Fear Of Scrutiny Research Articles

Biological aging analysis based on DNA methylation status for social anxiety disorder.

Social anxiety disorder (SAD) is a common disorder characterized by excessive fear of scrutiny and embarrassment, leading to severe distress and avoidance behaviors or dysfunctions. SAD and other relevant diseases have been reported to be associated with a higher risk of aging-related diseases, such as Alzheimer's disease, Parkinson's disease, and diabetes mellitus. Recently, epigenetic clock analysis, which measures biological aging based on comprehensive DNA methylation (DNAm) status, has been widely conducted. We conducted epigenetic clock analyses in patients with SAD and controls, examining various epigenetic age acceleration and DNAm-based predictive values of aging-related proteins (GrimAge components and GrimAge2 components), including leptin level. We used the publicly available DNAm dataset, GSE164056, which consists of 66 patients with SAD and 77 controls of Caucasian descent aged between 18 and 50 years. We conducted regression analyses investigating the association between SAD and various indices of epigenetic aging, using age and sex as covariates. None of the epigenetic clocks showed significant differences in age acceleration. Of the DNAm-based predictive values of aging-related proteins, leptin level in GrimAge components (q = 0.0123) and GrimAge2 components (q = 0.0123) were significantly lower in patients with SAD than in controls. The results of this study suggested that leptin may be involved in SAD pathogenesis as an aging-related protein. Therefore, further studies with different designs are required.

The prevalence of using beta-blockers and its relationship with social anxiety among health profession students at Umm Al-Qura University.

Social Anxiety Disorder (SAD) is an anxiety disorder characterized by excessive fear of scrutiny in social situations. Health students are more susceptible to SAD due to academic demands. They may resort to self-medication, particularly beta-blockers (BBs) for managing physical symptoms of SAD. The study aims to investigate the prevalence of beta-blocker use and its relationship with social anxiety disorder among health students at Umm Al-Qura University. In this cross-sectional study, 461 undergraduate health students participated in a questionnaire with 30 questions divided into three sections: The Social Phobia Inventory (SPIN), BBs usage behavior questionnaire, and demographic characteristics. The study found 56.2% had SAD. A total of 7.8% of the sample reported using BBs, and no significant correlation was found between the usage of BBs and the SAD score (P = 0.085). The study revealed significant relationships between the presence of SAD with gender, history of mental conditions, and correlation between the use of BBs with history of mental conditions. Although BBs usage is low among health students, the prevalence of SAD is alarming. The results could raise awareness about the need for early detection of SAD among health students.

Internet videoconferencing delivered cognitive behavioral therapy for social anxiety disoder: Protocol for a randomized controlled trial

BackgroundSocial anxiety disorder (SAD) is characterized by a fear of scrutiny in social or performance situations. Due to a number of barriers, many individuals do not seek treatment for SAD, resulting in a chronic and debilitating course. Cognitive behaviour therapy (CBT), and more recently Imagery Rescripting (ImR), have been found to be efficacious in the treatment of SAD when delivered face-to-face. However, the efficacy of these treatment approaches when delivered remotely, have not yet been examined in controlled trials. MethodsThe authors propose a two-group randomized controlled trial comparing the efficacy of videoconferencing delivered CBT (vCBT) for SAD against a waitlist control group. The study will recruit 78 adults in total with a primary diagnosis of SAD of at least moderate severity. The manualised high-intensity vCBT intervention will be delivered weekly over an 8-week period. After treatment completion, the waitlist participants will receive a high-intensity videoconferencing delivered ImR (vImR) intervention also delivered weekly over an 8-week period. Treatment for both groups will be delivered in real time via an online videoconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. ConclusionThis trial will report findings on the efficacy of a remote synchronous high-intensity vCBT and vImR intervention for SAD and benchmark the two different treatment methodologies against standard face-to-face CBT. The results have the potential to inform best-practice remote psychological treatment for SAD. Trial registrationThe trial was registered on the Australian New Zealand Clinical Trials Registry; ACTRN12623000313639 (5 April 2023).

