Social Phobia Inventory Research Articles

Exploring the efficacy of cognitive behavioral therapy and role-playing games as an intervention for adults with social anxiety

ABSTRACT Tabletop role-playing games (TTRPGs) have increased in popularity as a hobby and allows multiple people to play together online or in person. Group activities such as TTRPGs have been used to improve social skills and mental well-being Although there is qualitative and anecdotal studies and reports about the efficacy of the therapeutic application of TTRPGs, no related studies have employed quantitative measures or mental health screening tools. This study explored whether intentionally introduced cognitive behavioral therapy (CBT) delivered through the medium of TTRPG groups could positively affect social skills, reduce anxiety symptoms and behaviors, and enhance the mental well-being of participants. Data was collected from May 2020 to February 2021 using the Social Phobia Inventory, Generalized Anxiety Disorder Assessment, Social Skills Inventory, and Group Satisfaction Scale and debriefs with participants. The study was completed virtually. All the groups showed an average decrease in self-reported anxiety; one of the therapeutic TTRPG groups decreased in self-reported social anxiety, while the others remained the same. All of them showed improved social skill scores and the participants were very satisfied with the overall group experience, thus suggesting that their needs were met.

Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety

Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. ObjectivesThe first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. MethodIn the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. ResultsIn Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. ConclusionsThe results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.

Prevalence and associated factors of social phobia among high school adolescents in Northwest Ethiopia, 2021.

Social phobia is the third most common mental illness in the world. It harms educational achievement by increasing school absentees and prevents students to participate in class, and this leads to a significant impairment of the emotional, psychological, social, and physical wellbeing of students. The research done regarding social phobia and associated factors among high school students in low- and middle-income countries is limited. Therefore, this study aims to assess the prevalence and associated factors of social phobia among adolescents and have a pivotal role in further investigation. To assess the prevalence and associated factors of social phobia among high school adolescents in Northwest Ethiopia, 2021. An institutional-based cross-sectional study was conducted from 15 April to 14 May 2021, by using a simple random sampling technique to select a sample of 936 participants after proportional allocation to the six high schools. Social phobia was assessed by using the social phobia inventory (SPIN), independent variables like social support were assessed by Oslo social support scale, substance-related factors by ASSIST, and the rest of the other factors were assessed by structured questionnaires. Binary and multivariate analyses were done to identify factors associated with social phobia. Statistical significance was declared at a 95% confidence interval (CI) of p-value less than or equal to 0.05. The prevalence of social phobia among adolescents was found to be 40.2% (95% CI 37.0 to 43.4%). In the multivariable analysis, female sex (AOR = 1.374, 95% CI = 1.016, 1.858), poor social support (AOR = 2.408, 95% CI = 1.660, 3.493), having known chronic medical illness (AOR = 2.131, 95% CI = 1.173, 3.870), having a history of mental illness in the family (AOR = 1.723, 95% CI = 1.071, 2.773), and is highly risky alcohol user (AOR = 1.992 95% CI 1.034, 3.838) were factors significantly associated with social phobia symptoms. The overall prevalence of SP among adolescents was high. Therefore, early detection and adequate intervention are crucial to reducing the overall burden of social phobia among adolescents.

Studying online from home and social anxiety among university students: The role of societal and interpersonal mattering

<span lang="EN-US">Literature suggested that the enforcement of lockdowns such as the Movement Control Order (MCO) had limited physical social interaction and therefore increased the inclination on social media and other means of digital communication. This shift of social pattern was reported to alter the way young adults develop their mattering, the sense of how much they matter to others. While mattering has been reported as the protective factors against social anxiety, this study aims to investigate the contribution of interpersonal mattering and societal mattering on social anxiety among university students who had to study online from home during the enforcement of the MCO in Malaysia amidst the COVID-19 pandemic in early 2021. Purposive sampling was conducted to recruit 158 participants (89 females, 69 males) with their ages ranging from 18 to 25 years of age (M=21.77, SD=1.54) to respond to Mattering to Others Questionnaire, University Mattering Scale, and Social Phobia Inventory. The results of multiple linear regression supported the hypotheses that both types of mattering negatively predict social anxiety, and that interpersonal mattering was no longer a significant predictor when controlling for societal mattering.</span>

Fear of negative evaluation in a university population: The connections of body image, and social anxiety

