Adolescent Social Anxiety Research Articles

Rejection sensitivity and the development of social anxiety symptoms during adolescence: A five-year longitudinal study

Rejection sensitivity is a bias toward expecting rejection that can result from negative social experiences and degrade emotional adjustment. In this study, rejection sensitivity was expected to predict patterns of adolescent social anxiety over 5 years when considered alongside other known or expected risk and protective factors: peer rejection (peer-reported), emotion dysregulation, self-worth, temperament (parent-reported), female gender, and grade. Participants were 377 Australian students (45% boys; 79% White, 15% Asian) aged 10 to 13 years (M = 12.0, SD = .90) and their parents (84%) who completed seven repeated surveys across 5 years. In an unconditional latent growth model, social anxiety symptoms had a significant quadratic pattern of growth, with symptoms increasing about midway into the study when adolescents were age 14, on average. In a model with all predictors, rejection sensitivity was uniquely associated with a higher intercept and a more pronounced quadratic growth pattern of social anxiety symptoms. Other predictors of growth in symptoms were the temperamental trait of negativity affectivity and emotion dysregulation; negative affectivity was associated with a higher intercept and a more pronounced quadratic pattern, and emotion dysregulation was associated with a higher intercept and a less pronounced quadratic pattern. Gender was associated with the intercept, with girls higher in symptoms than boys.

Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: a clinical and cost analysis.

Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment? CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.

Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: a qualitative analysis of the experiences of young people, their parents and clinicians-in-training.

Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents. The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS). We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment. Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings. The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.

Self-focused attention and safety behaviours maintain social anxiety in adolescents: An experimental study.

BackgroundSelf-focused attention and safety behaviours are both associated with adolescent social anxiety. In adults, experimental studies have indicated that the processes are causally implicated in social anxiety, but this hypothesis has not yet been tested in a youth sample.MethodsThis experiment explored this possibility by asking high and low socially anxious adolescents (N = 57) to undertake conversations under different conditions. During one conversation they were instructed to focus on themselves and use safety behaviours, and in the other they focused externally and did not use safety behaviours. Self-report, conversation partner report and independent assessor ratings were taken.ResultsSelf-focus and safety behaviours increased feelings and appearance of anxiety and undermined performance for all participants, but only high socially anxious participants reported habitually using self-focus and safety behaviours.ConclusionsThe findings provide support for the causal role of self-focus and safety behaviours in adolescent social anxiety and point to the potential clinical value of techniques reversing them to treat the disorder.

Screening for Adolescent Social Anxiety: Psychometric Properties of the Severity Measure for Social Anxiety Disorder.

Social anxiety disorder (SAD) is a debilitating disorder that emerges during adolescence and confers a significant burden on interpersonal functioning. Currently available diagnostic interviews are lengthy and generally require clinically-trained experts to administer. Consequently, the identification of clinically valid self-report measures of social anxiety is necessary for streamlining assessment processes and routine outcome monitoring of adolescent social anxiety symptoms. Accordingly, the present study establishes the psychometric properties and predictive utility of the Severity Measure for Social Anxiety Disorder (SMSAD). Participants included 58 adolescents between 12 and 16years of age who met diagnostic criteria for SAD. In addition to the SMSADand other self-report measures, clinician and parent reports were obtained. Findings support the reliability and validity of the SMSAD, and highlight the clinical utility of this measure in comparison to previously validated measures of social anxiety. Overall, results indicate that the SMSAD is a valid and reliable measure for assessing and routinely tracking social anxiety symptoms in adolescents.

