Social Anxiety Disorder Symptoms Research Articles

An experimental examination of appearance-related safety behaviors in a clinical sample of women.

Appearance-related safety behaviors (ARSBs) have been identified as a key mechanistic target in individuals with elevated appearance concerns, social anxiety symptoms, and body dissatisfaction. The aim of the present study was to experimentally test the effect of fading these behaviors in individuals with body dysmorphic disorder (BDD), social anxiety disorder, and/or an eating disorder (ED). Ninety-four female participants were randomized to either a 1-month text message-based ARSB fading condition (n = 47) or a self-monitoring control condition (n = 47). Findings demonstrated that individuals in the ARSB fading condition saw significantly greater reductions in postmanipulation appearance concerns, appearance importance, ED symptoms, general anxiety, and depression. ARSB fading also led to lower BDD and social anxiety disorder symptoms, though this was only found among those who met for these respective diagnoses. Furthermore, we found that changes in appearance importance partially mediated the effect of condition on appearance concerns, BDD symptoms, social anxiety symptoms, and ED symptoms. Compared to the control, the ARSB fading group also demonstrated less reactivity to an in vivo appearance-related stressor task. This study provides strong evidence for the importance of ARSBs in the maintenance of appearance-related psychopathology among a clinical sample. Findings demonstrate the potential utility of reducing ARSBs as an overarching treatment strategy for appearance-related psychopathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived burdensomeness and thwarted belongingness as mediators of the relation between anxiety and suicidal ideation among adolescents.

Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation. These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT). Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity. These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior.

Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder: A randomized controlled trial

Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD. In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively. Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT. In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD. The study was prospectively registered at ClinicalTrials (NCT05015166).

The effect of social anxiety on threat acquisition and extinction: a systematic review and meta-analysis.

Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms.

The relationship between adverse childhood experiences and social anxiety disorder symptoms: the mediating role of rumination

AbstractThis study aimed to examine the mediating role of rumination in the relationship between adverse childhood experiences and social anxiety disorder symptoms. In this study, which was conducted with correlational design, one of the quantitative research methods, 878 participants were reached. 78.2% of the participants are women and 21.8% are men. In the study, self-report scales consisting of a personal information form, adverse childhood experiences scale, rumination scale, and Liebowitz social anxiety scale were administered to the participants. The analysis of the data regarding the research findings was carried out using the SPSS 25 package program. First of all, the relationship between adverse childhood experiences and social anxiety and rumination was examined; Then, parallel multi-agent analysis and serial intermediary analyses were performed using the Process V4.2 extension (Model 4). According to the findings, it was found that there was a significant positive relationship between adverse childhood experiences, social anxiety disorder symptoms, and rumination variables. It has also been observed that rumination has a mediating role in the relationship between adverse childhood experiences and social anxiety disorder symptoms. Examining the role of rumination in the relationship between childhood adverse events and social anxiety symptoms may help develop new interventions targeting SAD and expand the literature on the cognitive, behavioral, and affective vulnerabilities that early adverse events bring with them.

Social Anxiety Symptoms in Adolescents and Young Adults Recently Diagnosed with Cancer.

Purpose: Social anxiety disorder (SAD) remains an understudied potential link between the cancer experience and adolescent and young adult (AYA) cancer survivors' poor psychosocial outcomes. We investigated the frequency and duration of, as well as factors associated with, symptoms of SAD among AYAs with cancer. Methods: This longitudinal, mixed-methods study involved online surveys (including a validated screening tool for SAD) at recruitment and 6 months later, and a structured clinical interview. Results: Twenty-eight AYAs (aged 12-30 years, <1-year postdiagnosis, 50% male) completed the first survey (M = 6 months postdiagnosis). About 32% reported clinically significant SAD symptoms. Fourteen completed the follow-up survey (M = 12 months postdiagnosis), of which 9 (62%) reported persistent or worse symptoms of SAD significantly associated with emotional distress, physical appearance concerns, negative social cognitions, and depression. Conclusion: A subset of AYAs with cancer may experience clinically significant SAD symptoms that can affect their psychosocial well-being. Further work on how to best identify and support AYAs with SAD is needed.

Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial

Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = −0.10–0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (−0.13–0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (−4.62–0.67). A significant reduction in depression severity occurred in MEMI (−0.63–−0.60) but not SM (−0.31–−0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.

Examining co-occurring social anxiety in cognitive behavioral therapy for eating disorders: Does it change and does it moderate eating disorder outcomes?

Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT-ED or post-treatment outcomes in CBT-ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target. ED clients (N = 226) aged ≥16 years were treated with CBT-ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post-treatment. Baseline SAD was a weak moderator of early and post-treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology. Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre-treatment. SAD symptoms reduced over CBT-ED, but protocol enhancements such as exposure-based strategies that directly target co-occurring social-evaluative concerns may help achieve larger reductions in SAD symptoms. Eating disorders often co-occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by-product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols.

Interactions among stress, behavioral inhibition, and delta-beta coupling predict adolescent anxiety during the COVID-19 pandemic.

The COVID-19 pandemic brought about unprecedentedchangesand uncertaintyto thedailylivesof youth.The range of adjustment in light of a near-universal experience of COVID restrictions highlights the importance of identifying factors that may render some individuals more susceptible to heightened levels of anxiety during stressful life events than others. Two risk factors to consider are temperamental behavioral inhibition (BI) and difficulties in emotion regulation (ER). As such, the current paper focused on BI examined prior to COVID, because of its developmental link to anxiety and ER, as difficulties may be associated with differences in anxiety. We examined a neurocognitive marker of ER processes, delta-beta coupling (DBC). The current paper had two goals: (1) to examine BI in relation to COVID-related worry and social anxiety experienced during the pandemic, and (2) to explore the role of individual differences in early DBC in the relationship between BI and anxiety outcomes 6months apart during COVID-19 (n=86; T1 Mage =15.95, SD=1.73; T6 Mage =16.43, SD=1.73). We found support for the moderating role of DBC in the relationship between BI levels and social anxiety disorder (SAD) symptom severity during the pandemic. Here, high BI was predictive of increased SAD symptom levels in adolescents with stronger DBC.

Low-intensity mindfulness and cognitive–behavioral therapy for social anxiety: a pilot randomized controlled trial

BackgroundCognitive–behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive–behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety.MethodsParticipants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment.ResultsA group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51–1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention.ConclusionsThese results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others.Trial registrationUniversity Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Prevalence and Severity of Social Anxiety Symptoms and Their Relationship With Body Dysmorphic Symptoms.

Background Social anxiety disorder (SAD) is a subtype of anxiety characterized by avoidance, fear, and physical symptoms such as dry mouth, sweating, palpitations, and blushing. SAD is one of the most common mental disorders. Body dysmorphic disorder (BDD) is a mental disorder marked by a distressing or impairing preoccupation with imagined or minor flaws in one's physical appearance. Both disorders share similar symptoms. No satisfactory data have been provided about the prevalence of social anxiety symptoms in our region. In our study, we measured the prevalence and severity of SAD symptoms among adults in Riyadh City, as well as the sociodemographic factors associated with it. Additionally, the correlation between SAD and BDD was assessed. Methods Our study is quantitative, observational, and cross-sectional. It was conducted by administering a translated Arabic version of the Severity Measure for Social Anxiety Disorder scale and BDD scales in five locations in Riyadh, which include two general hospitals and three shopping malls. Data were analyzed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistical data are presented through mean values, standard deviations, and percentages. Results A total of 752 responses were received, of which 509 (68.32%) were from females with a mean age of 30.12 years. The majority of the sample had a low to middle family income, with 64% earning less than $2555 monthly. The sample possessed a good educational level; 63% had a bachelor's degree or higher. Our study also shows that 233 subjects (30.98%) had scores indicating a moderate to severe form of SAD. Among these participants, 86 (36.9%) had scores indicating a moderate to severe form of BDD. There was a significant positive correlation between SAD and BDD (r = 0.496). Conclusion The prevalence of SAD was 30.98%, which is higher compared to Western countries. Low income, education, and female gender have roles in the disease condition. Moreover, there was a linear relationship between SAD and BDD.

