Frequency and comorbidity of social phobia and social fears in adolescents.

This report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 adolescents, aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents met the DSM-IV criteria for social phobia sometimes in their life. More girls than boys received the diagnosis of social phobia and the frequency of the disorder increased with age. The lifetime frequency of social fears were much higher than that of social phobia. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia comorbid highly with depressive disorders, somatoform disorders and substance use disorders. Despite the high level of psychosocial impairment experienced by cases with social phobia and those with any social fears, only a small portion of them did receive professional help.     

Psychopathology of Adolescent Social Phobia

Sixty-three adolescents with social phobia and 43 with no psychiatric disorders were compared across a number of clinical variables. In addition to clinically impairing social fear, adolescents with social phobia had significantly higher levels of loneliness, dysphoria, general emotional over-responsiveness and more internalizing behaviors than normal controls and 57.1% of socially phobic adolescents had a second, concurrent diagnosis, 75% of which were other anxiety disorders. In addition, adolescents with social phobia were significantly less socially skilled. Though similar in some respects to childhood social phobia, adolescent social phobia has a unique clinical presentation. The importance of developmental differences on the development of age-appropriate interventions is discussed.     

Brief cognitive therapy for social phobia: a case series

Social phobia is a common and disabling anxiety disorder. The most effective psychological treatments for social phobia are cognitive therapy and exposure. However, the degree of improvement across these treatments is variable, and their implementation is costly and time-consuming. This study aimed to conduct a preliminary clinical evaluation of the effectiveness of a brief, new form of cognitive therapy based on a recent cognitive model of social phobia. Six consecutively referred patients with social phobia were treated using established single case series methodology. Brief cognitive therapy was effective with all patients demonstrating clinically significant improvements in all measures. Treatment gains were maintained at follow-up. The mean number of treatment sessions delivered was 5.5 and improvements compare favourably with previous treatment studies. Brief cognitive therapy for social phobia appears promising and it is potentially cost-effective. Future randomised and controlled evaluations of this brief treatment are warranted.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM-IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non-clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co-morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM‐IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non‐clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co‐morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Psychoanalytisch-orientierte Fokaltherapie der sozialen Phobie

Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy to treat anxiety disorders in clinical practice, evidence for the efficacy of psychodynamic therapy in anxiety disorders is unsatisfactory. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy in anxiety disorders. Psychodynamically oriented treatment manuals for anxiety disorders presently exist for generalized anxiety disorder and panic disorder. For social phobia (or social anxiety disorder), however, no manual for psychodynamic treatment has yet been published. Social phobia is a very frequent mental disorder characterized by an early onset, a chronic course, severe psychosocial impairments and high socio-economic costs and at the same time in spite of these facts one of the mental disorders which are scarcely diagnosed and treated. In this article, a manual for a 30-session (5 exploratory and 25 therapy sessions) short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. In the first part, the general principles of SE therapy are presented. In the second part, a manual specifically adapted to the treatment of social phobia is described. This manual includes specific additional treatment elements that have clinically proved to be useful in the therapy of social phobia. The treatment manual is presently used in a large-scale randomized controlled multi-center study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.     

Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study.

Social phobia is one of the most frequent mental disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive behavior therapies (CBT). In this last case, graded exposure to feared social situations is one of the fundamental therapeutic ingredients. Virtual reality technologies are an interesting alternative to the standard exposure in social phobia, especially since studies have shown its usefulness for the fear of public speaking. This paper reports a preliminary study in which a virtual reality therapy (VRT), based on exposure to virtual environments, was used to treat social phobia. The sample consisted of 36 participants diagnosed with social phobia assigned to either VRT or a group-CBT (control condition). The virtual environments used in the treatment recreate four situations dealing with social anxiety: performance, intimacy, scrutiny, and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors in order to reduce anxiety in the corresponding real situations. Both treatments lasted 12 weeks, and sessions were delivered according to a treatment manual. Results showed statistically and clinically significant improvement in both conditions. The effect-sizes comparing the efficacy of VRT to the control traditional group-CBT revealed that the differences between the two treatments are trivial.     

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.     

Modification of Cognitive-Behavioral Techniques in the Treatment of a Five Year-Old Girl with Social Phobia

Social phobia is a debilitating anxiety disorder that often goes undetected in young children, but can be effectively treated with cognitive-behavioral interventions. For children and adolescents, treatment usually includes education, social skills training, cognitive restructuring, relaxation training, and exposure. However, for very young children who present with social phobia, it is necessary to adapt treatment to the developmental level of the child. A case illustration demonstrates the way in which cognitive behavioral treatment (CBT) was modified for the treatment of a five year-old girl with social phobia. Several modifications were made, including utilizing novel exposure techniques and emphasizing parent management training in order to promote generalization of treatment gains outside of session.     

