Measures Of Social Anxiety Symptoms Research Articles

Efficacy of the Chinese version interpretation bias modification training in an unselected sample: A randomized trial

Training individuals to interpret ambiguous information in positive ways might be an effective method of reducing social anxiety. However, little research had been carried out in Chinese samples, and the effect of interpretation training on other processes such as attentional bias also remained unclear. This study examined the effect of interpretation bias modification program (IMP) on interpretation bias, social anxiety and attentional bias, and the possible mediation effects. 51 healthy adults were randomly assigned to either a 5-session IMP training that guided them to endorse benign interpretation in ambiguous scenarios or an interpretation control condition (ICC). Self-reported measures of social anxiety symptoms, attentional bias and interpretation bias were evaluated before and after training. Results showed that compared to control group, IMP group generated more positive interpretations and less negative interpretations after training (F(1,49) = 7.65, p<0.01, ηp2 = 0.14; F(1,49) = 14.60, p<0.01, ηp2 = 0.23respectively). IMP yielded greater interpretation bias reduction (F(1,49) = 12.84, p<0.01, ηp2 = 0.21) and social anxiety reduction (F(1,49) = 21.39, p<0.01, ηp2 = 0.30) than ICC, but change in attentional bias was not significant between IMP and the control group. Change in interpretation bias did not show a significant mediation effect in the relationship between training condition and social anxiety reduction. This study provided preliminary evidence for the efficacy of the Chinese version of IMP training. Possible methodological issues and interpretations underlying the findings were discussed. This study was registered in Chinese Clinical Trial Registry (www.chitr.org.cn), a WHO approved registry. The title of registration trial was "A Study on the efficiency of cognitive bias and attentional bias training on fear and phobia" and the registration number was ChiCTR2100045670.

Safety behaviours in social anxiety: An examination across adolescence

BackgroundSafety behaviours have been shown to be a key maintaining factor in Social Anxiety Disorder (SAD). In adults, a two-factor structure of safety behaviours reflecting ‘avoidance’ and ‘impression-management’ types has been identified. This has not yet been investigated in adolescents. AimsWe set out to investigate the factor structure of safety behaviours in relation to adolescent social anxiety symptoms and SAD, the extent to which this varies by age, and then to examine the association between the derived factor scores and other social anxiety related phenomena. MethodQuestionnaire measures of social anxiety symptoms, cognitions and safety behaviours, peer relationship outcomes, general anxiety and depression were collected from a community sample of 584 younger (11–14 years) and 208 older (16–18 years) adolescents, and a clinical sample of 80 adolescents (11–18 years) with a primary diagnosis of SAD. Four hypotheses were investigated using exploratory and confirmatory factor analyses, regressions, correlations and path analyses. ResultsA two-factor structure reflecting ‘avoidance’ and ‘impression-management’ safety behaviours was supported in the community and clinical sample. Older adolescents were found to use ‘impression-management’ behaviours more than younger adolescents after controlling for overall safety behaviour score. Both types of safety behaviour were significantly positively associated with social anxiety symptoms and cognitions. Path analyses revealed an indirect effect of social anxiety symptoms on peer victimisation, social satisfaction and friendship quality via ‘avoidance’, but not ‘impression-management’ safety behaviours. ConclusionsBoth ‘avoidance’ and ‘impression-management’ safety behaviours are associated with social anxiety symptoms and cognitions in youth, with age-related differences in their frequency. ‘Avoidance’ behaviours are specifically associated with negative outcomes for quality of peer relationships.

Establishing the Psychometric Properties of the Self-Report Liebowitz Social Anxiety Scale for Children and Adolescents in a General Population Adolescent Sample

Abstract. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) is a valid and reliable clinician-administered measure of social anxiety symptoms in young people. It has been adapted for self-report completion, and although the psychometric properties of this version of the scale have been examined in Spanish, Hebrew, and French language versions, this has not yet been done for the English language version. In the present study, we examined the factor structure and psychometric properties of the self-report version of the scale (LSAS-CA-SR) in a sample of UK adolescents recruited from schools. The factor structure of the scale was determined in our sample of N = 829; a four-factor structure, with interaction anxiety, interaction avoidance, performance anxiety, and performance-avoidance subscales, provided the best fit to the data. Measurement invariance of the scale was demonstrated across age and gender. Psychometric properties of the scale were sound, with good internal consistency (.88–.97), acceptable test-retest reliability (.45–.57), and evidence for convergent and divergent validity.

The Relationship between Symptoms and Social Functioning over the Course of Cognitive Behavioral Therapy for Social Anxiety Disorder.

