Reductions In Social Anxiety Research Articles

Bibliotherapy Treatment for Children With Adjustment Difficulties: A Comparison of Affective and Cognitive Bibliotherapy

This study compared outcomes following cognitive and affective bibliotherapy treatment with 79 children and adolescents in a residential home in Israel. Treatment children were compared to a control–no treatment group from the same home. Anxiety was measured through a self-report measure (Revised Children's Manifest Anxiety Scale; Reynolds & Richmond, 1985), and adjustment symptoms were measured with the Teacher's Report Form (Achenbach, 1991) completed by counselors in the residential home. Results indicate a reduction in social anxiety in both treatment groups compared with control. A reduction in adjustment symptoms was found only under affective bibliotherapy conditions. The study concludes that affective bibliotherapy is superior to cognitive bibliotherapy. The discussion focuses on a possible explanation of these results.

Why Underage College Students Drink in Excess

Background: Excessive alcohol consumption by underage students is a serious and persistent problem facing most U.S. colleges and universities. Purpose: This qualitative study explores why underage students engage in high-risk drinking and examines motivational cues that may serve as behavioral deterrents. Methods: Focus groups were conducted with college students under the age of 21 years (N=59) attending a large university in the southeast. All participants reported consuming five or more drinks in one sitting within the last two weeks (four or more for a female). Results: Participants attach positive expectancies to alcohol use, including peer influence/support and reduction of social anxiety. Negative social consequences such as embarrassment and relationship issues, including perceived sexual opportunities, were cited as disincentives for excessive drinking. Gender distinctions were present among the referenced costs and benefits of excessive alcohol consumption. Discussion: Overall, the negative consequences associated with excess drinking by underage college students are outweighed by positive expectancies such as social approval and acceptance by their peers. Translation to Health Education Practice: Understanding the language, motives and expectancies young people attach to alcohol use can enhance the efficacy of health education and prevention efforts.

Targeting the probability versus cost of feared outcomes in public speaking anxiety

Cognitive–behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive–behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive–behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed.

Mindfulness and Acceptance-Based Group Therapy for Social Anxiety Disorder: An Open Trial

Mindfulness and Acceptance-Based Group Therapy (MAGT) for Social Anxiety Disorder (SAD) is based largely on Acceptance and Commitment Therapy (ACT; Hayes et al., 1999), with enhanced mindfulness mostly from Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002). The purpose of this study was to assess the feasibility and initial effectiveness of MAGT for the treatment of SAD. Forty-two SAD patients were invited to take part in an open trial of MAGT. Participants completed measures of social anxiety, mindfulness and acceptance, depression, and rumination at pretreatment, midtreatment (6 weeks), posttreatment (12 weeks), and at a 3-month follow-up session. Twenty-nine participants completed the treatment and these participants reported that the treatment was helpful. Effect sizes for treatment completers ranged from 1.00 to 1.17 for the social anxiety symptom measures at follow-up. Intent-to-treat analyses revealed significant reductions in social anxiety, depression, and rumination and significant increases in mindfulness and acceptance, with effect sizes ranging from .65 to .76 on the social anxiety measures. This study demonstrates that MAGT is feasible and acceptable to SAD patients and provides further support for the use of mindfulness and acceptance-based interventions for the treatment of SAD.

Does Cognitive Behavioral Therapy Change the Brain? A Systematic Review of Neuroimaging in Anxiety Disorders

This systematic review aims to investigate neurobiological changes related to cognitive-behavioral therapy (CBT) in anxiety disorders detected through neuroimaging techniques and to identify predictors of response to treatment. Cognitive-behavioral therapy modified the neural circuits involved in the regulation of negative emotions and fear extinction in judged treatment responders. The only study on predictors of response to treatment was regarding obsessive-compulsive disorder and showed higher pretreatment regional metabolic activity in the left orbitofrontal cortex associated with a better response to behavioral therapy. Despite methodological limitations, neuroimaging studies revealed that CBT was able to change dysfunctions of the nervous system.

Attention training for generalized social anxiety disorder.

Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.

Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.

