Primary Social Phobia Research Articles

Anxious Children and Adolescents Non-responding to CBT: Clinical Predictors and Families' Experiences of Therapy.

Youths with an anxiety disorder, who had a primary social phobia diagnosis and those, who had a comorbid mood disorder, were more likely not to respond to manualized group CBT. Parents of those non-responding youths often considered them as motivated to overcome their difficulties, but due to their symptomatology, they were unreceptive, reluctant and ambivalent and therefore not actively involved in therapy. The non-responding youths with social phobia felt evaluated and nervous of what others thought of them in the group. The parents of the non-responding youths with a comorbid mood disorder felt the group format placed restraints on therapists' ability to focus on their individual needs.

Efficacy of a Danish version of the Cool Kids program: a randomized wait‐list controlled trial

The purpose of the study was to evaluate the efficacy of a Danish version of the Cool Kids program, a generic manualized group cognitive-behavioural therapy (CBT) program for anxiety disorders among children and adolescents. Children and adolescents (age 7-16) with a primary anxiety disorder diagnosis (n=109) were randomly allocated to group CBT ora wait-list (WL) control condition at a Danish university clinic. Results showed that the Danish version of the Cool Kids program was efficacious with 48.2% free of all anxiety diagnoses at post-treatment, compared with 5.7% in the WL condition, and large effect sizes on self-report measures of child anxiety symptoms rated by child, mother, and father (ηp2 range=0.18-0.24). Children and adolescents improved further from post-treatment to 3-month follow-up, and this improvement was maintained at 12-month follow-up. Participants with a primary diagnosis of social phobia (SoP) showed less improvement compared with other anxiety diagnoses. The study contributes to the evidence base for the Cool Kids program, previously only evaluated by its developers in Australia. Generic group CBT programs may not be the most appropriate treatment for children and adolescents with primary SoP.

Social Skills as a Mediator Between Anxiety Symptoms and Peer Interactions Among Children and Adolescents

The present study used a cross-sectional design to examine the relations among youth anxiety symptoms, positive and negative peer interactions, and social skills. Also examined was the mediating role of social skills in the relations between youth anxiety symptoms and positive and negative peer interactions. Youth sex and age were examined as moderators. The sample consisted of 397 children and adolescents (M = 10.11 years; 53.4% boys; 74.8% Hispanic Latino) referred to an anxiety disorders clinic. Anxiety symptoms, positive and negative peer interactions, and social skills were assessed using youth and parent ratings. Structural equation modeling results indicated that for youth ratings only, youth anxiety symptoms were negatively related to positive peer interactions controlling for primary social phobia and comorbid depressive disorders. For both youth and parent ratings, youth anxiety symptoms were positively related to negative peer interactions and negatively related to social skills. Also for both youth and parent ratings, social skills mediated the relations between youth anxiety symptoms and positive and negative peer interactions. For parent ratings only, the effects of youth anxiety symptoms and social skills on peer interactions were significantly moderated by youth age. Youth sex was not a significant moderator using youth and parent ratings. Findings suggest that difficulties with social skills and peer interactions are problematic features of youth referred for anxiety problems. Findings highlight the need to improve understanding of anxiety symptoms, social skills, and peer interactions in this population.

W06-03 - Internet-based psychotherapeutic interventions for social phobia: How much and what kind of therapeutic contact is needed?

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen's d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen's d = .00−.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as sessions or exercises completed.

Internet-based treatment of social phobia: A randomized controlled trial comparing unguided with two types of guided self-help

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Primary outcome measures were self-report measures of symptoms of social phobia. Secondary outcome measures included symptoms of depression, interpersonal problems, and general symptomatology. Measures were taken at baseline, post-treatment, and at 6-month follow-up. Data from a telephone-administered diagnostic interview conducted at post-treatment were also included. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen’s d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen’s d = 00–.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as lessons or exercises completed. These findings indicate that Internet-delivered treatment for social phobia is a promising treatment option, whether no support is provided or with two different types of therapist guidance.

Shyness 1: Distance Treatment of Social Phobia Over the Internet

The purpose of the present study was to examine the effectiveness of an Internet-based clinician-assisted computerized cognitive behavioural therapy programme for social phobia. A total of 105 individuals with social phobia were randomly assigned to a six-lesson cognitive behavioural treatment programme or to a waitlist control group. Treatment consisted of four components: six online lessons; homework assignments; participation in an online discussion forum; and regular email contact with a therapist. An intention-to-treat model was used for data analyses. A total of 78% of treatment group participants completed all lessons, and post-treatment data were obtained from 93/105 participants. Significant post-treatment differences between treatment and waitlist participants were found on two measures of symptoms of social phobia. Mean within- and between-group effect sizes (Cohen's d) for the primary social phobia outcome measures were 1.15, and 0.95, respectively. These results were comparable with those obtained in exemplary face-to-face treatment programmes. They provide further positive data about the utility of Internet-based guided self-help programmes for people with common mental disorders.