Underlying processes in the Norwegian Universal Preventive Program for social anxiety

Objective: Social Anxiety Disorder (SAD) is among the most common, widespread, and incapacitating psychiatric disorders, also among children and adolescents. Although efficient treatments have been reported, few children and adolescents receive adequate treatment. A universal prevention program has been shown to be efficacious both among those with syndromal and subsyndromal social anxiety. However, few universal prevention investigations undergo testing of mechanistic hypotheses or how an intervention works across levels of social anxiety. This study aims to test and report the processes underlying the effectiveness of an RCT prevention program to reduce social anxiety in a population-based sample of preadolescents. Method: A parallel multiple mediator model was used to examine the mediation of outcomes from the Norwegian Universal Prevention Program for Social Anxiety (NUPP-SA) by five intermediary variables that well approximate established DSM-5 social anxiety disorder diagnostic criteria. The sample consisted of 1748 pupils between 11 years - 14 years (SD = 1.1) of age assessed twice during a one-year period. Results: The NUPP-SA works differently for the total sample compared to those with social anxiety disorder symptoms. Among the former, the NUPP-SA intervention works via public performance, avoidance, physical/cognitive, and assertiveness factors. For the latter, the NUPP-SA works via the public performance factor. The intervention did not work for either group via the social encounter factor. Conclusion: Universal prevention programs are essential for reducing the impacts of chronic disorders at the individual, institutional, and societal levels. The results from this study support the notion that many children with various levels of social anxiety can be impacted with a Universal prevention intervention program specifically aimed at reducing public performance anxiety.

Presence and correlates of autistic traits among patients with social anxiety disorder.

Due to their similar behavioral presentation, it can sometimes be challenging to distinguish between a social anxiety disorder (SAD) and the social avoidance that is frequently described in autism spectrum disorder (ASD). Moreover, a growing body of evidences is reporting that a significant proportion of subjects with ASD also meet the requirements for SAD and, vice versa, subjects with SAD tend to exhibit a higher prevalence of autistic traits. In this framework, the current study aims to evaluate prevalence and correlates of autistic traits in a sample of adult subjects diagnosed with SAD and healthy controls (HC), also evaluating which autism spectrum dimensions may statistically predict higher SAD symptoms. 56 subjects with a clinical diagnosis of SAD and 56 gender and age matched HC were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Social Anxiety Spectrum - Short Version (SHY- SV) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum). SAD group scored significantly higher in all AdAS Spectrum and SHY-SV domains and total score compared to the HC group with no significant gender difference. SHY-SV total and domain scores, were strongly and positively and strongly correlated with all AdAS Spectrum domains and total score. AdAS Spectrum total score and Childhood/Adolescence, Non-Verbal Communication, Empathy and Restricted interests and Rumination domain scores score were significant predictors of higher SHY-SV score. Our results confirm the link between SAD and autistic traits also in adult population, describing not only high levels of autistic traits in SAD adults, but also significant correlations between many core features of the two disorders and a predictive role of autistic traits on higher SAD symptoms.