This study was a cross-sectional survey design that examined the connections of body image and perceived social anxiety as predictors of Fear of Negative Evaluation (FNE) in a university population in Nigeria. Using accidental sampling technique,two hundred and forty-five (245) students were selected from Adekunle Ajasin University Akungba-Akoko, Ondo State, Nigeria. The participants comprised of 120 [50.6%] males and 117 [49.4%] females. The participants age range from 16 to 34 years, [Mean = SD 22.42; =3.045]. FNE was measured by using Brief Fear of Negative Evaluation Scale, version 2 (BFNE-II), Body Shape Questionnaire (BSQ-8C), and social anxiety was measured using social phobia inventory (SPIN). The result revealed that body shape significantly predicted fear of negative evaluation among undergraduates [β= .03, t= .53, p > .05]. The result showed that social anxiety significantly predicted fear of negative evaluation among undergraduates [β= .51, t= 8.59, p < .01]. Also, body image, and social anxiety jointly significantly predicts fear of negative evaluation among undergraduates [F (2, 242) = 46.63, R = .53, R2= .23, p <.01]. Based on the findings of this study, it was recommended that, the Nigerian government through the Ministry of Education, in conjunction with National Universities Commission (NUC), as well as other stakeholders should inculcate psychological interventions programmes in school curriculum to expose students to coping strategies and managing fear of negative evaluation.

Social anxiety disorder and its associated factors: a cross-sectional study among medical students, Saudi Arabia

BackgroundSocial Anxiety disorder (SAD) is common worldwide. However, data from Saudi Arabia is deficient. This study aims to determine the prevalence of SAD across Saudi medical students and its associations with sociodemographic factors and their academic performance.MethodsThe main outcome was presence/absence of SAD and the secondary outcome was its level of severity. These were assessed from the Social Phobia Inventory. Associated factors included sociodemographic variables, as well as educational characteristics of students. Descriptive statistics were reported as counts and percentages, and unadjusted and adjusted odds ratios (OR) and their 95% confidence intervals (CIs) were computed through bivariate and multivariate logistic regression.ResultsOf 5896 Saudi medical students who participated in the study, the prevalence of SAD was almost 51%. While 8.21% and 4.21% had reported severe and very severe SAD, respectively. Older age students were at lower risk of developing SAD (OR = 0.92, 95% CI = 0.89 – 0.96). In contrast, females (OR = 1.13, 95% CI = 1.01 – 1.26), students enrolled in private colleges and colleges implementing non-problem-based learning (OR = 1.29, 95% CI = 1.09 – 1.52 and OR = 1.29. 95% CI = 1.15 – 1.46 respectively) were at higher risk. A significant elevated risk of SAD was found among students who had previously failed, and had a low GPA.ConclusionSAD is prevalent among the sampled population, and different associated factors were identified. Current results could raise the awareness of faculty members and healthcare providers towards early detection and management of these cases.

Measurement Invariance and Validity of the Short Form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12)

The short form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12) measures three partner-related attachment scales: fear of rejection, readiness for self-disclosure and conscious need for care. In addition to factor structure and reliability, the present study examined measurement invariance and validity using a non-clinical and a clinical sample of college students (N=208). Besides the BFPE12, the following Questionnaires were assessed: Short Form of Experiences in Close Relationships - Revised (ECR-RD8), Outcome Questionnaire (OQ-30), revised Beck Depression Inventory (BDI-II), Social Phobia Inventory (SPIN), and Test Anxiety Inventory (TAI-G). The factor structure is tested using confirmatory factor analysis (CFA), the internal consistency of the scales is quantified using McDonald's ω, the measurement invariance is investigated with two-group structural equation models, and the validity is examined using correlation and regression analyses. In both samples, the factor structure was confirmed (CFI>0.93; TLI>0.93; RMSEA<0.08; SRMR<0.08) and the reliability of all three scales was acceptable (ω>.7) - with the exception of need for care in the non-clinical group. We found configurational, metric and scalar measurement invariance regarding to the assignment in the clinical and non-clinical sample. In terms of convergent validity, fear of rejection and conscious need for care were associated with attachment-related anxiety (r=0.771 and r=0.539, p<0.001) and low readiness for self-disclosure was correlated with attachment-related avoidance (measured with ECR-RD8, r=- 0.704, p<0.001). Overall, the present study supports the factor structure, measurement invariance, reliability, and validity of the BPEQ12 in clinical and non-clinical samples.

French adaptation and validation of the Panic Disorder Severity Scale—self-report

BackgroundThe aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale – Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version.MethodsA sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial.ResultsThe French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach’s alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change.ConclusionsThe French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.