Effectiveness of Cognitive Behavioral Therapy and Rational Emotive Behavior Therapy in Reducing Social Anxiety among Overweight Adolescents

Background and objective: In recent decades, emphasis on diet and thinness has been considered by all social and racial classes. This study aimed to compare the cognitive-behavioral approach's effectiveness and rational-emotional behavior therapy in reducing social anxiety in overweight adolescents.Methods: The research method was quasi-experimental with pre-test and post-test design with the control and two-month follow-up. The statistical population of this study consisted of male and female adolescents who had been referred to clinics in Tehran in 2019 with overweight and obesity problems, among whom 60 were selected by convenience sampling method. After selecting the subjects, they were randomly assigned to experimental and one control groups. Interventions in both groups were group therapy and consisted of eight sessions for 120 minutes. Data were obtained by social anxiety questionnaire and analyzed using repeated-measures ANOVA and SPSS.22 software. The significance level in this study was considered to be 0.05.Results: The results showed that cognitive-behavioral approaches and rational-emotional behavior therapy effectively reduced social anxiety in overweight adolescents (p <0.001). However, there was no significant difference between the effectiveness of cognitive-behavioral and rational emotional behavior therapy on social anxiety.Conclusion: It can be concluded that the cognitive-behavioral approach and rational-emotional behavior therapy can have positive effects on reducing social anxiety in adolescents.

Prediction of Social Anxiety in Adolescence in the Context of Parental Attitudes and Emotion Regulation

Prediction of Social Anxiety in Adolescence in the Context of Parental Attitudes and Emotion Regulation

Cognitive predictors of adolescent social anxiety

BackgroundIdentifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social anxiety. Despite social anxiety typically starting in adolescence, prospective studies examining these cognitive processes in youth are lacking. The current study examined prospective associations between these five cognitive processes and social anxiety in a sample of 614 participants (53% girls; aged 11–14 years). MethodsPsychological processes, social anxiety symptoms, and depressive symptoms were assessed using self-report questionnaires at two time points. ResultsNegative social cognitions, safety behaviours, self-focused attention, and post-event processing predicted prospective levels of social anxiety over and above the effect of baseline levels of social anxiety. When these process variables were entered together in a regression model, three of them were independently associated with prospective social anxiety. Neither pre- nor post-event processing independently predicted later social anxiety over and above the effects of other psychological process variables. ConclusionsThe findings indicate that these psychological processes are promising targets for treatment in adolescent social anxiety.

Social Anxiety in Adolescents: A Narrative Review

Social Anxiety in Adolescents: A Narrative Review

동기체계와 지각된 어머니의 통제가 청소년의 사회불안에 미치는 영향: 성차를 중심으로

동기체계와 지각된 어머니의 통제가 청소년의 사회불안에 미치는 영향: 성차를 중심으로

Integrating Multiple Informants’ Reports: How Conceptual and Measurement Models May Address Long-Standing Problems in Clinical Decision-Making

Assessing youth psychopathology involves collecting multiple informants’ reports. Yet multi-informant reports often disagree, which necessitates integrative strategies that optimize predictive power. The trait-score approach leverages principal components analysis to account for the context and perspective from which informants provide reports. This approach may boost the predictive power of multi-informant reports and thus warrants rigorous testing. We tested the trait score approach using multi-informant reports of adolescent social anxiety in a mixed clinical and community sample of adolescents ( N = 127). The trait score incrementally predicted observed social anxiety (βs = 0.47–0.67) and referral status (odds ratios = 2.66–6.53) above and beyond individual informants’ reports and a composite of informants’ reports. The trait score predicted observed behavior at magnitudes well above those typically observed for individual informants’ reports of internalizing psychopathology (i.e., rs = .01–.15). Findings demonstrate the ability of the trait score to improve prediction of clinical indices and potentially transform widely used practices in multi-informant assessments.

