Generalized Social Anxiety Disorder Research Articles

Effectiveness of Social Skill Training Programme on Social Anxiety and Self-Esteem among Adolescents

Background: Social skill training is one of the most effective management for the client with social anxiety and self-esteem. Hence the investigator felt the need to evaluate the effectiveness of social skill training programme on social anxiety and self-esteem. Aim: to assess the effectiveness of social skill training program on social anxiety and self-esteem among adolescents studying in selected high schools of Bagalkot.” Methodology: True experimental study with pre test- post test control group design with 100 subjects selected through simple random sampling technique and assigned 50 adolescents to experimental group and 50 adolescents to control group by using computer generated random numbers. Data was collected using Kutcher Generalized Social Anxiety Disorder scale to assess the social anxiety and Rosenberg Self-esteem Scale to assess the self-esteem among adolescents. Social skill training program was administered for 45mins to 1 hour for 6 consecutive days for experimental group. Data were analyzed by using descriptive and inferential statistics in terms of frequency distribution, percentage, mean, mean percentage, Standard Deviation, paired‘t’ test, Unpaired ‘t’ test and Chi-square test. Findings: Findings related to significance of difference between post test social anxiety and self-esteem scores of experimental group and control group subjects revealed that, a statistically significant difference was found between post test social anxiety scores of experimental group and control group subjects [t=7.23), p<0.05].Similarly there was a statistically significant difference found between post-test self-esteem scores of experimental group and control group subjects [t=6.71, p<0.05]. Conclusion: The study proved that Social skill training programme on social anxiety and self-esteem among adolescents was effective, scientific, logical and cost effective strategy. Keywords: Adolescents, Social anxiety, Self-esteem, Effectiveness, Social skill training programme and Socio-demographic variables.

Discomfort with Friendly Giving in Individuals with Social Anxiety Disorder

Prior research focusing on social anxiety and impairment in friendships has explored the role of specific behaviors within friendships, such as receiving favors from a friend, in its relation to social anxiety symptoms and friendship quality. In a prior study, we examined three types of reactions to favors (negative reactions to favors, positive reactions to favors, and expectation of tit-for-tat behavior) and explored how these reactions relate to social anxiety, which resulted in the creation of the Favor Scale, a measure of an individual’s response to friendly giving. In the current study, we explore the psychometric properties of the Favor Scale in a sample of individuals with generalized social anxiety disorder (GSAD) and a sample of healthy controls (NOSAD). Results largely replicated the three-factor structure of the Favor Scale (with the removal of a single item in the GSAD group) and findings suggested both tit-for-tat behavior and negative reactions to favors are elevated in GSAD individuals compared to NOSAD individuals.

THE ASSOCIATION BETWEEN PERFECTIONISM AND SOCIAL ANXIETY AMONG ADOLESCENTS IN SELANGOR, MALAYSIA

Social anxiety is explained as noticeable anxiety or fear in one or more social situations where the individual is exposed to possible analysis by others. This research is aimed to determine the association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. A final sample of 327 participants, between 13 to 18 years old, was collected. Data collection was conducted in two public secondary schools and two private high schools in Selangor. This survey included three instruments of analysis: The Child-Adolescent Perfectionism Scale, Kutcher Generalized Social Anxiety Disorder Scale for Adolescents and Demographic Questionnaire. The results showed that there is a significant positive association between perfectionism and social anxiety. This study has proved the positive association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. Therefore, it is important to identify those students with these issues and guide them in an effective way to overcome the issues.

Phobia among residents in board training programs in Abha, Kingdom of Saudi Arabia, 2019.