Background The present study is aimed at investigating the relationship between changes in symptoms and changes in social functioning during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD). Methods Ninety-six patients with SAD were treated with manualized group CBT. Measures of social anxiety symptoms, depression symptoms, cognition, and social functioning were administered at baseline and endpoint. Using multiple regression analysis, we examined the associations between the changes in four aspects (work, home management, social leisure activities, and private leisure activities) of social functioning as dependent variables and the changes in four factors (social interaction, public speaking, observation by others, and eating and drinking in public) in social anxiety symptoms, depression symptoms, and cognition as independent variables. Results The changes in work functioning were predicted by the changes in the public speaking factor in social anxiety symptoms. The changes in depression symptoms predicted the changes in home management. The significant predictors of changes in social leisure activities were the changes in the social interaction factor and depression symptoms. The changes in private leisure activities were predicted by the changes in the observation by others factor. The changes in cognition predicted nothing. Conclusion The present study suggested that the changes in social anxiety or depression symptoms may predict several aspects of social functioning changes in patients with SAD over the course of CBT. In order to improve social functioning, our results may be useful for selecting the fear or feared situation in CBT for SAD. Trial Registration. The clinical study registration number in the Japanese trials registry is UMIN CTR 000031147.

Working alliance does not mediate the relation between outcome expectancy and symptom improvement following cognitive behavioural therapy for social anxiety disorder

AbstractA small body of research shows that the working alliance mediates the relation between outcome expectancy and treatment response, but this model has not been applied to the treatment of social anxiety disorder. The present study tests the hypothesis that the working alliance mediates the relation between outcome expectancy and symptom improvement within a randomized controlled trial testing the efficacy of virtual reality exposure therapy for social anxiety disorder. A sample of 54 individuals diagnosed with social anxiety disorder completed eight sessions of virtual reality exposure therapy or exposure group therapy. Participants completed standardized self-report measures of outcome expectancy at the first session, of the working alliance at each session, and three measures of social anxiety symptoms at pre- and post-treatment. The working alliance did not mediate the relation between outcome expectancy and symptom improvement across time points, dependent measures, and treatment type. Bayes factors were calculated for the relation between the working alliance and symptom reduction, while controlling for outcome expectancy and therapist effects. Results were inconclusive. These null findings are intriguing and urge further study of the mechanisms through which common factors relate to treatment response. Utilization of Bayesian analyses may help to clarify the nature of these relations.Key learning aims (1)Readers will consider the role of common factors in treatment for social anxiety disorder.(2)Readers will learn about how different common factors may interact with each other.(3)Readers will be encouraged to consider how the therapeutic relationship may manifest in a unique manner in treatment for social anxiety.

Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome.

The Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) are 20-item companion measures of social anxiety symptoms frequently used to evaluate outcome in treatment trials. The SIAS-6, SPS-6, and Social Interaction Phobia Scale (SIPS) are promising short forms of the SIAS and SPS. The current study evaluated whether it is sound to use these short scales instead of the full-length instruments to measure outcome in social anxiety disorder (SAD) treatment studies, using data from a trial in which 255 adults with SAD were treated with traditional or imagery-enhanced group cognitive-behavioral therapy. Several deficiencies with the short forms were identified including ceiling effects, inflated variances, imprecise effect size estimates, and a loss of statistical power when testing for between-treatment differences. Using the short forms can alter the substantive findings of a treatment trial, as genuine differences in efficacy between treatments can be missed. We recommend treatment outcome be measured using the full SIAS and SPS rather than the SIPS, SIAS-6, and SPS-6. The full-length instruments provide precise estimates of treatment effects and maximize the chance of detecting between-treatment differences when they exist. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Role of Shame and Self-Criticism in Social Anxiety: A Daily-Diary Study in a Nonclinical Sample

We sought to explore the daily association between shame and self-criticism, and the extent to which this association varies as a function of social anxiety symptoms. Fifty-nine undergraduate students completed a measure of social anxiety symptoms at a baseline meeting and then completed measures of shame experienced during significant social interactions and self-criticism following those interactions twice daily for 10 days. Social anxiety symptoms predicted more shame during daily social interactions and more self-criticism following them. Additionally, shame predicted subsequent self-criticism. This relationship was moderated by levels of social anxiety symptoms, such that those with higher levels of social anxiety symptoms exhibited high levels of self-criticism following daily social interactions characterized by both high and low shame, whereas those with lower levels of social anxiety symptoms showed high levels of self-criticism only after interactions with high levels of shame. These findings are consistent with the notion that self-criticism may serve as a regulatory coping method when experiencing shame, and that social anxiety difficulties are related to an inflexibly high level of self-criticism.

Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy

Background and objectivesAttention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT). MethodsNinety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up. ResultsABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures. LimitationsLimitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested. ConclusionsResults suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.

Are there social benefits? Exploring the role of positive consequences in the relationship between social anxiety symptoms and negative drinking consequences

Research has shown that college students with social anxiety experience more alcohol-related negative consequences, regardless of the amount of alcohol they consume. To better understand this relationship, it is important to examine social anxiety as a multidimensional construct, as well as explore the positive outcomes these students experience from drinking. The current study sought to examine the impact of positive drinking consequences on the relationship between behavioral (i.e. interaction and performance-type) and cognitive (i.e. fear of negative evaluation) social anxiety symptoms and alcohol-related negative consequences. Participants were 544 traditional age college students who reported consuming alcohol in the past month and completed measures of social anxiety symptoms, positive drinking consequences, and alcohol-related negative consequences. Positive drinking consequences moderated the relationship between social anxiety and alcohol-related negative consequences, such that students with more fear of negative evaluation and that experienced more positive drinking consequences reported more negative drinking consequences. Future directions and implications are discussed.

Social Anxiety and Fear of Causing Discomfort to Others: Diagnostic Specificity, Symptom Correlates and CBT Treatment Outcome

Patients with social anxiety disorder (SAD) report fear content relating to the perceived aversive consequences of their anxiety for others in their social environment. However, no studies to date have examined the diagnostic specificity of these fears to SAD as well as predictors to treatment response of these fears. To examine relative specificity of fears related to causing discomfort to others, as measured by Social Anxiety-Fear of Causing Discomfort to Others (SA-DOS), among patients with anxiety disorders, obsessive compulsive disorder (OCD) and major depressive disorder (MDD), in addition to relation between dysfunctional attitudes and treatment response among patients with SAD. In study 1, a large (n=745) sample of DSM diagnosed OCD, MDD and anxiety disorder participants completed the SA-DOS. In study 2, patient participants with SAD (n=186) participated in cognitive behavioural group therapy (CBGT) and completed measures of social anxiety symptoms and dysfunctional attitudes. In study 1, the SAD group demonstrated significantly elevated SA-DOS scores compared with participants with generalized anxiety disorder (GAD), OCD and panic disorder with or without agoraphobia (PD/A), but not the MDD group. In study 2, CBGT treatment was found to lead to significant reductions in SA-DOS scores. Need for approval (NFA) but not perfectionism, predicted treatment response to fears related to causing discomfort to others, with greater change in NFA relating to greater change in SA-DOS scores. These findings extend previous research linking allocentric fears to the phenomenology and treatment of SAD.

Impaired fear recognition and social anxiety symptoms in adolescence.

This study represents the first examination of adolescent anxiety in relation to peer emotion recognition, rather than adult emotion recognition. Additionally, we examine potential mechanisms for the development of Social Anxiety in females. Facial emotion recognition (FER) is important for accurate social cognition, which is impaired in individuals with various disorders, including anxiety disorders. Social anxiety often onsets during adolescence, is observed more commonly in females, and is often associated with FER difficulties. Given the importance of peer interaction during adolescence, and some evidence that FER may differ as a function of the stimuli (adolescent or adult faces), we sought to study FER in relation to social anxiety symptoms using stimuli portraying adolescent faces. Male and female adolescents (N=64) completed an online survey in which they rated 257 child and adolescent emotional faces and completed a self-report measure of social anxiety symptoms. We examined differences in emotion recognition (e.g., fear, anger, sadness) between individuals with high and low levels of social anxiety symptoms. Adolescents with high social anxiety symptoms were more likely to have problems correctly identifying fearful expressions (90.55% accuracy) compared to adolescents with low social anxiety symptoms (96.00% accuracy; t = 2.375, p = .021, d = 0.594), and this effect was observed exclusively in female adolescents. The observed sex difference in accurate identification of fearful faces in relation to social anxiety could suggest a potential mechanism for social anxiety development in adolescent females.