Psychometric properties and factor structure of the Iranian version of the Social Phobia Inventory (I-SPIN)

Introduction: Despite the high prevalence of social anxiety disorder and the necessity of conducting etiological studies, the existing measures of social anxiety lack robust factor structure due to methodological flaws, leading to doubtful results. Aim: The present study is aimed to investigate the factor structure, reliability, and convergent validity of the Iranian version of the Social Phobia Inventory (I-SPIN). Method: This is a cross-sectional, psychometric study. Two large samples (N1=1210, N2=228) have been selected with the convenience sampling method from the student population of the three different universities in Zanjan city (i.e., University of Medical Sciences, Azad, and Payame Noor University) who were studying in those universities from February to July 2020. CAQ-GE, BAI, BDI-II, and IUS-12 were used in the present study. Exploratory and confirmatory factor analysis were conducted using Mplus-7.4 and SPSS-26 was used to perform internal consistency and validity analyses. Results: Exploratory and confirmatory factor analysis revealed that the two-factor model best fit the data. Besides, the results indicated that the I-SPIN has a positive and significant correlation with anxiety-related measures (p&lt;0.01) and acceptable internal consistency (α=0.92). Conclusion: Considering the excellent psychometric properties and a robust factor structure of the I-SPIN in an Iranian college student sample, using this measure would improve the accuracy of future studies and help us broaden our knowledge of the underlying mechanisms of this disorder.

Association between perfectionism and life satisfaction among a sample of the Lebanese population: The indirect role of social phobia and validation of the Arabic version of the Social Phobia Inventory.

To assess the psychometric properties of the Social Phobia Inventory (SPIN), and evaluate the indirect effect of social phobia between perfectionism and life satisfaction (LS). A cross-sectional study enrolled 683 Lebanese adults (April-May 2021). The confirmatory factor analysis results confirmed the one-factor solution of the SPIN items (Cronbach's alpha = 0.92). Social phobia had an indirect effect in the association between rigid, self-critical, and narcissistic perfectionism and life satisfaction. The study results confirm the psychometric properties of the SPIN to assess social phobia and constitute a preliminary database of the variables that interplay with LS in the Lebanese population. Future studies should suggest clinical tools and techniques to cope with anxiety or reduce perfectionism to enhance LS.

PREVALENCE AND SOCIODEMOGRAPHIC CORRELATES OF SOCIAL ANXIETY DISORDER AMONG MEDICAL UNDERGRADUATES

Background: Social anxiety disorder is a common mental health disorder characterized by persistent fear of being embarrassed, humiliated, rejected and looked down by others. It can cause impairment in education and in professional achievement, quality of life and social relationships. The objective of this study was to measure the prevalence and study associated factors of social anxiety disorder among students of a tertiary medical college and hospital. Methods: This cross-sectional study was conducted among 403 medical students of a medical college and Hospital. The questionnaire used in the study had questions related to socio-demographic details and had the social phobia inventory (SPIN) questionnaire which was used to assess social anxiety disorder. Results: Out of 403 medical students, 61.53% (n=248) students were not having any type of social anxiety disorder. Among 38.46% (n=155) of students who were having SAD, 21.33%(n=86) were having mild SAD and 17.11% (n=69) were having signicant SAD. Mild social anxiety is considered as normal. Factors such as age, year of study, self- perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier were found to be statistically associated with SAD. Conclusion: Social anxiety disorder was signicantly associated with age, year of study, self perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier.

"Early Negative Memories, Humiliation and Defectiveness/Shame Schema: An Emotion-Focused Therapeutic Approach to Social Anxiety"

"Introduction: Recently emotion-focused therapy has developed as an additional approach and considers the role of primary emotions such as shame in the formation and persistence of SAD. Objectives: The purpose of this study was to investigate the theoretical model of emotion-focused therapy for SAD by considering the role of early negative memories, humiliation and the mediating role of self-defectiveness/shame schema in the etiology of SAD. Method: This cross-sectional descriptive study recruited a sample of 105 students, 44 males (41.9%) 61 females (58.1%), diagnosed with SAD by psychologists from Shahid Beheshti University Counseling Center. Participants ranging in age from 18 to 34 with a mean age of 23.1 years (SD=3.5) completed the Social Phobia Inventory, Humiliation Inventory, Early Life Experiences Scale, Defectiveness /Shame Schema subscale of the Young Schema Questionnaire-Short Form. Results: Data were analyzed using SmartPLS-SEM. The results showed that early childhood experiences and humiliation significantly predict SAD. Also, the indirect effects of the independent variables through defectiveness/shame schema on SAD were significant. Conclusions: Consistent with the assumptions of the emotion-focused approach to SAD, these results confirm that early life experiences and humiliation with the development of shame schemes play an important role in the etiology of SAD and must be considered for therapy to be effective. The results of this study suggest that the components of the emotion-focused model can have therapeutic value as targets of intervention in randomized clinical trials."