Implementation science challenges: hearing care professionals identify barriers to clinical research

Objectives Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals’ perceptions of barriers to participating in such research. Design A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: “One reason why it is hard to conduct intervention research studies in my centre/practice is….”. Participants were asked for reasons other than ‘time’ as this is universally reported as a barrier to clinical research. Results A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: “Competing demands/pressures” (18 statements), “Not a priority for management/organisation” (14 statements), “Lack of opportunity/support” (19 statements), “Clinician’s knowledge, confidence, and beliefs” (24 statements), and “Recruitment/adherence to protocols is challenging” (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the “academic elite”. Conclusion Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful.

Hypermentalizing in Social Anxiety: Evidence for a Context-Dependent Relationship.

Social anxiety (SA) means fear of scrutiny and of others’ negative evaluation, thus indicating that hypermentalizing (HMZ) (i.e., the over-attribution of intentions and thoughts to others) might be the most common error of social cognition in SA. However, evidence for this is weak. One explanation is that HMZ is not stable in SA, but rather context-dependent. The first aim of the current study was testing this hypothesis. The second aim was analyzing whether the association between SA and HMZ is moderated by a negative self-image. One-hundred and thirteen young adults (85.8% females; M = 21.1 years old; SD = 2.7) were assessed on measures of SA, HMZ, and self-image. Given the over-representation of females, conclusions may not be safely extrapolated to males. Results revealed that HMZ is associated with SA only in the self-referential social situation [B = 2.68 (95% CI: 0.72–4.65), p = 0.007]. This supports that HMZ is not global in SA (i.e., a stable cognitive style), but rather is active only in some contexts. Implications for the conceptualization and treatment of SA are discussed. Contrary to predictions, neither self-esteem, nor positive or negative self-schema moderated the association between SA and self-referential HMZ. This contradicts findings in the field of paranoid delusion and requires replication, including measures of implicit self-esteem.

Fear of scrutiny leads to hesitation during challenging encounters

Regardless of your opinion on the current state of law enforcement or the job you think we are doing, it may not be surprising to hear me say, “I knew it would happen; it was only a matter of time.” Knew what would happen, you might ask? In a word, second‐guessing. Street‐level hesitation that is rooted in fear. Not fear of what the armed assailant the officer is facing may do or if the individual suffering from an emotional crisis may charge while holding the knife instead of complying with orders to drop it, but rather, fear of what the incident may “look like” after the fact. I was hoping that I would be wrong when I discussed it with my colleagues, but recent events in Chicago proved that, unfortunately, my prediction was correct.

The Narrator as Dubious Witness: Adapting And the Soul Shall Dance for the Stage

Staged by East West Players in 1977, Wakako Yamauchi's And the Soul Shall Dance became one of the company's most successful and critically acclaimed productions. The drama launched Yamauchi's career as a playwright and helped East West Players (EWP) develop a strong audience base in the Japanese American community in southern California. Set in the 1930s in California's Imperial Valley, the play opens with the Japanese American Murata family surveying the damage caused by the accidental burning of their bathhouse. When the father (referred to only as “Murata” in the play) suggests that they might simply use the tub standing in the midst of razed walls, his wife Hana protests, “Everyone in the country can see us!” Murata quickly dismisses her concerns: “Who? Who'll see us? You think everyone in the country waits to watch us take a bath?” (157). Hana's uneasiness nevertheless injects a fear of scrutiny into the first scene of the play and turns those in the audience into the voyeurs whom she fears.

Perception matters for clinical perfectionism and social anxiety

Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N=602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N=180), and by using a variance decomposition model of self- and informant-report of perfectionism (N=134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants’ perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed.

The Dutch Social Interaction Anxiety Scale and the Social Phobia Scale: Reliability, Validity, and Clinical Utility

The social interaction anxiety scale (SIAS) and the social phobia scale (SPS) assess anxiety in social interactions and fear of scrutiny by others. This study examines the psychometric properties of the Dutch versions of the SIAS and SPS using data from a large group of patients with social phobia and a community-based sample. Confirmatory factor analysis revealed that the SIAS is unidimensional, whereas the SPS is comprised of three subscales. The internal consistency of the scales and subscales was good. The concurrent and discriminant validity was supported and the scales were well able to discriminate between patients and community-based respondents. Cut-off values with excellent sensitivity and specificity are presented. Of all self-report measures included, the SPS was the most sensitive for treatment effects. Normative data are provided which can be used to assess whether clinically significant change has occurred in individual patients.