Attentional control moderates the relationship between social anxiety symptoms and attentional disengagement from threatening information

Background and objectivesSocial anxiety is characterized by biased attentional processing of social information. However, heterogeneity of extant findings suggests that it may be informative to elucidate individual difference factors that modulate the processing of emotional information. The current study examined whether individual differences in components of attentional control (AC – shifting and focusing) moderated the link between social anxiety and attentional engagement and disengagement biases for threat-relevant cues. MethodsSeventy–five undergraduate students completed well-established measures of social anxiety symptoms, AC, and attentional bias for social threat information (modified probe detection task). ResultsModeration analyses revealed that at low levels of AC-shifting, increased social anxiety was associated with slower disengagement from threat-relevant compared to neutral social cues. In contrast, at high levels of AC-shifting, social anxiety was associated with faster disengagement from threat-relevant compared to neutral stimuli. Individual differences in AC-focusing did not moderate the social anxiety-attentional bias link. LimitationsCausal inferences cannot be made given the cross-sectional study design. The sample comprised individuals displaying a range of self-reported social anxiety symptoms; thus, generalizability to clinical samples remains to be established. The measurement of AC relied on subjective participant report. ConclusionsThe current findings underscore the importance of AC processes in understanding the nature of attentional bias mechanisms in anxiety.

Evaluating age differences in coping motives as a mediator of the link between social anxiety symptoms and alcohol problems.

The goal of this study is to evaluate whether coping motives mediate the relationship between self-reported symptoms of social anxiety and alcohol problems across different age groups, building on previous research conducted among emerging adults. This study focuses on adult drinkers, including emerging adults (aged 18-25 years; n = 148), young adults (aged 26-39 years; n = 68), and middle-aged adults (aged 40-65 years; n = 51). All participants completed measures of social anxiety symptoms, alcohol problems, and coping motives, administered via the Web. Invariance tests using structural equation modeling suggested that among emerging adults (and to some degree middle-aged adults), coping motives mediated the positive relationship between symptoms of social anxiety and alcohol problems. Interestingly, coping motives appeared to suppress a negative relationship between social anxiety and alcohol problems in young adults. Results suggest that it is critical to consider age differences when attempting to understand the relationships between symptoms of social anxiety, alcohol problems, and coping motives.

2860 – Reappraisal mediates the link between 5-HTTLPR and social anxiety symptoms

Mounting evidence suggests that social anxiety symptoms are related to (1) polymorphisms in the serotonin transporter gene promoter region ( 5-HTTLPR ) and (2) reduced use of adaptive forms of emotion regulation such as reappraisal. It is not known, however, whether reappraisal mediates the link between 5-HTTLPR and social anxiety. Participants to this study were unselected community volunteers, all Caucasians from a circumscribed geographical area. They were genetically tested for 5-HTTLPR status, and self-report measures of social anxiety symptoms and reappraisal use were obtained. The results indicated that participants with one or two low-expressing alleles displayed increased social anxiety symptoms and reduced levels of cognitive reappraisal. Cognitive reappraisal significantly mediated the influence of 5-HTTLPR on social anxiety symptoms, and this effect was evident on two different measures of reappraisal. Therefore, this study shows that cognitive reappraisal is a major intermediate phenotype of the social anxiety spectrum. Our correlational results suggest that individuals with low-expressing 5-HTTLPR genotypes may benefit the most from cognitive-behavioral psychotherapy because they do not appear to engage as frequently as others in reappraisal.

Reappraisal as a mediator in the link between 5-HTTLPR and social anxiety symptoms.

Social anxiety symptoms have been related to (a) polymorphisms in the serotonin-transporter gene-promoter region (also, serotonin-transporter-linked polymorphic region; 5-HTTLPR) and (b) reduced use of adaptive forms of emotion regulation such as reappraisal. It is not known, however, whether reappraisal functions as a mediator in the link between 5-HTTLPR and social anxiety. To address this issue, 182 unselected community volunteers were tested for 5-HTTLPR status, and self-report measures of social anxiety symptoms and reappraisal use were obtained. Relative to other participants, those with two low-expressing alleles displayed increased social anxiety and decreased reappraisal. As predicted, the influence of 5-HTTLPR on social anxiety symptoms was transmitted via reappraisal, and this effect of 5-HTTLPR was observed using two different measures of reappraisal. These findings suggest that cognitive reappraisal may be an intermediate phenotype of the social anxiety spectrum, and that individuals with low-expressing 5-HTTLPR genotypes may benefit the most from cognitive-behavioral psychotherapy because they do not appear to engage as frequently as others in reappraisal.