A follow-up study on treatment effects of cognitive-behavioral therapy on social anxiety disorder: Impact of COVID-19 fear during post-lockdown period

There is a paucity of research on the role of COVID-19 related fear and lockdown on social anxiety disorder (SAD). In a follow-up study during post-lockdown period, we compared social anxiety of individuals with SAD who received cognitive-behavioral therapy (CBT) versus psychoeducational-supportive therapy (PST) before the COVID-19 pandemic, and the impact of COVID-19 related fear. Social anxiety severity was rated by the Social Phobia Inventory (SPIN) at pre-intervention, post-intervention, and post-lockdown periods. Fear of COVID-19 was assessed during the post-lockdown period. The treatment effects in the CBT group (n = 33) were significantly better than the PST group (n = 32) at post-intervention; this was maintained at 14-months following intervention despite COVID-related lockdown. In the PST group, there was no change following the intervention; and the social phobia increased after lockdown. The CBT group had significantly less COVID-19 related fear than the PST group. Social anxiety was positively correlated with fear of COVID-19; and individuals with comorbidities had significantly more fear. Using the hierarchical multiple regression, SPIN post-intervention, COVID-19 fear, and duration of SAD predicted social anxiety severity during the post-lockdown period. In conclusion, the effect of CBT for SAD was maintained through lockdown and was associated with significantly less COVID-19 related fear.

Social anxiety disorder with comorbid major depression – why fearful attachment style is relevant

Individuals with social anxiety disorder (SAD) often suffer from comorbid major depressive disorder (MDD), which goes along with increased clinical and functional impairment. There has been little research on underlying differences regarding childhood adversities and attachment styles between individuals with SAD with and without comorbid MDD. In the present study, the consecutive sample comprised 612 SCID-diagnosed participants. Of these, n = 472 (62.3% women, 40.7 ± 13.8 years) showed SAD and comorbid MDD (SAD-MDD group) and n = 140 (47.9% women, 43.7 ± 14.7 years) showed just SAD (SAD group). The two groups were compared regarding SAD symptom severity (Social Phobia Inventory; SPIN), childhood adversities (Adverse Childhood Experience Questionnaire; ACE) and attachment styles (Attachment Style Questionnaire, ASQ). The SAD-MDD group reported significantly more severe SAD symptoms (p = .002, d = 0.30), more childhood adversities (p < .001, d = 0.35) and a higher level of fearful attachment style (p < .001, d = 0.30). Group significantly moderated the association between fearful attachment style and SAD symptom severity (β = .292, p < .05) but not between preoccupied attachment style and SAD symptom severity (β = −.184, p = .124; R2adj = .168, p < .05). Fearful attachment style mediated the association between childhood adversities and SAD symptom severity in the SAD-MDD group. Our study could identify a specific significance of fearful attachment style for the association between negative childhood experiences and social anxiety symptoms in SAD-MDD. Findings have specific implications for the therapeutic relationship.

A rasch analysis of three socialization and communication measures in 4th-year doctor of pharmacy students.

The impact of communication and anxiety on Doctor of Pharmacy students across three measures was examined. Data were collected (N = 120) from 4th-year Doctor of Pharmacy students at a historically black college/university using the Interprofessional Socialization and Valuing Scale, the Personal Report of Communication Apprehension, and the Social Phobia Inventory. Results of Rasch Differential Item Functioning Analysis indicated statistically significant differences between each ethnic group on subcomponents of anxiety in each measure (20% Caucasian, 43% African American, 31.7% Asian, and 4.2% others). Evidence from this study shows that racial demographics affect different subscales of anxiety across doctoral pharmacy students. While some pedagogical implications exist, issues within the measures and their items must also be addressed.

Memory bias and personality characteristics in college students with social anxiety disorder.