Have No Fear: The Neural Basis of Anxiolytic Drug Action in Generalized Social Phobia

Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological treatments for anxiety disorders such as social phobia. Despite widespread use of SSRIs over the last 20 years, our understanding of how these treatments correct the disabling psychological symptoms seen in anxiety disorders is still in its infancy. Neuropsychological models highlight a key role for corticolimbic neural circuitry in anxiety, in which excessive reactivity to threat at the level of the amygdala is left unchecked by cortical systems, which usually regulate excessive or inappropriate responses to these cues. This model has been widely supported by experimental evidence across a number of anxiety disorders, shown as an imbalance in activity and/or reduced connectivity across amygdala-medial prefrontal cortex networks believed to govern our responses to a potential environmental threat ( 1 Kim M.J. Loucks R.A. Palmer A.L. Brown A.C. Solomon K.M. Marchante A.N. Whalen P.J. The structural and functional connectivity of the amygdala: from normal emotion to pathological anxiety. Behav Brain Res. 2011; 223: 403-410 Crossref PubMed Scopus (597) Google Scholar ). In this issue of Biological Psychiatry, Phan et al. ( 2 Phan KL, Coccaro EF, Angstadt M, Kreger KJ, Mayberg HS, Liberzon I, Stein MB (2013): Corticolimbic brain reactivity to social signals of threat before and after sertraline treatment in generalized social phobia. Biol Psychiatry 73:329–336. Google Scholar ) present evidence that a 12 week SSRI treatment with sertraline normalizes aberrant threat responses in this corticolimbic circuit in generalized social phobia, revealing a potentially relevant neuropsychological mechanism of anxiolytic drug action. Corticolimbic Brain Reactivity to Social Signals of Threat Before and After Sertraline Treatment in Generalized Social PhobiaBiological PsychiatryVol. 73Issue 4PreviewGeneralized social phobia (gSP), also known as generalized social anxiety disorder, is characterized by excessive fear of scrutiny by others and pervasive avoidance of social interactions. Pathophysiologic models of gSP implicate exaggerated reactivity of the amygdala and insula in response to social evaluative threat, making them plausible targets for treatment. Although selective serotonin reuptake inhibitor (SSRI) treatment is known to be an effective treatment, little is known about the mechanism through which these agents exert their anxiolytic effects at a brain level in gSP. Full-Text PDF

A high-throughput clinical assay for testing drug facilitation of exposure therapy.

Several studies have demonstrated that D-cycloserine (DCS) facilitates exposure therapy. We developed a standardized test of this facilitation (i.e., a clinical assay), with the goal of testing for facilitation more quickly and inexpensively than a full clinical trial. We developed a standardized brief exposure in which participants with social anxiety disorder gave a videotaped speech. Participants were randomized to receive a single capsule of 250 mg DCS or a matching placebo prior to preparation for the speech. Distress levels were rated during the speech and again, approximately 1 week later, during a speech in an identical situation. Our primary measure of DCS's exposure-facilitating effect was between-session habituation: whether or not the participants showed less distress during the second speech compared to the first. We also measured levels of subjective anxiety and fear of scrutiny. Subjects randomized to receive DCS prior to their first speech were more likely to show between-session habituation than those who received placebo. We also found greater reduction of performance-related fear overall in the DCS group. Our clinical assay was able to detect exposure facilitation effects rapidly and in a highly standardized way, and is estimated to take a fraction of the time and costs of a clinical trial. Given the increasing interest in using medications to enhance learning-based psychotherapy, this high-throughput clinical assay approach may be a favorable method for testing novel mechanisms of action, and clarifying optimal parameters, for therapy facilitation.

A BIOPSYCHOSOCIAL MODEL OF SOCIAL ANXIETY AND SUBSTANCE USE

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction-based theories) to understand SAD-SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance-related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD-SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance-related behaviors.