Self-help cognitive–behavioral therapy with minimal therapist contact for social phobia: A controlled trial

Due to treatment accessibility and cost issues, interest in self-help programs (e.g., bibliotherapy, telehealth) for common psychological disorders is growing. Research supporting the efficacy of such a program for social anxiety, however, is limited. The present study examined the efficacy of an 8-week self-directed cognitive behavioral treatment with minimal therapist involvement for social phobia based on a widely available self-help book. Twenty-one adults with social phobia initially received either treatment (i.e. assigned readings in the workbook with limited therapist contact) or were wait-listed. Wait-listed patients eventually received the same self-directed treatment. Results revealed that the self-help/minimal therapist contact treatment was superior to wait-list on most outcome measures. Across the entire sample, reductions in social anxiety, global severity, general anxiety, and depression were observed at posttest and 3-month follow-up. These findings provide preliminary support for using this self-help workbook for individuals with mild to moderate social anxiety in conjunction with infrequent therapist visits to reinforce the treatment principles. Study limitations and future directions are discussed.

Continual training of attentional bias in social anxiety

Using the dot-probe paradigm, it has been shown that high social anxiety is associated with an attentional bias toward negative information. In the present study, individuals with high social anxiety were divided into two groups randomly. One group was the attentional bias training group (Group T), and the other was the control group (Group C). For Group T, 7 days’ continuous training of attentional bias was conducted using the dot-probe paradigm to make socially anxious individuals focus more on positive face pictures. The results showed that the training was effective in changing attentional bias in Group T. Scores of the Social Interaction Anxiety Scale (SIAS) in Group T were reduced compared to Group C, while the scores of Social Phobia Scale (SPS) and scores of Negative Evaluation Scale (FNE) showed no difference between the two groups, which suggested a limited reduction of social anxiety.

Treating adolescents with social anxiety disorder in school: an attention control trial

Anxiety disorders are often undetected and untreated in adolescents. This study evaluates the relative efficacy of a school-based, cognitive-behavioral intervention compared to an educational-supportive treatment for adolescents with social anxiety disorder. Thirty-six students (30 females), ages 14 to 16, were randomized to a 12-week specific intervention, Skills for Social and Academic Success (SASS), or a credible attention control matched for structure and contact, conducted in school. Independent evaluations and adolescent self-reports indicated significant reduction in social anxiety for SASS compared to the control group. Parent reports of their children's social anxiety did not discriminate between treatments. In the specific intervention, 59%, compared to 0% in the control, no longer met criteria for social anxiety disorder following treatment. Superiority of the SASS intervention was maintained 6 months after treatment cessation. The study provides evidence that intervention for social anxiety disorder that emphasizes exposure and social skills is efficacious. Results indicate that clinical improvement is sustained for at least 6 months, and that, overall, adolescents with social anxiety disorder do not respond to non-specific treatment. This investigation has public health implications by demonstrating that effective interventions can be transported to nonclinical settings.

The psychological impact in children of using Microskin, a novel spray-on semi permanent cover for mature scars from burns

Objective: To examine the impact in young people on self esteem, behaviour, body image, peer relationships and family function, of using a new product to cover mature scars from burns. Methods: 20 young people with a range of severity of burn and a variety of placement of burn scars were randomised to the Microskin use group or to waitlist. Assessments on a range of variables were taken on entry to the study and at 6 weeks after usage began. Results: Remarkable improvements are reported in self-esteem, behaviours, body image, peer relationships and family function as well as social behaviour, Conclusions and implications for discussion: This remarkable new product appears to be able to assist young people to come to terms with permanent mature scars from burns. Reductions in social anxiety, as well as surprising improvements in a range of internal psychological functioning, and family dynamics suggest that the product should be made more easily available, Further studies are planned to support the current evidence from the pilot study.

