Social skills and social phobia: An investigation of DSM-IV subtypes

Social phobia is characterized as pervasive social timidity in social settings. Although much is known about this disorder, aspects of its clinical presentation remain unexplored, in particular characteristics that distinguish the generalized and non-generalized subtypes. For example, it remains unclear whether patients with the non-generalized subtype display social skills deficits in social interactions, and if so, are these deficits clinically, as well as statistically, significant? In this study, adults with either the non-generalized (NGSP; n = 60) or generalized (GSP; n = 119) subtype of social phobia and adults with no psychological disorder (n = 200) completed an extensive behavioral assessment of social skill and social anxiety. As expected, adults with NGSP and GSP reported equal distress and displayed similar rates of avoidance during an Impromptu Speech Task when compared to adults with no disorder. In contrast, the three groups were distinctly different when interacting with another person in various social situations. Adults with NGSP displayed social skill deficits when compared to individuals with no disorder, but they had fewer deficits than the GSP subtype. However, the identified skill deficits were clinically as well as statistically significant only for the GSP subtype. The results are discussed in terms of the contribution of skill deficits to the conceptualization and treatment of social phobia.     

Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder.

The validity of the social phobia subtype distinction was examined in a large sample of carefully diagnosed social phobics (N = 89). Generalized and specific subtypes were diagnosed reliably, and the generalized subtype showed a consistent pattern of greater symptom severity than did the specific subtype. In addition, generalized social phobics with and without avoidant personality disorder were compared, and a difference was found for only 1 of 4 parameters. The results are discussed in terms of the validity of subtyping in social phobia and the diagnostic boundary between social phobia and avoidant personality disorder.     

Relations Among Symptoms of Social Phobia Subtypes, Avoidant Personality Disorder, Panic, and Depression

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia.     

Symptoms of Specific and Generalized Social Phobia: An Examination of Discriminant Validity and Structural Relations With Mood and Anxiety Symptoms

Current models divide social phobia into specific (SSP) and generalized (GSP) subtypes and suggest strong overlap between GSP and avoidant personality disorder (APD). Meanwhile, other research suggests reclassifying anxiety and mood disorders as fear and distress disorders. To unify these separate lines of research, this study was designed to test the hypothesis that SSP is more related to fear disorders (e.g., panic and phobias), whereas GSP and APD are more related to distress disorders (e.g., depression and generalized anxiety). Confirmatory factor analysis suggested the best-fitting model had symptoms of GSP, APD, and depression loading on one factor, and symptoms of SSP, panic, and specific phobias loading on a second factor. Key components of this model were (a) the inclusion of GAD symptoms reduced model fit and (b) GSP and APD symptoms significantly predicted SSP symptoms; this is consistent with conceptualizations of individuals with both GSP and SSP reporting performance anxiety.     

Framing social information and generalized social phobia

Patients with generalized social phobia (GSP, N=33) and matched community controls (N=31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.     

Role of social skills training in adolescents with social anxiety disorder

Background/Objective: Social skills training (SST) is frequently included in the treatment of social anxiety disorder (SAD) in both children and adolescents, although there is no empirical evidence to support it. Consequently, our objective is to study the role and effects of SST in the treatment of a sample of adolescents with SAD. Method: A total of 108 adolescents diagnosed with generalized social phobia were randomly assigned to two treatment conditions (with and without SST) and a control group waiting list (WLCG). The evaluation included self-report measures, observational tests and blind evaluators. Results: Both interventions significantly reduced the number of social situations feared/avoided with respect to the WLCG, which worsened. Likewise, both interventions were effective but the group with SST obtained better results in the post-test and follow-ups, as well as a lower dropout rate (6:1). Conclusions: The use of SST reduces the dropout rate of treated adolescents and increases the effectiveness of the Intervention Program for Adolescents with Social Phobia.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.     

Social phobia in youth: the diagnostic utility of feared social situations

The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n=50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n=49), and youth without an anxiety disorder (n=41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth.     