Some individuals are more susceptible to recalling false information about events that never happened in their life. Nevertheless, there are several factors, such as personality characteristics, that appear to be related to memory performance. Social anxiety also provokes memory deficits for events that happen to other people, because these individuals tend to focus on their own inner selves rather than on external signs. To investigate the influence of the personality characteristics of individuals with social anxiety disorder (SAD) on memory performance. In this study, 183 university students had their memory tested using a complex emotional story about a mother and her son. Only subjects without clinical symptoms of depression and general anxiety (N = 148; 61 with SAD) were included in the study. Participants were compared for differences in personality characteristics using the Factorial Inventory of Personality and for SAD using the Social Phobia Inventory. The main results showed that memory performance of individuals with low percentile ranks in the personality characteristic dominance, i.e., those with low self-esteem, remembered more true information about the story than those with high scores when they did not have SAD. The results are helpful to foster better understanding of the personality characteristics related to SAD, such as low dominance, which implies low self-esteem and difficulties with trust and with imposing themselves on others. The results could help development and improvement of techniques for therapeutic intervention.

Social Anxiety Disorder among Undergraduate Students: Exploring Association with Self-esteem and Personality Traits

Background: Social phobia impacts negatively on the social and academic life of students and exerts a detrimental effect on the quality of life of the bearer. The study examined the burden of social anxiety disorder (SAD), the relationship of SAD with sociodemographic variables and self-esteem, and the big five personality traits correlates of both SAD and self-esteem among undergraduate students. Methods: Participants completed the Social Phobia Inventory (SPIN), the Big Five Personality Trait Inventory (BFPI), Rosenberg Self-Esteem Scale, and a sociodemographic questionnaire. The relationships between variables were explored using bivariate and multivariate statistics. Results: Two hundred and eighty (62.5%) participants reported significant SAD, mostly in the mild form (50.9%). There was a significant negative correlation between the SPIN scores and the total score on BFPI, extraversion, agreeableness, conscientiousness, openness, and self-esteem and a positive correlation with the neuroticism subscale. Similarly, a significant positive correlation with self-esteem and agreeableness, extraversion and conscientiousness, and a negative correlation between neuroticism subscale of BFPI were noted. Younger age also significantly increased the risk of social anxiety among the participants. Conclusions: The burden of social phobia among the undergraduate students was high, and highly correlated with personality traits and self-esteem. The study underscores the need to consider several factors in reducing social performance anxiety among undergraduate students with central effort geared toward reducing neuroticism and promotion of positive self-imagery and appraisal.

Mental Imagery and Social Pain in Adolescents-Analysis of Imagery Characteristics and Perspective-A Pilot Study.

Background: Mental imagery (MI) may play a key role in the development of various mental disorders in adolescents. Adolescence is known to be a fragile life period, in which acceptance by one’s favored peer group is extremely important, and social rejection is particularly painful. This is the first pilot study investigating MI and its relationship to social pain (SP). Method: A sample of 80 adolescents (14–20 years; 75.3% female) completed a web-based quasi-experimental design about the contents and characteristics of their spontaneous positive and negative MI and associated emotions, and were asked to complete the Social Pain Questionnaire, the Becks Depression Inventory and the Social Phobia Inventory. Results: A higher score of SP was significantly associated with increased fear, sadness, and feelings of guilt, and less control over negative MI. Characteristics of negative MI were more precisely predicted by SP scores than depression- and social anxiety scores. Adolescents with higher SP-scores more often reported negative images including social situations and were more likely to perceive negative images in a combination of field-and observer perspectives than adolescents with lower SP scores. Conclusion: SP-sensitivity seems to be linked to unique characteristics of negative MI, which reveals the strong emotional impact of social exclusion in youths. The results do not allow causal conclusions to be drawn, but raise questions about previous studies comparing each imagery perspective individually.

Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial.