Background:Phobia is an extreme form of anxiety or fear which is triggered by a given situation or object or even danger associated with a situation or object for more than 6 months. There are three main forms of phobia: social phobia (social anxiety disorder), specific phobia, or agoraphobia. Agoraphobia is a form of anxiety disorder where one fears and avoids situations or places that might cause them to panic. The main purpose of this study is to investigate phobia among residents in broad training programs in Abha city and compare phobia between residents in broad training programs and general practitioners in Abha city.Methods:It is a cross-sectional study. The study was conducted in Abha city of Saudi Arabia from December 2019 to March 2020. It included a representative sample of medical doctors under broad training programs and general practitioners (none trained) in all the health-care centers. A link for the survey questionnaires was created and shared with the respondents. The questionnaire included sociodemographics of the participants, the Kutcher Generalized Social Anxiety Disorder Scale, and the Psychometric Properties and Clinical Utility of the Specific Phobia Questionnaire in an Anxiety Disorders Sample for specific phobia.Results:The study included 300 physicians. Majority of them (81%) were in the age group between 25 and 30 years. Males represent 54% of them. There was no statistically significant difference between resident physicians and general practitioners regarding the avoidance of different social situations.Conclusion:Overall, the residents in board training programs in Abha city expressed lower levels of discomfort, anxiety, distress, avoidance, fear, and life interference of some social and specific situations compared to general practitioners.

Trial-Based Cognitive Therapy: Efficacy of a New CBT Approach for Treating Social Anxiety Disorder with Comorbid Depression

The present study aims to evaluate the efficacy of Trial-Based Cognitive Therapy (TBCT), a new cognitive-behavioral therapy approach, for generalized social anxiety disorder (GSAD) in a population with high rates of comorbid disorders, especially depression. This two-arm randomized clinical trial included 39 adults (TBCT = 18; waitlist group = 21) diagnosed with GSAD. The TBCT group received 16 weekly sessions of individual TBCT. Symptom severity was assessed at pre- and post-treatment. Participants in the TBCT group showed reduction in social anxiety, social avoidance, and depression, all associated with a large effect size. No differences between pre- and post-treatment scores were observed in the waitlist condition. Results also showed that comorbidity significantly moderated treatment efficacy. Patients with comorbid conditions showed greater reductions in social anxiety symptoms across treatment than those with SAD only. In summary, TBCT was effective in reducing social anxiety and depressive symptoms, particularly for patients with comorbidity.

Altered regional and integrated resting-state brain activity in general social anxiety disorder patients before and after group cognitive behavior therapy

We aimed to investigate the recovery neuromechanism underlying the treatment efficacy in generalized social anxiety disorder (GSAD). We recruited fifteen patients with GSAD and nineteen healthy control (HC) participants, all of whom underwent a baseline resting-state fMRI scan. The GSAD patients underwent an additional fMRI scan after group cognitive behavior therapy (GCBT). Amplitude of low-frequency fluctuation (ALFF) and degree centrality (DC) measures were used to examine altered regional and integrated spontaneous brain activity in group comparisons. After GCBT, ALFF of the right precuneus decreased. At baseline, the GSAD group showed higher ALFF in the left precuneus and the left middle temporal gyrus (MTG) and lower ALFF in the lingual gyrus compared with the HC group. The DC of the left precuneus and the MTG were attenuated and the right putamen increased in the post-treatment group. The changes in DC in the precuneus were positively correlated with changes in clinical symptom. The abnormal ALFF of the precuneus, MTG and lingual gyrus may be the neural underpinning of GSAD, whereas the neural response to symptom remission after GCBT was achieved by a rebalance within the default mode network.

What's the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder.

Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

Aberrant pulvinar effective connectivity in generalized social anxiety disorder.