Social inhibition and treatment‐resistant depression

AbstractBackground A personality trait of introversion/social inhibition is increasingly recognized as relevant to the phenomenology and course of depression. We sought to examine the relationship between social inhibition and treatment resistance in depressed patients.Method Data on depression history and severity, self‐reported social inhibition and social support, anxiety disorders, treatments trialled and psychiatrist‐rated ‘treatment resistance’ were collected from a sample of 177 depressed patients referred to a tertiary referral Mood Disorders Unit.Results Depressed patients in the ‘high’ social inhibition group had significantly higher psychiatrist‐rated levels of ‘treatment resistance’, lower perceived social support and had higher rates of social phobia preceding their depression.Conclusion Clinicians managing difficult‐to‐treat depression should remain aware of the potential role of high social inhibition and low perceived social support in maintaining depression. Further, clinicians should consider the possibility of primary social phobia, as failure to provide specific treatments may be one of the many contributors to the overall category of ‘treatment‐resistant depression’. Copyright © 2007 John Wiley & Sons, Ltd.

Differential Occurrence of Comorbidity Within Childhood Anxiety Disorders

Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues.

Comorbid Generalized Anxiety Disorder in Primary Social Phobia: Symptom Severity, Functional Impairment, and Treatment Response

—As many as 50% of patients with a primary anxiety disorder may meet criteria for an additional anxiety disorder. However, there is insufficient research on the co-occurrence of the anxiety disorders, although investigations of this nature may facilitate our understanding of their cause, phenomenology, and treatment. The present study examined the occurrence of generalized anxiety disorder (GAD) among patients with social phobia (SP) compared with SP patients without GAD. Of 122 treatment-seeking patients meeting DSM-III-R criteria for SP, 29 (23.8%) also met criteria for an additional diagnosis of GAD. SP patients with comorbid GAD demonstrated greater severity on measures of social anxiety and avoidance, general anxiety, cognitive (but not somatic) symptoms of anxiety, depressed mood, functional impairment, and overall psychopathology. Group differences remained significant when comorbidity with other anxiety and mood disorders was controlled. The content of worry among the SP patients with GAD was not specific to social concerns and appeared similar to the reported content of worry in samples of patients with primary GAD. Nevertheless, SP patients with and without GAD responded similarly to cognitive-behavioral group therapy for social phobia. Implications for the understanding and treatment of comorbid SP and GAD are discussed.

Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey.

General population data were used to study co-morbidities between lifetime social phobia and mood disorders. Data come from the US National Comorbidity Survey (NCS). Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2.9), dysthymia (2.7) and bipolar disorder (5.9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10-15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders. Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.

Exposure in vivo vs social skills training for social phobia: Long-term outcome and differential effects

This study examined the long-term effectiveness of specific exposure in vivo (individual IE or group GE) and of office-based social skills training (group SST) in two groups of patients with social inhibition (primary social skills deficits or primary social phobia). Seventy-eight outpatients were divided into these two subgroups according to clinical assessment. Twenty-seven patients received SST which consisted of 25 twice a week 90-min group sessions: 32 patients received GE and 17 IE. Exposure in vivo consisted of 4 weekly (8-hr in the group condition included 2 hr discussion; 3 hr in the individual condition included 1 hr discussion) sessions. Self-rating-assessments were carried out at pre- and post-treatment, at 3 months- and 2.5 yr follow-up. The general results indicate that all three treatment modes led to clinically and statistically-significant improvements in the main problem area (social anxiety, skills deficits), in other neurotic complaints (depression, obsessions, psychosomatic complaints) and in attribution-style. Patients with the diagnosis of primary phobia seemed to get the same profit from either treatment and showed slightly better gains (in all treatment modalities) than patients with skills deficits at long-term follow-up. Within the subgroup with skills deficits there was a tendency for superior outcome of group exposure. These results and recommendations for future research are discussed.

Comparison of Social Anxiety in Patients with Social Phobia and Panic Disorder

Differential response patterns to the SCL-90R in patients with social phobia and panic disorder are presented. The differences are discussed in light of Liebowitz's distinction between primary social phobia and the secondary social fears of panic disorder patients. Treatment implications are also discussed.