Correlation of Intensity of Use of Social Media with The Level of Social Anxiety in Adolescents

Background - Social media provides many positive impacts and ease of interaction, but not a few negative impacts, one of them is anxiety. Indonesia ranks 4th in the world in the use of social media with an average duration of usage for 8 hours 51 minutes every day. Though adolescence is an age where someone is very susceptible to anxiety. This anxiety if coupled with the high intensity of use of social media in adolescents is feared will have an effect on social interaction and cause anxiety to be higher and at risk of becoming social anxiety due to the lack of real communication to the social environment.Purpose - to find out the correlation between the intensity of the use of social media with the level of social anxietyin adolescentsMethods - This research uses observational method with Cross Srectional design.Results - Based on the results of the data analysis test, the value of p = 0.00 (p 0.05) is obtainedConclusion - There is a correlation between the intensity of the use of social media and social anxiety.

Unfamiliar Untrained Observers’ Ratings of Adolescent Safety Behaviors Within Social Interactions with Unfamiliar Peer Confederates

Adolescents experiencing social anxiety often engage in safety behaviors―covert avoidance strategies for managing distress (e.g., avoiding eye contact)―that factor into the development and maintenance of their concerns. Prior work supports the psychometric properties of the Subtle Avoidance Frequency Examination (SAFE), a self-report survey of safety behaviors. Yet, we need complementary methods for assessing these behaviors within contexts where adolescents often experience concerns, namely, interactions with unfamiliar peers. Recent work indicates that, based on short, direct social interactions with adolescents, individuals posing as unfamiliar peers (i.e., peer confederates) and without assessment training can capably report about adolescent social anxiety. We built on prior work by testing whether we could gather valid SAFE reports from unfamiliar untrained observers (UUOs), who observed adolescents within archived recordings of these short social interactions. A mixed clinical/community sample of 105 adolescents self-reported on their functioning and participated in a series of social interaction tasks with peer confederates, who also provided social anxiety reports about the adolescent. Based on video recordings of these tasks, trained independent observers rated adolescents’ observed social skills, and an additional set of UUOs completed SAFE reports of these same adolescents. Unfamiliar untrained observers’ SAFE reports (a) related to adolescents’ SAFE self-reports, (b) distinguished adolescents on clinically elevated social anxiety concerns, (c) related to trained independent observers’ ratings of adolescent social skills within interactions with peer confederates, and (d) related to adolescents’ self-reported arousal within these same interactions. Our findings support use of unfamiliar observers’ perspectives to understand socially anxious adolescents’ interpersonal functioning.

Mindfulness-Based Interventions for Adolescent Social Anxiety: A Unique Convergence of Factors.

Social anxiety disorder (SAD) is a debilitating and often chronic psychiatric disorder that typically onsets during early adolescence. Cognitive behavior therapy (CBT), the current “gold-standard” treatment for SAD, tends to focus on threat- and fear-based systems hypothesized to maintain the disorder. Despite this targeted approach, SAD ranks among the least responsive anxiety disorders to CBT in adolescent samples, with a considerable proportion of individuals still reporting clinically significant symptoms following treatment, suggesting that the CBT-family of interventions may not fully target precipitating or maintaining factors of the disorder. This gap in efficacy highlights the need to consider new therapeutic modalities. Accordingly, this brief review critically evaluates the emergent literature supporting the use of mindfulness-based interventions (MBIs) for treating adolescent SAD. MBIs may be particularly relevant for addressing maintaining factors within this diagnosis, as they may target and interrupt cycles of avoidance and de-motivation. Despite limitations in the relative lack of randomized controlled trials (RCTs) on this topic, a unique convergence of factors emerge from the extant literature that support the notion that MBIs may hold particular promise for attenuating symptoms of SAD in adolescents. These factors include: (1) MBIs demonstrate the ability to directly engage symptoms of SAD; (2) MBIs also show consistent reduction of anxiety, including symptoms of social anxiety in adolescent populations; and (3) MBIs demonstrate high rates of feasibility and acceptability in anxious adolescent samples. We briefly review each topic and conclude that MBIs are an encouraging treatment approach for reducing symptoms of social anxiety in adolescents. However, given the lack of research within MBIs for adolescent SAD in particular, more research is needed to determine if MBIs are more advantageous than other current treatment approaches.