Psychosoziale Interventionen bei Patientinnen mit Brustkrebs

Breast cancer patients are subject not only to physical strain but also to substantial psychological and social stress as well as major threats and challenges.The paper presented gives an overview of the research status on psychosocial interventions to support patients in their coping endeavours.Psychosocial basic care of women with breast cancer is performed by the physicians treating oncologically and includes information fitting patients' information needs,and responding to their emotional stress.Evaluated training and educational programs are available for physicians to enhance their psychosocial competence.Psychosocial basic care is completed by psychoeducational interventions.In 20–30% of women with breast cancer, there is a need for a special psychotherapeutic treatment.Especially, supportive and cognitive-behavioral therapies in an individual or a group setting contribute to a reduction of anxiety and depression. Even anticipated side-effects of somatic treatments can be diminished by psychotherapy. Research in the field supports that there is a need for broad integration of psychosocial interventions into disease management programs for women suffering from breast cancer.     

Psychiatric correlates of childhood shyness in a nationally representative sample

Relations between adult anxiety and mood disorders and retrospective reports of excessive childhood shyness were investigated in the US National Comorbidity, Survey (n=5877). Results indicated that 26% of women and 19% of men described themselves as 'very shy' when they were growing up. Of these shy individuals, 53% of women and 40% of men met criteria for a lifetime diagnosis of one or more anxiety or mood disorders. Relations between excessive shyness and each of the anxiety and mood disorders were examined after adjusting for elevated neuroticism, self-criticism, and low maternal care. The largest odds ratios were found for social phobia in both men and women, particularly for the complex subtype of this disorder. Significant associations also emerged for posttraumatic stress disorder in women and for major depressive disorder in men. Childhood shyness remained significantly associated with a lifetime history of social phobia when individuals with current (past year) social phobia were excluded from the analysis. The results of this study suggest that childhood shyness is strongly related to the complex subtype of social phobia in the general population. Excessive shyness does not appear to be strongly associated with other anxiety and mood disorders when related psychosocial and developmental dimensions are statistically controlled. Finally, many individuals who report excessive childhood shyness do not meet criteria for any anxiety or mood disorder. In a similar fashion, approximately 50% of individuals with a lifetime history of complex social phobia did not view themselves as very shy when growing up.     

School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study

Social anxiety disorder, whose onset peaks in adolescence, is associated with significant impairment. Despite the availability of effective treatments, few affected youth receive services. Transporting interventions into schools may circumvent barriers to treatment. The efficacy of a school-based intervention for social anxiety disorder was examined in a randomized wait-list control trial of 35 adolescents (26 females). Independent evaluators, blind to treatment condition, evaluated participants at preintervention, postintervention, and 9 months later. Adolescents in the intervention group demonstrated significantly greater reductions than controls in social anxiety and avoidance, as well as significantly improved overall functioning. In addition, 67% of treated subjects, compared to 6% of wait-list participants, no longer met criteria for social phobia following treatment. Findings support the possible efficacy of school-based intervention for facilitating access to treatment for socially anxious adolescents.     

Effectiveness of treatments for social phobia in an applied field

Social phobia is one of the most common disorders and one that requires the most attention from psychological clinics. The aim of this article was to study the effectiveness of psychological treatments in a University Psychological Clinic. Seventy-one social phobia patients requested psychological assistance. The average number of assessment sessions was 3.8 and the average number of treatment sessions was 16.1. Therapeutic success reached 64.2%, withdrawal percentage was 11.3%, and drop-out percentage was 24.5%. The effect size (Cohen's d) achieved in the Social Avoidance and Distress Scale (SAD) and Fear of Negative Evaluation Scale (FNE) were 1.96 and 1.78, respectively. Comparing these results with efficacy research (particularly meta-analysis), it has been shown that the treatment effectiveness achieved is very similar. It is concluded that cognitive behavioural treatments for social phobia can be transferred from research settings to clinical practice.     

Frequency, comorbidity, and psychosocial impairment of specific phobia in adolescents

Investigated the frequency, comorbidity, and psychosocial impairment of specific phobia and specific fears among 1,035 adolescents 12 to 17 years old. The adolescents were recruited from 36 schools in the province of Bremen, Germany. Specific phobia and other psychiatric disorders were coded based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria using the computerized Munich version of the Composite International Diagnostic Interview (Wittchen & Pfister, 1996). Thirty-six (3.5%) of the adolescents met DSM-IV criteria for specific phobia sometime in their life. Of all the subtypes of specific phobia, animal and natural environment phobia were the most common. More girls than boys received the diagnosis of specific phobia. One third of the adolescents with specific phobia also had depressive and somatoform disorders. Despite the high level of psychosocial impairment experienced by individuals with specific phobia both during the worst episode of their disorder and in the last 4 weeks, only a small portion of them sought professional help.     

