Maintenance Of Social Anxiety Disorder Research Articles

Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues

Biases in attention processes are thought to play a crucial role in the aetiology and maintenance of Social Anxiety Disorder (SAD). The goal of the present study was to examine the efficacy of a programme intended to train attention towards positive cues and a programme intended to train attention towards negative cues. In a randomised, controlled, double-blind design, the impact of these two training conditions on both selective attention and social anxiety were compared to that of a control training condition. A modified dot probe task was used, and delivered via the internet. A total of 129 individuals, diagnosed with SAD, were randomly assigned to one of these three conditions and took part in a 14-day programme with daily training/control sessions. Participants in all three groups did not on average display an attentional bias prior to the training. Critically, results on change in attention bias implied that significantly differential change in selective attention to threat was not detected in the three conditions. However, symptoms of social anxiety reduced significantly from pre- to follow-up-assessment in all three conditions (dwithin = 0.63–1.24), with the procedure intended to train attention towards threat cues producing, relative to the control condition, a significantly greater reduction of social fears. There were no significant differences in social anxiety outcome between the training condition intended to induce attentional bias towards positive cues and the control condition. To our knowledge, this is the first RCT where a condition intended to induce attention bias to negative cues yielded greater emotional benefits than a control condition. Intriguingly, changes in symptoms are unlikely to be by the mechanism of change in attention processes since there was no change detected in bias per se. Implications of this finding for future research on attention bias modification in social anxiety are discussed.Trial RegistrationClinicalTrials.gov NCT01463137

Heart rate variability and its neural correlates during emotional face processing in social anxiety disorder

The monitoring and regulation of one's own physiological reactions and cardioregulatory abnormalities are central to the aetiology and maintenance of social anxiety disorder (SAD). We therefore explored the neural correspondences of these heart rate alterations.21 patients with SAD and 21 matched healthy controls (HCs) underwent 3T-fMRI scanning. Simultaneously, high-frequency heart rate variability (HF-HRV) was acquired during a short-term resting period and an implicit emotional face-matching task.Compared to HCs, patients with SAD reported increased self-focused attention while being less accurate in estimating their heartbeats. Physiologically, they showed less HF-HRV at rest and during task. Across groups, HF-HRV at rest correlated positively with activation in visual face-processing areas. The right caudate nucleus showed an interaction of group and cardioregulation: Activation in this region was positively correlated in patients with SAD but negatively in HCs. We conclude that cardioregulation is altered in SAD on the subjective, physiological, and brain level.

Mediators of the relationship between social anxiety and post-event rumination

A variety of cognitive and attentional factors are hypothesised to be associated with post-event rumination, a key construct that has been proposed to contribute to the maintenance of social anxiety disorder (SAD). The present study aimed to explore factors contributing to post-event rumination following delivery of a speech in a clinical population. 121 participants with SAD completed measures of trait social anxiety a week before they undertook a speech task. After the speech, participants answered several questionnaires assessing their state anxiety, self-evaluation of performance, perceived focus of attention and probability and cost of expected negative evaluation. One-week later, participants completed measures of negative rumination experienced over the week. Results showed two pathways leading to post-event rumination: (1) a direct path from trait social anxiety to post-event rumination and (2) indirect paths from trait social anxiety to post-event rumination via its relationships with inappropriate attentional focus and self-evaluation of performance. The results suggest that post event rumination is at least partly predicted by the extent to which socially anxious individuals negatively perceive their own performance and their allocation of attentional resources to this negative self-image. Current findings support the key relationships among cognitive processes proposed by cognitive models.