Corticolimbic Brain Reactivity to Social Signals of Threat Before and After Sertraline Treatment in Generalized Social Phobia

Generalized social phobia (gSP), also known as generalized social anxiety disorder, is characterized by excessive fear of scrutiny by others and pervasive avoidance of social interactions. Pathophysiologic models of gSP implicate exaggerated reactivity of the amygdala and insula in response to social evaluative threat, making them plausible targets for treatment. Although selective serotonin reuptake inhibitor (SSRI) treatment is known to be an effective treatment, little is known about the mechanism through which these agents exert their anxiolytic effects at a brain level in gSP. We acquired functional magnetic resonance imaging data of brain response to social signals of threat (fearful/angry faces) in 21 gSP patients before and after they completed 12 weeks of open-label treatment with the SSRI sertraline. For comparison, 19 healthy control (HC) subjects also underwent two functional magnetic resonance imaging scans, 12 weeks apart. Whole-brain voxelwise analysis of variance revealed significant Group×Time interactions in the amygdala and the ventral medial prefrontal cortex. Follow-up analyses showed that treatment in gSP subjects reduced amygdala reactivity to fearful faces (which was exaggerated relative to HCs before treatment) and enhanced ventral medial prefrontal cortex activation to angry faces (which was attenuated relative to HCs before treatment). However, these brain changes were not significantly related to social anxiety symptom improvement. SSRI treatment response in gSP is associated with changes in a discrete limbic-paralimbic brain network, representing a neural mechanism through which SSRIs may exert their actions.

Cash and fraud: A destructive alliance revisited

AbstractBy all accounts, today's business environment is a “perfect storm” for fraud. Today's economic climate places more emphasis on success—no matter how it is achieved. Many business leaders and managers begin to rationalize away any wrongdoings as completely appropriate. And computer technology has often made fraud easier. As a result of all this, self‐serving and inappropriate decisions may now routinely be made without any without fear of scrutiny. In layman's terms, this is a workable definition of fraud. The authors of this article take a close look at this troubling situation and discuss what to do about it. © 2012 Wiley Periodicals, Inc.

Development and Validation of the Social Exercise and Anxiety Measure (SEAM): Assessing Fears, Avoidance, and Importance of Social Exercise

In two studies (N = 416; N = 118) examining responses from undergraduates, we developed the Social Exercise and Anxiety Measure (SEAM) and tested its factorial, convergent, and divergent validity. Our results demonstrate that the SEAM exhibits an excellent three factor structure consisting of the following subscales: Social Exercise Self-efficacy, Gym Avoidance, and Exercise Importance. In both studies, Social Exercise Self-efficacy correlated negatively and Gym Avoidance correlated positively with social interaction anxiety, fear of scrutiny, and fear of negative evaluation. Exercise Importance correlated positively with frequency of exercise and frequency of public exercise. Implications for the mental and physical health of individuals with high levels of social anxiety are discussed.

Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears

Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with disordered eating. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation, and social appearance anxiety. Results indicated that social appearance anxiety predicted body dissatisfaction, bulimic symptoms, shape concern, weight concern, and eating concern over and above fear of scrutiny, social interaction anxiety, and fear of positive evaluation. Fear of negative evaluation uniquely predicted drive for thinness and restraint. Structural equation modeling supported a model in which social appearance anxiety and fear of negative evaluation are vulnerabilities for both social anxiety and eating disorder symptoms. Interventions that target these negative social evaluation fears may help prevent development of eating disorders.

Fear and avoidance of eye contact in social anxiety disorder

Background Excessive fear of scrutiny is a defining feature of social anxiety disorder. Eye contact may trigger feelings of being scrutinized, and although eye contact is commonly feared in persons with social anxiety disorder, it has been studied little. The purpose of this study was to characterize fear and avoidance of eye contact in patients with social anxiety disorder and in nonpatient samples. Methods Gaze fears and avoidance, social anxiety, and depression were assessed in 44 patients with generalized social anxiety disorder, 17 matched healthy comparison subjects, and 79 undergraduates. Patients were reassessed after 8 to 12 weeks of treatment with paroxetine. A new self-report instrument, the Gaze Anxiety Rating Scale (GARS), was used to assess fear and avoidance of eye contact, and its psychometric properties were analyzed. Results Patients with generalized social anxiety disorder, in comparison with healthy control participants, reported significantly increased levels of fear and avoidance of eye contact, which decreased significantly after 8 to 12 weeks of treatment with paroxetine. Fear and avoidance of eye contact were significantly associated with severity of social anxiety in all 3 samples. The GARS demonstrated excellent internal consistency within each sample. Conclusions Self-reported fear and avoidance of eye contact are associated with social anxiety in both nonpatient and social anxiety disorder samples. Preliminary psychometric analyses suggest that the GARS has utility in the assessment of gaze anxiety.