Sociodemographic and psychological features of social phobia in adolescents

The objective of this study is to analyze the demographic and clinical features of adolescent with social phobia based on the subtype. The sample included 120 adolescents diagnosed of Social Phobia (specific or generalized). The results show statistically significant differences between both subtypes of social phobia; so much in gender as on each measure that evaluate anxiety, social avoidance, fear of negative evaluation and other correlates. These data are consistent with results informed by several studies with adult population and provide useful information for the investigation and the clinical practice.     

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.     

The effects of social anxiety and depression on the evaluation of facial crowds

Facial crowds of emotion connoting approval or criticism are linked to the fears of socially anxious individuals. We examined evaluation ratings and decision latencies of mixed facial displays by individuals with generalized social phobia (GSPs, n = 18), individuals with comorbid depression and GSP (COMs, n = 18), and normal controls (CONs, n = 18). First, we postulated that GSPs will assign more negative ratings to predominantly disapproving audiences as compared to CONs, and that GSPs will be faster in their evaluation of these audiences (negative bias hypothesis). Second, we expected depression, but not social anxiety, to be associated with diminished positive evaluation of audiences containing predominantly happy expressions and with a slower processing of such positive cues (the impaired positivity hypothesis). Results supported the negative bias hypothesis, and provided partial support for the impaired positivity hypothesis. The importance of examining the processing of complex non-verbal cues in social anxiety and in depression is discussed.     

A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

Social anxiety and related social impairment are linked to self‐efficacy and dysfunctional coping

Thomasson, P. & Psouni, E. (2010). Social anxiety and related social impairment are linked to self‐efficacy and dysfunctional coping. Scandinavian Journal of Psychology, 51, 171–178. This study investigated relationships between severity of social anxiety as well as related experiences of social impairment and self‐efficacy, social control and coping strategies. Social anxiety was regarded as a continuum ranging from mild social discomfort to totally inhibiting anxiety. Participants (N = 113, ages 19–60 years), recruited from a forum for individuals with social phobia and among university students, responded to a self‐administered questionnaire. Besides the expected association between a low sense of social control and more severe social anxiety and related social impairment, we found severity of social anxiety and related impairment to be associated with low self‐efficacy. This relationship was partly mediated by dysfunctional coping strategies. We suggest that low self‐efficacy may increase an individual’s tendency to rely on dysfunctional coping strategies for dealing with anxiety experienced in social situations. In turn, using dysfunctional coping strategies appears to exacerbate the experience of impairment from social anxiety.     

Enduring without avoiding: Pauses and verbal dysfluencies in public speaking fear

Direct measures of overt behavior have been underutilized in speech and other social fear, anxiety, and phobia research. This study demonstrates the usefulness of such variables in the evaluation of public speaking fear. A molecular behavioral assessment methodology was used to examine pauses and verbal dysfluencies of individuals with circumscribed speech fear (n=8) or general social anxiety (n=8), as well as nonanxious control participants (n=16), during an impromptu speech behavior test. Speech fear and generally social anxious individuals paused more often and for a longer duration than the nonanxious group. Results also indicated greater increases in state anxiety during the speech in the circumscribed speech fear sample, relative to the generalized social anxiety and control groups. Taken together with other research, these findings provide evidence that circumscribed speech fear is a meaningful subtype and can be independent of generalized social anxiety. The utility of measuring pausing and verbal dysfluencies in the behavioral assessment of speech fear and other social anxiety and phobia is discussed.     

The influence of social instructions on the effectiveness of a cognitive interview used with very young child witnesses