Measurement and Construct-Level Invariance of the Revised Child Anxiety and Depression Scale (RCADS)

Abstract: Measurement and construct-level invariance of the Dutch Revised Child Anxiety and Depression Scale’s test scores (RCADS) across gender and ethnic (minority) backgrounds of the four largest ethnic groups of children living in the Netherlands (i.e., native Dutch; Moroccan; Turkish; or Surinamese/Antillean) was evaluated. Symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder were rated by 2,679 mainstream elementary schoolchildren ( Mage = 10.61). Results from discrete multiple-group confirmatory factor analyses showed that factor means were generally insensitive to gender bias. However, moderate violations of measurement invariance between native Dutch and the three ethnic minority groups were found for social phobia, panic disorder, and separation anxiety disorder symptoms. Girls had higher mean levels on all RCADS subscales compared to boys. Furthermore, with a few exceptions, children from ethnic minority groups reported higher levels of symptoms of panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder compared to native Dutch children. Scores derived from the RCADS are largely comparable between elementary school boys and girls, but for three out of six subscales, caution is warranted when comparing mean level differences of native Dutch children with children of Turkish, Moroccan, and Surinamese/Antillean ethnic backgrounds.

Motivations for Cannabis Use in Individuals with Social Anxiety Disorder (SAD).

Social anxiety disorder (SAD) is a debilitating psychiatric condition. Consequently, it is common for those affected to resort to cannabis to cope with their symptoms. The primary objective of this study was to understand the differences between motivations for cannabis use in adults with and without SAD. We employed convergent, mixed methods to collect the data. Twenty-six individuals (age: 27.9 ± 7.3 years; 54% female) with and twenty-six (age: 27.4 ± 6.7 years; 50% female) without SAD were administered Marijuana Motives Measure (MMM). Motivations to initiate, continue, and maintain cannabis use were assessed in 12/26 participants in both groups using in-depth interviews. Cannabis weekly consumption was 3.8-fold and frequency 1.3-fold higher in the SAD group. Coping (F = 10.02; p <0.001; η2 = 0.46) and social (F = 2.81; p = 0.036; η2 = 0.19) motivations were also higher in the SAD group, after controlling for age, sex, and current CUD. The need to cope with symptoms of SAD may have been the driving force for repeated cannabis consumption. Psychoeducational programs educating children about the risk of using cannabis to cope with SAD should be implemented in vocational settings early on.

Attention bias vs. attention control modification for social anxiety disorder: A randomized controlled trial

Gaze-Contingent Music Reward Therapy (GC-MRT) is an eye-tracking-based attention bias modification protocol for social anxiety disorder (SAD) with established clinical efficacy. However, it remains unclear if improvement following GC-MRT hinges on modification of threat-related attention or on more general enhancement of attention control. Here, 50 patients with SAD were randomly allocated to GC-MRT using either threat faces or shapes. Results indicate comparable reductions in social anxiety and co-morbid depression symptoms in the two conditions. Patients in the shapes condition showed a significant increase in attention control and a reduction in attention to both the trained shapes and threat faces, whereas patients in the faces condition showed a reduction in attention to threat faces only. These findings suggest that enhancement of attention control, independent of valence-specific attention modification, may facilitate reduction in SAD symptoms. Alternative interpretations and clinical implications of the current findings are discussed.

Cognitive Factors in Social Anxiety Disorder and Relevant Interventions

Understanding how social interactions and fear responses affect mental health requires research on cognitive aspects of social anxiety disorder (SAD). SAD could be a substantial factor in a person's emotional, interpersonal, and professional areas of life. By examining cognitive issues, researchers can develop more effective treatments by understanding the biases and thought patterns that can contribute to the emergence and duration of SAD. Previous research focused on cognitive functioning, self-esteem, attentional biases, and the impact of cognitive biases on social interactions. The information-processing model and the cognitive model of SAD, which emphasizes negative interpretations and high expectations of oneself, are the main theories. To improve therapeutic outcomes, studies primarily focused on people with social anxiety across a range of age groups. In looking at different studies done on interventions for SAD, it has been shown that individualized treatment plans had the greatest impact on diminishing SAD symptoms and treating individuals to overcome their anxiety.

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population.