Background: Internet-delivered psychotherapy represents an impactful large-scale solution for addressing psychological disorders. In spite of its flexibility and scalability, the fact that the ones in need have to initiate and sustain the curse of the treatment by themselves comes with considerable downsides in terms of treatment adherence. One solution could be to increase the ease of use and attractivity of the strategies and assignments from such programs. The present study aims to address this issue by incorporating a series of self-oriented strategies to the validated internet-delivered short version of the Unified Protocol (UP). By this mean we intend to complement the symptom-focused assignments, which may be more suitable in a therapist assisted context, with ones designed for self-enhancement, which may be easier approached as self-initiated. Based on a randomized controlled non-inferiority trial we compared the modified version of the UP with the standard short version.Method: The trial design was factorial, with two parallel arms and three measurement moments (baseline, post-intervention and 6-months follow-up). A total of 284 participants were randomly assigned to the intervention or the active control groups. The intervention group (baseline n = 142) received the self-enhanced nine modules of the UP (Self-enhanced 9UP) while the active control (baseline n = 142) received the standard nine modules (9UP). The newly added techniques were inspired by the acceptance and commitment therapy and were specific for self-concepts such as self-compassion or unconditional self-acceptance. Both programs lasted for 9 weeks. The non-inferiority of the Self-enhanced 9UP was tested against a margin of d = −0.35, on the following primary outcome measures: Patient Health Questionnaire 9 (PHQ9) – operationalization for depression; Generalized Anxiety Disorder 7 (GAD7) – operationalization for generalized anxiety or worry; Social Phobia Inventory (SPIN) – operationalization for social phobia; and Panic Disorder Severity Scale-Self Report (PDSS-SR) – that showed participants’ level of panic. Treatment adherence was assessed through the drop-out analyses and the engagement in completing the homework assignments. Secondary outcome measures included several self-concept measures: Self-Compassion Scale (SCS); Rosenberg Self-Esteem Scale (RSES); Unconditional Self-Acceptance Questionnaire (USAQ); New General Self-Efficacy Scale (NGSE); and Self-Concept Clarity Scale (SCCS). On the secondary outcomes we explored the potential boost of effectiveness produced by the newly added self-enhancement components.Results: The dropout rates were similar in both groups (approximately 45%) and high overall. Adherence to treatment assignments was also modest and similar between groups (on average participants completed approximately half of the tasks), without a statistically significant bias toward the self-enhancement ones. Overall, both the intention-to-treat and completers analyses yielded no significant group by time interactions for any of the post-intervention and follow-up measurements, but a few non-inferiority analyses suggested that the Self-enhanced 9UP had a significantly weaker effectiveness than the standard 9UP. Within-group analyses showed significant alleviations on all the primary and secondary outcomes for both groups. The effect size estimates were mainly medium and high, and their magnitude tended to be kept also at 6-months follow-up.Discussion: We failed to increase treatment adherence, but we found support with some exceptions, for the non-inferiority hypothesis. Hence, the alterations performed to the 9UP protocol, although they did not boost the treatment attractiveness, they also did not decrease the treatment effectiveness as suggested by most non-inferiority analyses. Likewise, the gain on self-concepts was produced by both groups. Hence, the short version of the UP seems to have the potential of effectively alleviating a larger palette of psychological variables associated with mental health symptoms than previously known. Even though our main objective was only partially achieved, these secondary results are insightful and could open new avenues of research.Clinical Trial Registration: This trial has been registered at ClinicalTrials.Gov (NCT03917550; 17 April 2019; https://clinicaltrials.gov/ct2/show/NCT03917550).

Predictors of suicidal ideation in social anxiety disorder – evidence for the validity of the Interpersonal Theory of Suicide

BackgroundThis study aims to identify covariates of suicidal ideation (SI) in a large sample of individuals diagnosed with social anxiety disorder (SAD). MethodsIn a cross-sectional design, 305 individuals (38.4 ± 14.1 years, 59% female) with SAD were assessed by the Social Phobia Inventory, Beck Depression Inventory, Adverse Childhood Experience Questionnaire, State Trait Anger Expression Inventory, Beck Scale for Suicidal Ideation and the Interpersonal Needs Questionnaire. ResultsSAD individuals with SI (n = 142, 46.6%) reported higher SAD and depression symptoms, more adverse childhood experiences (ACE), higher state anger (SA), perceived burdensomeness (PB) and higher thwarted belongingness (TB) compared to SAD individuals without SI (n = 163, 53.4%). In binary logistic regression, PB (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.06–1.15), TB (OR = 1.05, 95% CI = 1.02–1.07), SA (OR = 1.07, 95% CI = 1.01–1.13) and ACE (OR = 1.18, 95% CI = 1.03–1.35) emerged as significant covariates of acute SI (Nagelkerke's R2 = 0.39). Receiver operating characteristic (ROC) curves showcased the following areas under the curve (AUC): PB (AUC = 0.78), TB (AUC = 0.76), SA (AUC = 0.62) and ACE (AUC = 0.62). Multinomial logistic regression (no SI = ref.) showcased similar results for passive and active SI (n = 42), with SA reaching significance only for active SI. The Youden index identified appropriate cut-off values for PB, TB, SA and ACEQ by maximizing sensitivity and specificity. LimitationsCross-sectional design and self-reporting measures limit generalization. ConclusionOur findings confirm the validity of the Interpersonal Theory of Suicide concerning SI in SAD. PB and TB with SA and ACE may support the valid assessment of SI in therapeutic settings.