What Are You Really Saying? Associations between Shyness and Verbal Irony Comprehension

Verbal irony exploits the ambiguity inherent in language by using the discrepancy between a speaker's intended meaning and the literal meaning of his or her words to achieve social goals. Irony provides a window into children's developing pragmatic competence. Yet, little research exists on individual differences that may disrupt this understanding. For example, verbal irony may challenge shy children, who tend to interpret ambiguous stimuli as being threatening and who have difficulty mentalizing in social contexts. We examined whether shyness is related to the interpretation of ironic statements. Ninety‐nine children (8–12 year olds) listened to stories wherein one character made either a literal or ironic criticism or a literal or ironic compliment. Children appraised the speaker's belief and communicative intention. Shyness was assessed using self‐report measures of social anxiety symptoms and shy negative affect. Shyness was not related to children's comprehension of the counterfactual nature of ironic statements. However, shyness was related to children's ratings of speaker meanness for ironic statements. Thus, although not related to the understanding that speakers intended to communicate their true beliefs, shyness was related to children's construal of the social meaning of irony. Such subtle differences in language interpretation may underlie some of the social difficulties facing shy children. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Psychometric Properties of the Liebowitz Social Anxiety Scale in a Longitudinal Study of Latinos With Anxiety Disorders

The Liebowitz Social Anxiety Scale (LSAS) is one of the most commonly used measures of social anxiety symptoms. To date, no study has examined its psychometric properties in a Latino sample. The authors examined the reliability, temporal stability, and convergent validity of the LSAS in 73 Latinos diagnosed with an anxiety disorder. The original LSAS subscales showed excellent internal consistency and temporal stability over a 1-year period. Participants with social anxiety disorder (SAD) scored significantly higher on all LSAS subscales than participants without SAD, supporting the convergent validity of the LSAS. Similar results were obtained for four subscales proposed by Safren and colleagues. Results have implications for the use of the LSAS as a measure of severity or outcome when comparing diverse populations. Future investigations in larger Latino samples are needed to examine the factor structure of the LSAS.

The separate and interactive effects of drinking motives and social anxiety symptoms in predicting drinking outcomes

PurposeOur goal was to test the separate and interactive effects of drinking motives and social anxiety symptoms in predicting drinking-related consumption and problems. MethodsParticipants (N=730; 59.7% female) were undergraduate college students who completed measures of social anxiety symptoms, drinking motives, alcohol consumption, and drinking problems. ResultsGreater social anxiety symptoms were significantly associated with less alcohol consumption, and there was some evidence that greater social anxiety symptoms were also associated with greater alcohol-relevant problems. Significant interactions between social anxiety and motives indicated that a) alcohol use was most pronounced for individuals high in enhancement motives and low in social anxiety symptoms; and b) among participants low in coping motives, drinking problems were greater for individuals high (vs. low) in social anxiety symptoms. ConclusionsMore fully identifying the individual difference factors that link social anxiety symptoms with drinking outcomes is important for informing prevention and intervention approaches.

Psychometric evaluation of the Social Interaction Phobia Scale

The present study evaluated the psychometric properties of a novel measure of social anxiety symptoms, the Social Interaction Phobia Scale (SIPS), as a stand-alone item set, using an undergraduate sample (N=512). The 14-item SIPS has three subscales assessing Social Interaction Anxiety, Fear of Overt Evaluation, and Fear of Attracting Attention. Confirmatory factor analyses replicated the three-factor structure for the SIPS originally reported by Carleton et al. All SIPS scores demonstrated good internal consistency. The convergent validity of the SIPS was supported by strong and positive correlations between all SIPS scores and measures of social anxiety and fear of evaluation; the finding that the relationships between all SIPS scores and a social anxiety measure were stronger than relationships between all SIPS scores and measures of other constructs supported the discriminant validity of the SIPS. Results suggest that the SIPS possesses excellent psychometric properties.

“Social Anxiety Disorder Carved at its Joints”: Evidence for the taxonicity of social anxiety disorder

Previous findings suggest that social anxiety disorder may be best characterized as having a dimensional latent structure ( Kollman et al., 2006; Weeks et al., 2009). We attempted to extend previous taxometric investigations of social anxiety by examining the latent structure of social anxiety disorder symptoms in a large sample comprised of social anxiety disorder patients (i.e., putative taxon members) and community residents/undergraduate respondents (i.e., putative complement class members). MAXEIG and MAMBAC were performed with indicator sets drawn from a self-report measure of social anxiety symptoms, the Social Interaction Phobia Scale ( Carleton et al., 2009). MAXEIG and MAMBAC analyses, as well as comparison analyses utilizing simulated taxonic and dimensional datasets, yielded converging evidence that social anxiety disorder has a taxonic latent structure. Moreover, 100% of the confirmed social anxiety disorder patients in our overall sample were correctly assigned to the identified taxon class, providing strong support for the external validity of the identified taxon; and k-means cluster analysis results corroborated our taxometric base-rate estimates. Implications regarding the conceptualization, diagnosis, and assessment of social anxiety disorder are discussed.