Revisiting a taxonomy of social anxiety and assertiveness in adolescence: evidence for a cognitive approach

This research explored a taxonomy combining social anxiety and assertiveness and further applied a cognitive approach for predicting those constructs in adolescents. Participants were 679 adolescents (mean age = 16.68; 61.3% female) who self-reported on interpersonal assertive schemas, negative automatic social thoughts, social anxiety, and assertive behavior. Social anxiety and assertive behavior were grouping variables in a cluster analysis, resulting in three groups: assertive, indifferent, and socially anxious adolescents. The moderator role of the groups was then studied within a structural equation model proposing both social anxiety and assertive behavior to be predicted by cognitive schemas and automatic thoughts. This model fitted all three groups, portraying assertive behavior as directly predicted by cognitive structures whereas social anxiety was directly dependent on automatic thoughts. Assertive deficit and social anxiety seem to co-occur and fit within a theoretical and practical cognitive approach, demanding careful consideration of specific symptomology in adolescent social anxiety.

OFC and its connectivity with amygdala as predictors for future social anxiety in adolescents

Social anxiety is a common problem that usually emerges at puberty, during which great developmental changes occur both in the brain and mental state. However, little is known about the influence of social anxiety on adolescents’ brain and behavior. The present study investigated the neural basis of social anxiety using voxel-based morphometry (VBM) and functional connectivity analysis. Then we investigated whether social anxiety is associated with attention bias. Furthermore, we investigated the neural basis of this association. Finally, longitudinal data was used to test if these biomarkers could predict social anxiety. The results indicated that social anxiety is positively associated with the grey matter volume (GMV) of orbital-frontal cortex (OFC), and the functional connectivity (FC) of OFC-amygdala. Mediation analysis revealed that the relationship between social anxiety and attention avoidance is partly mediated by the FC of OFC-amygdala. Finally, the present study demonstrated a close relationship between FC of the OFC-amygdala, the GMV of the OFC and the individual’s social anxiety one year later. The present study suggested the aberrant structure of OFC and its connectivity with amygdala as the neural underpinning of social anxiety, which might serve as a compensatory mechanism to decrease attention avoidance and promote effective emotion regulation.

Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study

Adolescents’ exposure to negative life events (NLEs) and potentially traumatic events is highly prevalent and increases their risk of developing psychological disorders considerably. NLE exposure has also been linked to the development of social anxiety disorder (SAD) among older children and young adolescents. Despite the relatively low treatment efficacy reported for children and adolescents suffering from SAD, few studies have addressed the extent to which resilience factors, such as social support and social self-efficacy, are associated with SAD symptoms. This study examined whether social support and social self-efficacy predict, and buffer against SAD symptoms using a large, population-based sample of adolescents, among whom a large proportion have experienced NLEs. The results reveal that NLEs are significantly associated with SAD symptoms, while social support and social self-efficacy are both negatively associated with SAD symptoms. Only the NLEs × social support interaction significantly predicted SAD symptoms, with social support attenuating the association between NLEs and SAD symptoms. Moreover, increases in both social self-efficacy and social support were associated with reduced SAD symptoms, over and above variance explained by social support alone. Our cumulative results suggest that interventions that can modify both social support and social self-efficacy may help reduce SAD symptoms in at-risk adolescents.

The effects of modifying mental imagery in adolescent social anxiety.