Recent neuroimaging findings in general social anxiety disorder (gSAD) have extended our understanding of the neural mechanisms of gSAD beyond an amygdala-centric fear-based hyperactivity model to include other brain regions and networks relevant to salient cues. In particular, higher order areas compromising visual networks that process emotional and social information have been implicated. The pulvinar anchors this network and is a key regulatory node that mediates complex sensory inputs and the integration between limbic and frontal brain systems. However, the role of the pulvinar and specifically alteration of its effective connectivity with the rest of the brain has not been examined in the pathophysiology of gSAD, a disorder characterized by aberrant socio-emotional processing. The main aim of this study was to examine the pulvinar network effective connectivity in gSAD. In this study, we recruited 21 individuals with gSAD and 19 demographically matched healthy controls (HC), who performed an emotional face processing task while brain activity was recorded using functional magnetic resonance imaging (fMRI). To examine pulvinar-based network dynamics, Granger causality (GC) based effective connectivity (EC) analysis was applied on fMRI data to compare gSAD and HC. The EC analysis revealed heightened casual influential dynamics between pulvinar in higher order visual and frontal regions in gSAD. In conclusion, these preliminary data suggest a novel network-based cortico-pulvino-cortical neural mechanism in the pathophysiology of gSAD.

Group cognitive behavioral therapy modulates the resting-state functional connectivity of amygdala-related network in patients with generalized social anxiety disorder.

BackgroundAmygdala is considered as the core pathogenesis of generalized social anxiety disorder (GSAD). However, it is still unclear whether effective group cognitive behavioral therapy (CBT) could modulate the function of amygdala-related network. We aimed to examine the resting-state functional connectivity (rsFC) of the amygdala before and after group CBT.MethodsFifteen patients with GSAD were scanned on a 3T MR system before and after 8 weeks of group CBT. For comparison, nineteen healthy control participants also underwent baseline fMRI scanning. We used bilateral amygdala as seed regions and the rsFC maps of the right and left amygdala were created separately in a voxel-wise way. Clusters survived two-tailed Gaussian Random Field (GRF) correction at p <0.05 (voxel z value >2.3).ResultsCompared with baseline, patients with CBT showed significantly decreased connectivity of the left amygdala with the right putamen, the left dorsal medial prefrontal cortex (dmPFC) and the right dorsal anterior cingulate cortex (dACC). Especially, the changes of the connectivity between the left amygdala and the dACC positively correlated with changes of the anxiety symptom in patients. Furthermore, in relative to controls, patients showed higher connectivity of left amygdala with dmPFC and dACC at baseline, while normal after CBT.ConclusionsShort-term group CBT could down-regulate the abnormal higher connectivity of prefrontal-amygdala network, along with clinical improvement. This may provide a potential biomarker to monitor the treatment effect of CBT in GSAD patients.

Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder

Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n=37) compared to individuals without a GSAD diagnosis (NOSAD; n=26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis.

Oxytocin modulation of amygdala functional connectivity to fearful faces in generalized social anxiety disorder.

The neuropeptide oxytocin (OXT) is thought to attenuate anxiety by dampening amygdala reactivity to threat in individuals with generalized social anxiety disorder (GSAD). Because the brain is organized into networks of interconnected areas, it is likely that OXT impacts functional coupling between the amygdala and other socio-emotional areas of the brain. Therefore, the aim of the current study was to examine the effects of OXT on amygdala functional connectivity during the processing of fearful faces in GSAD subjects and healthy controls (HCs). In a randomized, double-blind, placebo (PBO)-controlled, within-subjects design, 18 HCs and 17 GSAD subjects performed a functional magnetic resonance imaging task designed to probe amygdala response to fearful faces following acute intranasal administration of PBO or OXT. Functional connectivity between the amygdala and the rest of the brain was compared between OXT and PBO sessions using generalized psychophysiological interaction analyses. Results indicated that within individuals with GSAD, but not HCs, OXT enhanced functional connectivity between the amygdala and the bilateral insula and middle cingulate/dorsal anterior cingulate gyrus during the processing of fearful faces. These findings suggest that OXT may have broad pro-social implications such as enhancing the integration and modulation of social responses.