Motor cortex excitability correlates with novelty seeking in social anxiety: a transcranial magnetic stimulation investigation

Social anxiety disorder (SAD) is characterised by fear of scrutiny by other people, avoidance of social situations and vegetative/motor symptomatology. The correlation between reduced striatal dopaminergic (DA) function, SAD motor symptoms and the high occurrence of SAD in patients with Parkinson's disease (PD), suggests a link between SAD and movement diseases caused by dopamine dysfunction. However, little is known about the electrophysiological aspects of SAD. We applied single- and paired-pulse transcranial magnetic stimulation (TMS) to investigate excitatory and inhibitory mechanisms of the primary motor cortex (M1) in 15 SAD patients and the relationship between these neurophysiological measures and clinical symptoms or temperamental traits. Data were compared with those obtained in 15 age- and sex-matched healthy volunteers. SAD patients showed significantly higher harm avoidance scores and lower novelty seeking scores when compared to controls. TMS measures did not significantly differ between groups. However, in SAD patients the cortical silent period (CSP) duration and the amount of long-interstimulus interval intracortical inhibition were significantly correlated with the NS score. Accordingly with NS reduction and CSP shortening reported in PD, the relationship between NS levels and the excitability of inhibitory circuits of the M1 may support the hypothesis that DA dysfunction could underlie NS deficits in SAD. Furthermore, these data suggest that "trait variables" (i.e., NS) are more closely related to neurophysiological measures than SAD symptoms, which represent "state variables" linked to social performance.

Understanding social anxiety as a risk for alcohol use disorders: Fear of scrutiny, not social interaction fears, prospectively predicts alcohol use disorders

Increasing evidence indicates that social anxiety may be a premorbid risk factor for alcohol use disorders (AUD). The aim of this study was to replicate and extend previous work examining whether social anxiety is a risk factor for AUD by evaluating both the temporal antecedence and non-spuriousness of this relationship. We also examined whether social anxiety first-order factors (social interaction anxiety, observation anxieties) served as specific predictors of AUD. A non-referred sample of 404 psychologically healthy young adults (i.e. free from current or past Axis I psychopathology) was prospectively followed over approximately two years. Social anxiety (but not depression or trait anxiety) at baseline significantly predicted subsequent AUD onset. The relationship between social anxiety and AUD remained even after controlling for relevant variables (gender, depression, trait anxiety). Further, social anxiety first-order factors differentially predicted AUD onset, such that observation anxieties (but not social interaction anxiety) were prospectively linked to AUD onset. This study provides further support that social anxiety (and fear of scrutiny specifically) appears to serve as an important and potentially specific AUD-related variable that deserves serious attention as a potential vulnerability factor.

The many faces of social anxiety disorder.

Social anxiety disorder, also known as social phobia, is one of the most prevalent anxiety disorders, affecting 7-13% of subjects in the community at some time in their lives. Despite being eminently treatable, it remains largely under-recognised and, therefore, undertreated. The disorder is characterized by a fear of scrutiny by others, with sufferers experiencing excessive anxiety in social and performance situations. This excessive anxiety usually leads to avoidance behaviour that can severely affect normal daily living. With onset commonly occurring during childhood or adolescence, social anxiety disorder may disrupt normal patterns of development of social and personal relationships, often having a long-term impact on emotional stability in social or working life. If left untreated, the course of social anxiety disorder is frequently complicated with comorbid conditions, particularly major depression or substance abuse. This review assesses the size of the clinical problem by evaluating current and lifetime prevalence estimates, age of onset, risk factors and evolution of the clinical course; thereby providing the rationale for early recognition and prompt treatment.