) in more detail.

Effects of safety behavior fading on social anxiety and emotional disclosure

Individuals with social anxiety disorder commonly engage in safety behaviors (SBs), which are behavioral and cognitive strategies employed in an effort to avoid or decrease the likelihood of a feared threat outcome and decrease anxiety in social situations. These behaviors are thought to be dysfunctional and play a key role in contemporary models of the disorder. The current experimental study sought to expand upon existing research by examining the role of SBs in social anxiety and self-disclosure. Participants with elevated social anxiety symptoms (N = 115) were randomized to either a two-week SB fading manipulation or a no-instruction control. Self-report measures were administered pre- and post-manipulation, and participants completed an in-vivo speech task at post. SB fading led to lower social anxiety symptoms at post relative to the control. SB fading also led to greater self-reported openness to general self-disclosure and emotional disclosure compared to the control, though these effects were modest. No condition effect on emotional reactivity to a speech task was observed. SB fading led to greater observer-rated disclosure on the speech task than control, though this was only found among those high in dispositional self-disclosure at baseline. The present study provides further evidence for the importance of SBs in social anxiety and suggests SB fading might lead to greater comfort with self-disclosure. Limitations and directions for future research are discussed.

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.

Neurophysiological Responses to Interpersonal Emotional Images: Associations with Symptoms of Depression and Social Anxiety.

Affective neuroscience research using electrocortical event-related potentials has provided valuable insights on alterations in emotion processing in internalizing disorders. However, internalizing disorders are accompanied by additional impairments in social cognition and functioning, and most extant research examines neural responses to broad categories of emotional scenes or faces presented irrespective of context. Examining neural reactivity specifically to interpersonal emotional scenes may more precisely capture and disentangle processes involved in depression and social anxiety, two highly comorbid forms of psychopathology. The current study validated a novel set of positive and threatening interpersonal emotional stimuli in a sample of emerging adults (N = 114) who completed a modified emotional interrupt paradigm while electroencephalogram and behavioral data were recorded. Participant ratings of valence and arousal supported the validity of the emotional images. Consistent with prior research, sustained neurophysiological processing indexed by the late positive potential (LPP) was observed for interpersonal emotional images, especially positive, compared with neutral images. Elevated LPP reactivity to both positive and threatening interpersonal images moderated the effects of chronic interpersonal stress on social anxiety symptoms, such that enhanced LPP reactivity in conjunction with higher levels of chronic interpersonal stress was associated with elevated social anxiety symptoms. These results were unique to social anxiety symptoms and not symptoms of depression, suggesting sustained neural processing of interpersonal stimuli may differentiate social anxiety from depression. Future research on emotional reactivity specifically within the interpersonal domain is needed to inform our understanding of developmental pathways to internalizing psychopathology.

Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study.

Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.

Randomized controlled trial of attention bias modification in a racially diverse, socially anxious, alcohol dependent sample

ObjectiveAttention biases may be an important treatment target for both alcohol dependence and social anxiety. This is the first ABM trial to investigate two (vs. one) targets of attention bias within a sample with co-occurring symptoms of social anxiety and alcohol dependence. Additionally, we used trial-level bias scores (TL-BS) to capture the phenomena of attention bias in a more ecologically valid, dynamic way compared to traditional attention bias scores. MethodAdult participants (N = 86; 41% Female; 52% African American; 40% White) with elevated social anxiety symptoms and alcohol dependence were randomly assigned to an 8-session training condition in this 2 (Social Anxiety ABM vs. Social Anxiety Control) by 2 (Alcohol ABM vs. Alcohol Control) design. Symptoms of social anxiety, alcohol dependence, and attention bias were assessed across time. ResultsMultilevel models estimated the trajectories for each measure within individuals, and tested whether these trajectories differed according to the randomized training conditions. Across time, there were significant or trending decreases in all attention TL-BS parameters (but not traditional attention bias scores) and most symptom measures. However, there were not significant differences in the trajectories of change between any ABM and control conditions for any symptom measures. ConclusionsThese findings add to previous evidence questioning the robustness of ABM and point to the need to extend the effects of ABM to samples that are racially diverse and/or have co-occurring psychopathology. The results also illustrate the potential importance of calculating trial-level attention bias scores rather than only including traditional bias scores.