Modulation of Resting-State Amygdala-Frontal Functional Connectivity by Oxytocin in Generalized Social Anxiety Disorder

Generalized social anxiety disorder (GSAD) is characterized by aberrant patterns of amygdala-frontal connectivity to social signals of threat and at rest. The neuropeptide oxytocin (OXT) modulates anxiety, stress, and social behaviors. Recent functional neuroimaging studies suggest that these effects are mediated through OXT's effects on amygdala reactivity and/or amygdala-frontal connectivity. The aim of the current study was to examine OXT's effects on amygdala-frontal resting-state functional connectivity (rsFC) in GSAD patients and healthy controls (HCs). In a randomized, double-blind, cross-over design, 18 GSAD and 18 HC participants received intranasal OXT (24 IU or 40.32 μg) or placebo (PBO) before resting-state functional magnetic resonance imaging. In individuals with GSAD, OXT enhanced rsFC of the left and right amygdala with rostral anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC), and in doing so, reversed (ie, 'normalized') the reduced amygdala-frontal connectivity observed relative to HCs evident on PBO. Higher social anxiety severity in GSAD subjects correlated with lower amygdala-ACC/mPFC connectivity on PBO and higher social anxiety also correlated with greater enhancement in amygdala-frontal connectivity induced by OXT. These findings show that OXT modulates a neural circuit known for social threat processing and emotion regulation, suggesting a neural mechanism by which OXT may have a role in the pathophysiology and treatment of social anxiety disorder.

Smiles may go unseen in generalized social anxiety disorder: Evidence from binocular rivalry for reduced visual consciousness of positive facial expressions

Research has demonstrated increased attention to negative social cues and reduced attention to positive social cues in generalized social anxiety disorder (GSAD), but little is known about whether GSAD also involves differences in lower levels of visual processing. This study explored visual experience in GSAD compared to participants with generalized anxiety disorder (GAD) and healthy controls using binocular rivalry. Participants were presented with dissimilar images to each eye, and the two images competed for perceptual dominance. Consistent with the hypothesis that GSAD involves a reduced visual salience for positive social cues, we found that smiling faces were dominant for significantly shorter durations in GSAD compared to GAD and controls. Contrasting with our hypothesis of greater visual salience of negative social cues, we found no difference in negative stimuli salience. These findings are consistent with the broader view that a perceiver's affective state directly influences the content of visual consciousness.

ABERRANT REWARD CENTER RESPONSE TO PARTNER REPUTATION DURING A SOCIAL EXCHANGE GAME IN GENERALIZED SOCIAL PHOBIA

Generalized social anxiety disorder (GSAD) is characterized by excessive fear of public scrutiny and reticence in social engagement. Previous studies have probed the neural basis of GSAD often using static, noninteractive stimuli (e.g., face photographs) and have identified dysfunction in fear circuitry. We sought to investigate brain-based dysfunction in GSAD during more real-world, dynamic social interactions, focusing on the role of reward-related regions that are implicated in social decision-making. Thirty-six healthy individuals (healthy control [HC]) and 36 individuals with GSAD underwent functional magnetic resonance imaging (fMRI) scanning while participating in a behavioral economic game ("Trust Game") involving iterative exchanges with fictive partners who acquire differential reputations for reciprocity. We investigated brain responses to reciprocation of trust in one's social partner, and how these brain responses are modulated by partner reputation for repayment. In both HC and GSAD, receipt of reciprocity robustly engaged ventral striatum, a region implicated in reward. In HC, striatal responses to reciprocity were specific to partners who have consistently returned the investment ("cooperative partners"), and were absent for partners who lack a cooperative reputation. In GSAD, modulation of striatal responses by partner reputation was absent. Social anxiety severity predicted diminished responses to cooperative partners. These results suggest abnormalities in GSAD in reward-related striatal mechanisms that may be important for the initiation, valuation, and maintenance of cooperative social relationships. Moreover, this study demonstrates that dynamic, interactive task paradigms derived from economics can help illuminate novel mechanisms of pathology in psychiatric illnesses in which social dysfunction is a cardinal feature.