BackgroundThe identification of negative self-imagery as a maintenance factor in adult social anxiety has led to enhanced treatments for this population. Whilst intrusive negative imagery is commonly reported by socially anxious adolescents, no studies have demonstrated that it plays a causal role in maintaining symptoms. To assess this possibility, we undertook an experimental study manipulating social self-imagery in high socially anxious adolescents.MethodsHigh socially anxious adolescents undertook two conversations under different conditions. During one conversation they held a negative social self-image in mind, and in the other they held a benign social self-image in mind. Self-report, conversation partner report and independent assessor ratings were taken.ResultsWhen participants held a negative self-image in mind, they reported feeling more anxious, and believed they looked more anxious and performed more poorly. Furthermore, they overestimated how anxious they looked compared to conversation partner ratings. As well as distorting participants’ perception of their anxious appearance, holding a negative image in mind also had observable effects on the interaction. Participants were rated as looking more anxious and performing less well by their conversation partner when they held such images in mind, and the conversation was rated more critically by conversation partners and independent observers. Finally, a preliminary mediation analysis suggested that the detrimental effect of negative imagery on the social interaction may be partly due to the spontaneous use of avoidant safety behaviours.ConclusionsThe findings provide support for a causal role of negative self-imagery in adolescent social anxiety and point to the potential clinical value of techniques targeting imagery to treat the disorder.

Co-Occurring Trajectories of Depression and Social Anxiety in Childhood and Adolescence: Interactive Effects of Positive Emotionality and Domains of Chronic Interpersonal Stress.

Deficits in positive emotionality (PE) have been implicated in the etiology of both social anxiety and depression; however, factors that contribute to divergent social anxiety and depression outcomes among youth low in PE remain unknown. Extant research suggests that parent-child stress and peer stress demonstrate differential patterns of associations with social anxiety and depression. Thus, the present study examined prospective interactive effects of PE and chronic parent-child and peer stress on simultaneously developing trajectories of social anxiety and depression symptoms among 543 boys and girls (age 8-16 at baseline, M[SD] = 11.94[2.32] 55.6% female). Parents reported on youth PE at baseline. Domains of chronic interpersonal (parent-child and peer) stress occurring between baseline and 18-months were assessed via child-report by trained interviews using the Youth Life Stress Interview (Rudolph and Flynn Development and Psychopathology, 19(2), 497-521, 2007). Youth completed self-report measures of depression and social anxiety every three months from 18- to 36- months (7 assessments). Conditional bivariate latent growth curve models indicated that main effects of parent-child stress, but not peer stress, predicted trajectories of depression in boys and girls. In girls, high levels of chronic interpersonal stress in both domains predicted stable, elevated trajectories of social anxiety symptoms regardless of PE. In boys, PE contributed to a pattern of differential susceptibility whereby boys high in PE were particularly susceptible to the effects of chronic interpersonal stress, for better or worse.

A Paradigm for Understanding Adolescent Social Anxiety with Unfamiliar Peers: Conceptual Foundations and Directions for Future Research

Adolescents who experience social anxiety concerns often display symptoms and impairments when interacting with unfamiliar peers. For adolescent clients, reducing symptoms and impairments within these interactions comprises a key treatment target within exposure-based therapies for social anxiety. Recent work on mechanisms of change in exposure-based therapies highlights the need for therapeutic exposures to simulate real-world manifestations of anxiety-provoking social situations. Yet, researchers encounter difficulty with gathering ecologically valid data about social interactions with unfamiliar peers. The lack of these data inhibits building an evidence base for understanding, assessing, and treating adolescent clients whose concerns manifest within these social interactions. Consequently, we developed a paradigm for understanding adolescent social anxiety within social interactions with unfamiliar peers. In this paradigm, we train peer confederates to interact with adolescents as if they were a same-age peer, within a battery of social interaction tasks that mimic key characteristics of therapeutic exposures. Leveraging experimental psychopathology and multi-modal assessment approaches, this paradigm allows for understanding core components of social interactions with unfamiliar peers relevant to exposure-based therapy, including stimuli variability, habituation, expectancy violations, peers' impressions about socially anxious adolescents, and maladaptive coping strategies that inhibit learning from exposures (e.g., safety behaviors). We detail the conceptual and empirical foundations of this paradigm, highlight important directions for future research, and report "proof of concept" data supporting these research directions. The Unfamiliar Peer Paradigm opens new doors for building a basic science that informs evidence-based services for social anxiety, within clinically relevant contexts in adolescents' social worlds.