Cognitive Therapy vs Interpersonal Psychotherapy in Social Anxiety Disorder

Cognitive therapy (CT) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder (SAD). Interpersonal psychotherapy (IPT) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of SAD. No direct comparisons of the treatments for SAD in an outpatient setting exist. To compare the efficacy of CT, IPT, and a waiting-list control (WLC) condition. Randomized controlled trial. Two academic outpatient treatment sites. Patients Of 254 potential participants screened, 117 had a primary diagnosis of SAD and were eligible for randomization; 106 participants completed the treatment or waiting phase. Treatment comprised 16 individual sessions of either CT or IPT and 1 booster session. Twenty weeks after randomization, posttreatment assessment was conducted and participants in the WLC received 1 of the treatments. The primary outcome was treatment response on the Clinical Global Impression Improvement Scale as assessed by independent masked evaluators. The secondary outcome measures were independent assessor ratings using the Liebowitz Social Anxiety Scale, the Hamilton Rating Scale for Depression, and patient self-ratings of SAD symptoms. At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC. Regarding response rates and Liebowitz Social Anxiety Scale scores, CT performed significantly better than did IPT, and both treatments were superior to WLC. At 1-year follow-up, the differences between CT and IPT were largely maintained, with significantly higher response rates in the CT vs the IPT group (68.4% vs 31.6%) and better outcomes on the Liebowitz Social Anxiety Scale. No significant treatment × site interactions were noted. Cognitive therapy and IPT led to considerable improvements that were maintained 1 year after treatment; CT was more efficacious than was IPT in reducing social phobia symptoms.

Face value: Eye movements and the evaluation of facial crowds in social anxiety

Scientific evidence is equivocal on whether Social Anxiety Disorder (SAD) is characterized by a biased negative evaluation of (grouped) facial expressions, even though it is assumed that such a bias plays a crucial role in the maintenance of the disorder. To shed light on the underlying mechanisms of face evaluation in social anxiety, the eye movements of 22 highly socially anxious (SAs) and 21 non-anxious controls (NACs) were recorded while they rated the degree of friendliness of neutral-angry and smiling-angry face combinations. While the Crowd Rating Task data showed no significant differences between SAs and NACs, the resultant eye-movement patterns revealed that SAs, compared to NACs, looked away faster when the face first fixated was angry. Additionally, in SAs the proportion of fixated angry faces was significantly higher than for other expressions. Independent of social anxiety, these fixated angry faces were the best predictor of subsequent affect ratings for either group. Angry faces influence attentional processes such as eye movements in SAs and by doing so reflect biased evaluations. As these processes do not correlate with explicit ratings of faces, however, it remains unclear at what point implicit attentional behaviors lead to anxiety-prone behaviors and the maintenance of SAD. The relevance of these findings is discussed in the light of the current theories.

Familial risk factors in social anxiety disorder: calling for a family-oriented approach for targeted prevention and early intervention

Within the last decade, social anxiety disorder (SAD) has been identified as a highly prevalent and burdensome disorder. Both the characterization of its symptomatology and effective treatment options are widely documented. Studies particularly indicate that SAD aggregates in families and has its onset in early adolescence. Given the family as an important context for children's cognitive, emotional and behavioural development, familial risk factors could be expected to significantly contribute to the reliable detection of populations at risk for SAD. Reviewing studies on familial risk factors for SAD argues for the importance of parental psychopathology and unfavourable family environment, but also denotes to several shortcomings such as cross-sectional designs, short follow-up periods, diverging methodologies and the focus on isolated factors. Using a prospective longitudinal study that covers the high-risk period for SAD, including a broader spectrum of putative risk factors may help to overcome many of the methodological limitations. This review sets out to develop a more family-oriented approach for predicting the onset and maintenance of SAD that may be fruitful to derive targeted prevention and early intervention in SAD.

Attention and Memory Biases in Social Anxiety Disorder: The Role of Comorbid Depression

Cognitive biases play an important role in the onset and maintenance of Social Anxiety Disorder (SAD). Few studies, however, have examined the role of comorbid Major Depressive Disorder (MDD) in the processing of emotional material. In addition, little is known about the relation among different cognitive biases. In the current study, 73 participants (54.79% female) completed an emotion face dot-probe task followed by a recognition memory test. Compared to participants with SAD, participants with comorbid SAD and MDD oriented away from supraliminally presented angry faces. Subsequently, SAD participants with and without comorbidity recognized fewer angry faces than non-disordered controls. Furthermore, attention biases for subliminally presented stimuli predicted recognition accuracy only for comorbid participants. These results suggest that the presence of comorbid MDD affects attentional orienting in SAD participants. In addition, it highlights the interconnectedness of attention and memory biases for comorbid participants.