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms. Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-relatedsymptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms. Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity. Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Long-Term Outcomes and Cost-Effectiveness of an Internet-Based Self-Help Intervention for Social Anxiety Disorder in University Students: Results of a Randomized Controlled Trial

Social anxiety disorder (SAD) is widespread among university students and is associated with high costs for the society. While unguided internet- and mobile-based interventions (IMIs) may have short-term effects in reducing SAD symptoms, evidence for their long-term efficacy and cost-effectiveness is still limited. The aim of this study is to examine the 6-month outcomes of an IMI for university students with SAD. Participants were recruited via mass mails sent to enrolled students and included if they were at least 18 years old, met the diagnostic criteria of SAD in a structured clinical interview for DSM-IV axis I disorders (SCID-I), and provided written informed consent. In a prospective study designed as a two-armed randomized-controlled trial, 200 students (mean age 26.7 years) diagnosed with SAD were randomly assigned to an IMI or a waitlist control (WLC) condition. The IMI consisted of nine weekly sessions based on the cognitive-behavioral treatment model for social phobia by Clark and Wells. The primary outcome was SAD symptom severity assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). A health economic evaluation from a societal and healthcare perspective examined the costs related to the symptom-free status and quality-adjusted life years (QALYs) gained. Statistically significant differences in SAD symptom severity previously found at posttreatment favoring the IMI were maintained at a 6-month follow-up [SIAS (Cohen’s d = 0.59 ; 95% CI, 0.30, 0.87) and SPS (Cohen’s d = 0.83 ; 95% CI, 0.54, 1.1)]. From a societal perspective, at a willingness to pay (WTP) of €0, the intervention was found to have a 92% and 93% probability of cost-effectiveness compared with the WLC per symptom-free status and QALY gained, respectively. From a healthcare perspective, the likelihood of cost-effectiveness of the intervention was 97% per symptom-free status at a WTP of €1000 (US$1326) and 96% per QALY gained at a WTP of €6000 (US$7956). This IMI is effective in treating university students with SAD and has an acceptable likelihood of cost-effectiveness compared with WLC from a societal perspective. This intervention can be integrated into university healthcare to reach students with SAD as it is scalable, shows a high probability of cost-effectiveness, and overcomes known treatment barriers. This trial is registered with DRKS00011424.

Longitudinal predictors of health-related quality of life in isolated dystonia

ObjectiveTo determine longitudinal predictors of health-related quality of life (HR-QoL) in an international multicenter cohort of patients with isolated dystonia.MethodsOut of 603 dystonia patients prospectively enrolled in the Natural History Dystonia Coalition study, 155 were assessed three times within 2 years for HR-QoL, symptoms of depression, generalized anxiety disorder (GAD), and social anxiety disorder (SAD), as well as dystonia severity and dystonic tremor. In addition, the impact of botulinum neurotoxin (BoNT) injections on HR-QoL was evaluated after 1 year.ResultsDepressive symptoms at baseline predicted lower HR-QoL on all subscales after 2 years (all p ≤ 0.001). Higher GAD scores at baseline predicted lower HR-QoL related to general health, pain and emotional well-being, whereas higher SAD scores predicted higher pain-related QoL after 2 years (all p ≤ 0.006). Dystonia severity at baseline predicted social functioning (p = 0.002). Neither dystonic tremor, age, or sex predicted HR-QoL at 2 years. Two latent categories were revealed across the three-time points: Category 1 with higher total HR-QoL scores (mean HR-QoL = 74.4% ± 16.1), susceptible to symptoms of depression and SAD, and Category 2 with lower total HR-QoL scores (mean HR-QoL = 45.5% ± 17.6), susceptible to symptoms of GAD. HR-QoL improved over the course of 1 year irrespective of the use of BoNT.ConclusionThe longitudinal impact of psychiatric symptoms on HR-QoL emphasizes the importance of incorporating mental health treatment, in particular also the therapy of anxiety disorders, into treatment regimens for dystonia.