Understanding and Treating Social Phobia

Social phobia, a relatively obscure disorder, is receiving increased attention due to evidence suggesting that it is more prevalent and debilitative than once thought. The purpose of this article is to help counselors better understand the nature of and treatments for this disorder. Effective behavioral and pharmacological approaches are reviewed, and counseling implications are discussed to increase counselors' confidence in providing treatment to people with social phobia.     

Latina breast cancer survivors' lived experiences: diagnosis, treatment, and beyond

Latina breast cancer survivors are not benefiting from advances in psychosocial interventions. Despite their greater breast cancer burden, there is a dearth of information about this population. This qualitative study examined the experiences of 18 immigrant Latina breast cancer survivors along the survivorship continuum, from diagnosis to long-term survivorship. The authors conducted separate focus groups with women in the acute, reentry, and long-term survivorship stages. Through grounded theory analysis, the authors uncovered 5 themes of experience: perceptions of psychological well-being, impact of diagnosis, impact of treatment, need for social support, and development of new attitudes. Some themes were applicable across all survivorship stages, whereas others were more salient at a particular stage. Within themes, the authors identified experiences reported in the general literature (i.e., the debilitating effect of chemotherapy) and distinct cultural experiences (i.e., fear that a cancer diagnosis leads to certain death). Results suggest that treatments tailored for each survivorship stage are more likely to be effective than generic interventions. These findings have the potential to lessen health disparities in utilization of psychosocial treatments by Latina breast cancer survivors.     

Diagnostic Comorbidity in Adults With Generalized Anxiety Disorder: Impact of Comorbidity on Psychotherapy Outcome and Impact of Psychotherapy on Comorbid Diagnoses

The current study examined the impact of comorbidity on cognitive and behavioral therapies for generalized anxiety disorder (GAD) as well as the impact of these therapies on diagnoses comorbid to GAD. Seventy-six treatment-seeking adults with principal diagnoses of GAD received 14 sessions of therapy. Most (n = 46; 60.5%) of the sample had at least one comorbid diagnosis. Although the presence of comorbid diagnoses was associated with greater severity of GAD symptoms at pretreatment, greater severity of comorbid major depression, simple phobia, and social phobia was associated with greater change in symptoms of GAD in response to treatment, with no effect on maintenance of gains during a 2-year follow-up. Further, psychotherapy for principal GAD led to a reduction in number of comorbid diagnoses and in severity of social phobia, simple phobia, and major depression at posttreatment. At 2-year follow-up severity of social and simple phobia remained below pretreatment levels, whereas severity of depression was no longer significantly below pretreatment levels. These results suggest that although people with comorbid disorders enter treatment with more severe GAD symptomatology, they demonstrate greater change, and therefore such comorbidity does not diminish the efficacy of cognitive and behavioral therapies for GAD. In addition, the impact of these treatments for GAD may generalize to reduced severity of simple phobia, social phobia, and major depression; however, gains in severity of major depression are not maintained.     

Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.     

Intercorrelations and developmental pathways of mothers' and fathers' loneliness during pregnancy,infancy and toddlerhood – STEPS study

Our aim was to study the inter‐correlations and developmental pathways of mothers' and fathers' social and emotional loneliness during pregnancy (20th pregnancy week), infancy (child aged 8 months), and early childhood (child aged 18 months). Moreover, we aimed to study whether mothers and fathers who have different developmental profiles (identified by latent growth curve mixture models) differ in their experiences of marital dissatisfaction (RDAS), social phobia (SPIN) and depression (BDI) during pregnancy. Both mothers' social and emotional loneliness and fathers' social and emotional loneliness were highly stable, and within individuals these loneliness factors were strongly correlated. However, the correlations between mothers' loneliness experiences and fathers' loneliness experiences were weaker than expected. Separate latent growth curve groups were identified, which differed in feelings of marital dissatisfaction, social phobia, and depression. These groupings revealed that the higher the loneliness was, the more the parents experience these other psychosocial problems.     

社交焦虑个体外显与内隐自尊的研究

社交恐惧图式理论、社交恐惧模式、和社交恐惧认知行为模式等认知理论,都认为社交恐惧产生于不良的自我图式。为了探讨社交恐惧个体是否具有不良的自我图式,要求40名高社交恐惧个体和30名低社交焦虑个体完成了自尊量表和内隐联想任务。结果发现：高社交恐惧个体在自尊量表上的得分显著低于低社交恐惧个体,但在内隐自尊上,他们都有着积极的自尊,且无显著差异。这一研究结果不支持社交恐惧的认知理论。根据自我呈现理论讨论了研究结果。