Does modified interpretation bias influence automatic avoidance behaviour?

AbstractCognitive bias modification (CBM) studies suggest a causal role of interpretation biases in the aetiology and maintenance of Social Anxiety Disorder. However, it is unknown if the effects of induced biases transfer to behaviour. In two analogue studies, behavioural changes in response to aversive and positive stimuli were measured after the induction of positive and negative interpretation biases in ‘averagely anxious’ participants. Responses to emotional multi‐facial displays (‘crowds’) were measured using an indirect Approach–Avoidance Task (AAT). The crowds comprised different ratios of either neutral and angry faces or happy and angry faces. In Experiment 1, negatively trained participants (NETs) showed a faster avoidance response for the neutral–angry crowds when the number of angry pictures in the crowd increased. This response pattern resembles the one previously found in socially anxious individuals. Experiment 2 replicated the effect of the cognitive bias manipulation on conceptually comparable material, but did not show transfer to the behavioural task. These studies add to the body of knowledge regarding successful modification of interpretive bias and generalizability to a behavioural task. Copyright © 2010 John Wiley & Sons, Ltd.

Effects of Safety Behaviour On the Maintenance of Anxiety and Negative Belief Social Anxiety Disorder

Safety behaviour plays an important role in the maintenance of social anxiety disorder (SAD). SAD patients engage in various safety behaviours in social situations in order to decrease the risk of negative evaluations from others. The present study examined the effect of safety behaviour on the maintenance of anxiety and negative belief in SAD by using Structural Equation Modelling (SEM). Participants were a healthy group (442) and a SAD group (46) who met the SAD criteria for DSM-IV and who had high scores of SAD symptoms. In the assumed maintenance model, independence variables were safety and avoidance behaviour and dependence variables were anxiety and negative belief. This result showed that the SAD group significantly has more high scores than the healthy group in all scales of anxiety, negative belief and avoidance behaviour, expect for safety behaviour. The result of the multiple-group procedure indicated that safety behaviour contributes more strongly to anxiety and negative belief in the SAD group than in the healthy group. It is speculated that the SAD group have a stronger link between safety behaviour and negative belief than the healthy group, whereas frequency of the use of safety behaviour is equivalent between two groups. These results support the findings of previous studies.

The Social Thoughts and Beliefs Scale: Psychometric Properties and its Relation with Interpersonal Functioning in a Non-Clinical Sample

Cognitive theorists maintain that maladaptive cognitions play an important role in the formation and maintenance of social anxiety disorder. The Social Thoughts and Beliefs Scale (STABS; Turner et al. Psychol Assessment 15:384–391, 2003) was developed to assess the broad domain of cognitions associated with social anxiety in a clinical sample. The present study with 469 college students examined the applicability of the STABS with a non-clinical sample and its relation with social anxiety symptoms and indices of interpersonal functioning. The STABS scales showed good reliability (internal consistency), adequate convergent and discriminant validity, and acceptable concurrent and incremental concurrent validity in predicting social interaction anxiety or outcomes of interpersonal functioning. The STABS appears to have good psychometric properties measuring two dimensions, assessing thoughts of social comparisons and thoughts of social ineptness, and appears to be appropriate for use with non-clinical samples.

Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.

Etiology of Social Anxiety Disorder in Children and Youth

AbstractSocial Anxiety Disorder is a heterogeneous and distressing problem for many children and youth. Unravelling its multiple causes is essential for a full understanding of the condition. This selective review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent-child interactions (attachment, parenting styles). We conclude that genetic influences, behavioural inhibition and parent-child interactions play significant and interactive roles in the development and maintenance of social anxiety disorder. Other influences are also acknowledged, such as peer relationships, social skills deficits and traumatic experience. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.