Social Anxiety as a Moderator of the Relationship Between Perceived Norms and Drinking

College students overestimate the drinking of their peers, and the more they overestimate, the more they drink. The present research was designed to evaluate social anxiety as a moderator of the relationship between perceived norms and drinking among college men and women. Participants included 1,217 first-year residence-hall students (62.8% women) who completed Web-based assessments of social anxiety, perceived norms, and self-reported drinking. Results replicated previous research in that students overestimated the drinking of their peers (d = 0.75, p < .001). Students who had higher social anxiety drank somewhat more but did not differ from students who had lower social anxiety on perceived norms. However, the relationship between perceived norms and drinking was stronger among students who had higher social anxiety (d = 0.92, p < .001) relative to less socially anxious students (d = 0.02, p = NS). Higher levels of social anxiety were associated with a stronger relationship between perceived norms and drinking for both men (d = 0.86, p < .001) and women (d = 0.50, p < .001) but stronger for men (d = 0.26, p < .001). These results corroborate previous literature, which suggests that social factors are important determinants of drinking in this population and suggest that social anxiety is associated with susceptibility to peer influences on drinking. Additional work evaluating whether reductions in social anxiety may ameliorate the impact of perceived norms on drinking would be worthwhile.

Cognitive mechanisms of social anxiety reduction: An examination of specificity and temporality.

Cognitive theories posit that exposure-based treatments exert their effect on social anxiety by modifying judgmental biases. The present study provides a conservative test of the relative roles of changes in judgmental biases in governing social anxiety reduction and addresses several limitations of previous research. Longitudinal, within-subjects analysis of data from 53 adults with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) social phobia diagnosis revealed that reductions in probability and cost biases accounted for significant variance in fear reduction achieved during treatment. However, whereas the reduction in probability bias resulted in fear reduction, the reduction in cost bias was merely a consequence of fear reduction. A potential implication is that exposure-based treatments for social anxiety might focus more attention on correcting faulty appraisals of social threat occurrence.

The Tridimensional Personality Questionnaire: Changes during psychological treatment of social phobia

Thirty-nine individuals completed 12 weekly group sessions of psychological therapy for social phobia (social anxiety disorder). Before and after treatment, participants filled out the Tridimensional Personality Questionnnaire (TPQ, [Cloninger C.R., 1987a. A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44, 573–58]) and measures of social anxiety and depression. Treatment led to a significant reduction in social anxiety, depression, harm avoidance, and reward dependence. However, only pre–post changes in harm avoidance and depression were significantly correlated with pre–post changes in social anxiety. These results suggest that harm avoidance shows state-dependent changes during the course of treatment for social phobia. The implications of these findings for the trait/state distinction of the TPQ scales are discussed.

Analysis of crisis intervention processes.

The remediation processes in psychosocial crisis intervention were modeled focusing on cognitive orientation. Frequent observations and subsequent process modeling constitute a novel approach to process research and reveal process-outcome associations. A sample of 40 inpatients who were assigned to treatment in a crisis intervention unit was monitored in order to study the process of crisis intervention. The process data consisted of patients' self-ratings of the variables mood, tension, and cognitive orientation, which were assessed three times a day throughout hospitalization (M = 22.6 days). Linear time series models (vector autoregression) of the process data were computed to describe the prototypical dynamic patterns of the sample. Additionally, the outcome of crisis intervention was evaluated by pre-post questionnaires. Linear trends were found pointing to an improvement of mood, a reduction of tension, and an increase of outward cognitive orientation. Time series modeling showed that, on average, outward cognitive orientation preceded improved mood. The time series models partially predicted the treatment effect, notably the outcome domain "reduction of social anxiety," yet did not predict the domain of symptom reduction. In conclusion, crisis intervention should focus on having patients increasingly engage in outward cognitive orientation in order to stabilize mood, reduce anxiety, and activate their resources.

Group Social Skills Training or Cognitive Group Therapy as the Clinical Treatment of Choice for Generalized Social Phobia?