The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children

The aim of this study was to explore the change and associated risk and protective factors of social anxiety symptoms among Chinese children. A 2-year longitudinal study was performed in a general primary and secondary school population in Anhui Province, China including 816 children in grades 3, 4, and 7. Children's social anxiety symptoms were assessed using the Social Anxiety Scales for Children (SASC) at three assessments. The overall prevalence of children's elevated social anxiety symptoms ranged from 15.2% to 16.4% across three assessments. Children's overall mean SASC scores were 5.6 (SD =3.7), 5.3 (SD =3.8), and 5.3 (SD =4.1) at three assessments, respectively, but the difference was not statistically significant. However, children's social anxiety symptom levels and change among different subgroups was not stable across 2-year follow-up. Multivariable logistic regression analysis indicated that age, severe family dysfunction, quality of life, positive coping, negative coping, depressive symptoms and self-esteem were predictive factors for childhood elevated social anxiety symptoms. The findings suggested that the overall social anxiety symptoms showed a relatively stable pattern over time. The identified risk and protective factors may provide scientific evidence for school, family, and health authorities to conduct necessary intervention.

Neural correlates of a computerized attention modification program in anxious subjects.

Computerized attention modification is a relatively new and empirically validated treatment approach for different types of anxiety disorders. However, its neural basis and processes involved are poorly understood. This study examined the effect of a one-time application of an attention modification program (AMP) on neural substrates underlying emotion processing in individuals with high social anxiety. Fourteen individuals with elevated social anxiety symptoms completed an emotional face processing task during functional magnetic resonance imaging before and after AMP, and were subsequently exposed to a laboratory stressor. Results revealed the following: First, there was attenuated activation from pre- to post-AMP in the bilateral amygdala, bilateral insula and subgenual anterior cingulate cortex. Second, post-AMP, individuals exhibited increased activation in several regions of the prefrontal cortex (PFC). Third, those individuals with greater enhancement of ventromedial PFC activation after AMP showed diminished attentional allocation for threat and attenuated anxiety reactivity to the stressor. We conclude that AMP exerts effects that are similar to those previously reported for standard anxiolytics; however, it also appears to foster deployment of top-down brain processes aimed to regulate anxiety.

Modifying automatic approach action tendencies in individuals with elevated social anxiety symptoms

Research suggests that social anxiety is associated with a reduced approach orientation for positive social cues. In the current study we examined the effect of experimentally manipulating automatic approach action tendencies on the social behavior of individuals with elevated social anxiety symptoms. The experimental paradigm comprised a computerized Approach Avoidance Task (AAT) in which participants responded to pictures of faces conveying positive or neutral emotional expressions by pulling a joystick toward themselves (approach) or by moving it to the right (sideways control). Participants were randomly assigned to complete an AAT designed to increase approach tendencies for positive social cues by pulling these cues toward themselves on the majority of trials, or to a control condition in which there was no contingency between the arm movement direction and picture type. Following the manipulation, participants took part in a relationship-building task with a trained confederate. Results revealed that participants trained to approach positive stimuli displayed greater social approach behaviors during the social interaction and elicited more positive reactions from their partner compared to participants in the control group. These findings suggest that modifying automatic approach tendencies may facilitate engagement in the types of social approach behaviors that are important for relationship development.

An Evaluation of the Applicability of the Tripartite Constructs to Social Anxiety in Adolescents

The current study examined the tripartite model of anxiety and depression in relation to social phobia in a nonclinical sample of adolescents (ages 13–17). Adolescent/parent dyads participated in a semistructured interview and completed self-report measures of the tripartite constructs and social anxiety. Adolescents gave an impromptu speech, and heart rate was monitored. Low positive affect, high negative affect, and high physiological hyperarousal were characteristic of adolescents diagnosed with social phobia; adolescents with elevated social anxiety symptoms who did not meet criteria for social phobia did not evidence low positive affect. Heart rate reactivity during the speech was not significantly correlated with social anxiety symptomatology or with self-reported physiological hyperarousal.

Interactive Roles of Pubertal Timing and Peer Relations in Predicting Social Anxiety Symptoms Among Youth

The interaction between early maturation and problematic peer relations in relation to social anxiety symptoms was examined among 167 adolescents aged 10–17 years. Results indicated that early-maturing youth with problematic peer relations evidenced elevated social anxiety symptoms. Findings are discussed in terms of theoretical implications for adolescent social anxiety development.