PLASMA OXYTOCIN IMMUNOREACTIVE PRODUCTS AND RESPONSE TO TRUST IN PATIENTS WITH SOCIAL ANXIETY DISORDER

Generalized Social Anxiety Disorder (GSAD) is characterized by excessive fear and avoidance of several types of social and performance situations. The pathophysiology is not well understood, but research in animals and humans has provided evidence that oxytocin helps regulate normal social affiliative behavior. Previous work in healthy male subjects demonstrated a rise in plasma oxytocin after receiving a high trust signal. To examine the oxytocin system in GSAD, we measured plasma oxytocin in GSAD patients and controls, before and after the social "Trust Game," a neuroeconomic test examining trust behavior and reaction to trust using real monetary incentives. Thirty-nine subjects with GSAD and 28 healthy controls provided three blood samples for oxytocin measurement before the Trust Game, and one sample after the game. Plasma estradiol was also measured at baseline. The Trust Game protocol version prioritized the sending of a signal of high cooperation and trust to all participants. All analyses controlled for gender and estradiol levels. Mean oxytocin levels post-Trust Game (P = .025), and overall (area under the curve, P = .011) were lower in GSADpatients compared to controls, after controlling for sex and estradiol. There was no significant change in oxytocin levels after the game in either group. We report low plasma oxytocin levels in patients with GSAD during a prosocial laboratory task paradigm. Additional research will be important to further examine the relationship between oxytocin and social behavior in GSAD.

Interpretation training in individuals with generalized social anxiety disorder: a randomized controlled trial.

To examine the efficacy of a multisession computerized interpretation modification program (IMP) in the treatment of generalized social anxiety disorder (GSAD). The sample comprised 49 individuals meeting diagnostic criteria for GSAD who were enrolled in a randomized, double-blind placebo-controlled trial comparing IMP (n = 23) with an interpretation control condition (ICC; n = 26). The interpretation training procedures comprised a word-sentence association task in which participants decided whether a word implying a threatening or benign meaning was related to an ambiguous social scenario. In the IMP group, participants were reinforced for interpreting ambiguous social information in a nonthreatening and more benign manner. In the ICC group, participants were reinforced with equal frequency for interpreting ambiguous social information in either a threatening or benign manner. Intent-to-treat and completer analyses revealed that IMP significantly decreased threat interpretations and increased benign interpretations from pre- to post-assessment relative to the ICC group. Moreover, IMP participants displayed significantly larger reductions in clinician-rated social anxiety symptoms and functional impairment as well as self-reported trait anxiety and depression relative to ICC participants. Groups did not differ on change in self-rated social anxiety symptoms. Participants no longer meeting DSM-IV criteria for GSAD at post-assessment were 65% in IMP and 13% in ICC. These results suggest that computerized interpretation training procedures may be beneficial for treating social anxiety disorder.

Avoidant personality disorder in individuals with generalized social anxiety disorder: What does it add?

Avoidant personality disorder (AvPD) has a high level of symptom overlap and comorbidity with generalized social anxiety disorder (GSAD). We examined whether the presence of comorbid AvPD adds significant clinically relevant information for individuals seeking treatment for GSAD. Results suggested that AvPD was significantly associated with poorer quality of life and greater disability in univariate, but not multivariate analyses. Endorsement of more AvPD symptoms was associated with increased disability, increased risk of intimacy, and lower social support, even after covariate adjustment. Specifically, AvPD item 3, hard to be “open” even with people you are close to, was most strongly correlated with quality of life and disability. A binary diagnosis of AvPD alone adds little beyond a marker of greater GSAD severity and depression among patients with GSAD, while a specific feature of AvPD not captured by the GSAD diagnosis, namely emotional guardedness, may be associated with greater impairment.