IntroductionThe modified cognitive interview (MCI) is an investigative interview method used to help child eyewitnesses to enhance the quality of their testimonies (Memon et al., 2010). Composed of cognitive (mnemonics) and social instructions, it indeed supports young witnesses to retrieve and to accurately report all their memories. If the benefits of the mnemonics on the MCI efficiency have been now established (e.g., Holliday & Albon, 2004; Verkampt & Ginet, 2010), the contribution of its social components has however not been deeply explored to date. This is notably the case of two main social instructions presented at the right beginning of an interview: the “Child can say ‘I don’t know”’ and the “Interviewer knows nothing about the facts” instructions.ObjectiveThis study aimed at evaluating the influence of these two social instructions on the effectiveness of MCI mnemonics, designed to be used by police officers to gather very young children's testimonies.MethodTo this end, 59 children aged 4 to 5.9 participated in a painting session and were interviewed two days later with a full modified cognitive interview (MCI), a MCI minus the “Child can say I don’t know” instruction, a MCI minus the “Interviewer knows nothing about the event” instruction, or a structured (control) interview that was solely composed of social instructions.ResultsThe results indicated an increase of 42% more correct information recollected with a full MCI relative to a structured interview during the free recall phase. However, the withdrawal of the “Interviewer knows nothing about the event” instruction from the MCI led the children to report 21% less information. This drop reached 3% with the MCI minus the “Child can say I don’t know” instruction.ConclusionChildren testimonies are therefore more informative when the mnemonics of the MCI are presented to the children along with social instructions.     

Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression

People with social anxiety disorder (SAD) use different types of safety behaviors that have been classified as avoidance vs. impression management. The current study investigated differences in safety behavior subtype use in 132 individuals with principal diagnoses of social anxiety disorder (SAD, n = 69), major depressive disorder (MDD, n = 30), and nonpatient controls (n = 33) across two social contexts: an interpersonal relationship-building task (social affiliation) and a speech task (social performance). We examined whether diagnostic groups differed in safety behavior subtype use and whether group differences varied by social context. We also explored relationships between avoidance and impression management safety behaviors, respectively, and positive and negative valence affective and behavioral outcomes within the social affiliation and social performance contexts. Safety behavior use varied by diagnosis (SAD > MDD > nonpatient controls). The effect of diagnosis on impression management safety behavior use depended on social context: use was comparable for the principal SAD and MDD groups in the social performance context, whereas the SAD group used more impression management safety behaviors than the MDD group in the social affiliation context. Greater use of avoidance safety behaviors related to higher negative affect and anxious behaviors, and lower positive affect and approach behaviors across contexts. Impression management safety behaviors were most strongly associated with higher positive affect and approach behaviors within the social performance context. These findings underscore the potential value of assessing safety behavior subtypes across different contexts and within major depression, in addition to SAD.     

Resolving ambiguity: the effect of experience on interpretation of ambiguous events in generalized social phobia

The authors examined the effect of learning on multiple encounters with sources of social ambiguity in individuals with generalized social phobia (GSP). The authors modified G. B. Simpson and H. Kang's (1994) paradigm and presented prime-target word pairs to individuals with GSP and nonanxious controls (NACs) to prime threat and nonthreat meanings of homographs and examine the effect of this priming on later encounters with that homograph. Consistent with previous research, NACs showed faster response latencies naming a target primed by a homograph with the same meaning activated in two successive trials than naming the same target primed by an unrelated word. Furthermore, NACs showed slower response latencies naming a target when a different meaning of the homograph prime was activated in successive trials than naming a target primed by an unrelated word. GSP participants did not show this pattern in learning a nonthreat meaning of a homograph. These results support the hypothesis that a faulty learning mechanism may be involved in social anxiety.     

Rééducation des compétences socio-émotionnelles pour des adultes présentant une déficience intellectuelle

IntroductionThe aim of the present study was to improve socio-emotional skills in adults with intellectual disability (ID) in order to remediate their social behavior difficulties.MethodThe socio-emotional skills reeducation program (Barisnikov, 2007) was proposed to 17 ID adults. Participants’ socio-emotional skills were assessed in pre- and post-reeducation period using tasks from the “Socio-Cognitive and Emotional Battery” (Barisnikov & Hippolyte, 2011).ResultsPost-reeducation assessment showed that the performance of participants was significantly improved on both “Emotion Attribution Task” and “Social Resolution task”. The significant reduction in their behavioral problems was also observed. These results demonstrated that the improvements were not limited to participants’ socio-emotional processing abilities but were also generalized to their daily functioning.ConclusionThe program provides an interesting tool to improve socio-emotional processing abilities and social behavior in adults with ID.