This study focused on determining whether group social skills training (SST) or cognitive-behavioral group therapy (CBT) works best to treat social anxiety in psychiatric patients. Participants were psychiatric outpatients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of generalized social phobia (GSP). A matching procedure was used to obtain two equivalent samples in both conditions N = 48 . It was shown that both SST and CBT were effective in reducing social and general anxiety, decreasing the severity of psychopathology and increasing social skills and self-control. As for differential effects, patients participating in SST experienced a significantly greater reduction of social anxiety and a greater increase in social skills than those in CBT. Moreover, it was shown that social anxiety and social skills scores of the SST group at follow-up reached the level of a normal reference group, whereas those of the CBT participants improved only to that of nonsocially anxious patients with anxiety disorders. Finally, it was revealed that commitment to and satisfaction with treatment of participants in both conditions did not differ. Keeping in mind that this was a quasiexperimental study, the authors concluded that in a clinical setting, group SST may be the best way to treat psychiatric patients with GSP, where comorbidity is the rule rather than the exception.

Recent developments in the psychopharmacology of social phobia.

The past 2 decades have witnessed an upsurge in the interest in anxiety disorders. Much research effort has been dedicated to panic disorder and obsessive-compulsive disorder. However, it is only very recently that we have begun to understand some of the basic principles about the psychopharmacology of social phobia. Drug classes thus far studied include beta-blockers, nonselective and irreversible monoamine oxidase inhibitors (MAOIs), and benzodiazepines. Beta blockers appear to be of use in specific social phobias, such as public speaking, whereas they are of little use in generalized social phobia. There is considerable evidence suggesting that MAOIs are effective in reducing both social anxiety as well as social avoidance in generalized social phobia. A disadvantage of the conventional irreversible MAOIs is their risk for hypertensive crises when combined with dietary tyramine. Thus far only a small number of studies with selective MAO-A inhibitors, such as moclobemide and brofaromine, have been conducted in social phobia, and the results indicate that both compounds are effective. Drugs exerting selective and specific actions on certain components of, for example, the serotonergic system, can now be studied, and it is hoped that the role of 5-hydroxytryptamine) and other neuronal systems in social phobia can be elucidated. In order to gain more information about selective serotonergic drugs, the first double-blind placebo-controlled study with fluvoxamine was recently published. Preliminary results indicate a reduction in social anxiety after a prolonged treatment period. Finally, the role of peptides in the treatment of social phobia is critically reviewed. The MSH/ACTH analog Org 2766 was investigated in patients suffering from social phobia.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative outcome study of four cognitive therapies in the treatment of social anxiety

This clinical outcome study compared four separate cognitive behavioral and one behavioral treatment for reducing social anxiety with a waiting list control. Subjects were adults who responded to advertisements for treatment. In the cognitive-behavioral conditions, subjects were trained to modify their disruptive cognitions and/or emit adaptive cognitions relevant to interpersonal behavior with the specific content and techniques determined by the particular cognitive therapy. In the behavioral condition, subjects modeled and rehearsed appropriate social interpersonal behaviors. Subjects were assessed pre and post-treatment on self-report measures of social anxiety, measures of general anxiety, clinical scales of anxiety, depression and hostility, and behavioral, and physiological concomitants of social anxiety. Subjects in all active treatment conditions showed improvement on the measures of social anxiety and the behavioral measure. However, only those in the cognitive treatment conditions, demonstrated treatment effects on general anxiety and the clinical scales. The results indicate the efficacy of both cognitive and behavioral approaches to the reduction of social anxiety. However, they fail to demonstrate clear distinctions between the various cognitive therapies.

Cognitive therapy vs exposure in vivo in the treatment of obsessive-compulsives

Eighteen DSM-III diagnosed obsessive-compulsives were randomly allocated to two treatment conditions: (1) Rational Emotive Therapy (RET) and (2) exposure in vivo. RET consisted of analyzing irrational thoughts; exposure in vivo was self-controlled. Treatment consisted of ten sessions. Both treatments resulted in significant improvement on anxiety/discomfort and the Maudsley Obsessional Compulsive Inventory, and in a reduction of social anxiety. In addition, RET resulted in significant changes on depression. Results were maintained up to a follow-up six months later. No significant differences were found between the two conditions.

Self-instructions and reduction of social anxiety.

12 male college students experienced four interactions which they rated for tension and enjoyment. The instruction to treat a female as a close friend was most enjoyable and associated with least tension.