Lack of Association between Brain-Derived Neurotrophic Factor Gene Val66Met Polymorphisms and Generalized Social Anxiety Disorder in Korean Population

ObjectiveSeveral lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays a role in the pathophysiology of anxiety. We analyzed the association of the BDNF gene polymorphism, G196A (val66met), in the coding region of exon XIIIA in chromosome 11p13, and generalized social anxiety disorder (GSAD).MethodsPatients with GSAD (n=73) and age-matched control subjects (n=152) were tested for the BDNF (val66met) polymorphism. A clinical interview and a Mini-International Neuropsychiatric Interview were conducted by trained psychiatrists in order to diagnose GSAD. The symptomatic characteristics of the GSAD patients were assessed with the Hamilton Anxiety Rating Scale, the Beck Anxiety Inventory, the Retrospective Self Report of Inhibition, the Spielberger State-Trait Anxiety Inventory, and the Liebowitz Social Anxiety Scale.ResultsThere were no significant differences in the frequencies of the genotypes (χ2=0.961, degree of freedom [df]=2, p=0.619), alleles (χ2=0.415, df=1, p=0.519), or allele (methionine) carriers (χ2=0.019, df=1, p=0.889) between the patients and controls. In addition, when we compared the severity of social anxiety symptom as determined by the clinical scales with the genotypes of the BDNF gene, we could not find any significant differences between the genotypes or allele carriers.ConclusionThese results do not support the hypothesis that the BDNF gene might be a candidate gene for susceptibility or severity of GSAD in the Korean population in this study.

Neural response to eye contact and paroxetine treatment in generalized social anxiety disorder

Generalized social anxiety disorder (GSAD) is characterized by excessive fears of scrutiny and negative evaluation, but neural circuitry related to scrutiny in GSAD has been little studied. In this study, 16 unmedicated adults with GSAD and 16 matched healthy comparison (HC) participants underwent functional magnetic resonance imaging to assess neural response to viewed images of faces simulating movement into eye contact versus away from eye contact. GSAD patients were then treated for 8 weeks with paroxetine, and 15 patients were re-imaged. At baseline, GSAD patients had elevated neural response to eye contact in parahippocampal cortex, inferior parietal lobule, supramarginal gyrus, posterior cingulate and middle occipital cortex. During paroxetine treatment, symptomatic improvement was associated with decreased neural response to eye contact in regions including inferior and middle frontal gyri, anterior cingulate, posterior cingulate, precuneus and inferior parietal lobule. Both the magnitude of GSAD symptom reduction with paroxetine treatment and the baseline comparison of GSAD vs. HCs were associated with neural processing of eye contact in distributed networks that included regions involved in self-referential processing. These findings demonstrate that eye contact in GSAD engages neurocircuitry consistent with the heightened self-conscious emotional states known to characterize GSAD patients during scrutiny.

Medial frontal hyperactivity to sad faces in generalized social anxiety disorder and modulation by oxytocin

Generalized social anxiety disorder (GSAD) is associated with heightened limbic and prefrontal activation to negative social cues conveying threat (e.g. fearful faces), but less is known about brain response to negative non-threatening social stimuli. The neuropeptide oxytocin (Oxt) has been shown to attenuate (and normalize) fear-related brain activation and reactivity to emotionally negative cues. Here, we examined the effects of intranasal Oxt on cortical activation to non-threatening sad faces in patients with GSAD and matched controls (Con). In a double-blind placebo-controlled within-subjects design, the cortical activation to sad and happy (vs. neutral) faces was examined using functional magnetic resonance imaging following acute intranasal administration of 24 IU Oxt and placebo. Relative to the Con group, GSAD patients exhibited heightened activity to sad faces in the medial prefrontal cortex (mPFC/BA 10) extending into anterior cingulate cortex (ACC/BA 32). Oxt significantly reduced this heightened activation in the mPFC/ACC regions to levels similar to that of controls. These findings suggest that GSAD is associated with cortical hyperactivity to non-threatening negative but not positive social cues and that Oxt attenuates this exaggerated cortical activity. The modulation of cortical activity by Oxt highlights a broader mechanistic role of this neuropeptide in modulating socially negative cues in GSAD.