Empirical sleep assessment in the home: A convenient,inexpensive approach

We have previously reported on a sleep assessment device (SAD) that addresses shortcomings inherent in self-report sleep data and polysomnography. The SAD produces a sleep record by tape recording subjects' verbal responses to auditory cues spaced at fixed intervals throughout the night. In prior studies, the SAD proved to be a reliable and valid assessment tool according to electroencephalographic comparisons. Herein, we report on the unassisted home use of the SAD by eight normal volunteers and four bedmates. Subjects and bedmates completed sleep questionnaires for 12 nights and subjects also employed the SAD the last 6 nights. Comparisons of subjects and bedmates self-report sleep data before and during SAD use indicated that the SAD did not disrupt sleep. Subjects were able to self-administer successfully the SAD in their homes. SAD data closely matched subjects' self-report data. The present study found the SAD to be an accurate, unobtrusive, and easily utilized empirical measure of sleep in the natural environment. In so doing, it extends the demonstrated reliability and validity of the SAD from the sleep laboratory to the home with normal sleepers.     

Emotional variability and clarity in depression and social anxiety

Recent research has underscored the importance of elucidating specific patterns of emotion that characterise mental disorders. We examined two emotion traits, emotional variability and emotional clarity, in relation to both categorical (diagnostic interview) and dimensional (self-report) measures of major depressive disorder (MDD) and social anxiety disorder (SAD) in women diagnosed with MDD only (n?=?35), SAD only (n?=?31), MDD and SAD (n?=?26) or no psychiatric disorder (n?=?38). Results of the categorical analyses suggest that elevated emotional variability and diminished emotional clarity are transdiagnostic of MDD and SAD. More specifically, emotional variability was elevated for MDD and SAD diagnoses compared to no diagnosis, showing an additive effect for co-occurring MDD and SAD. Similarly diminished levels of emotional clarity characterised all three clinical groups compared to the healthy control group. Dimensional findings suggest that although emotional variability is associated more consistently with depression than with social anxiety, emotional clarity is associated more consistently with social anxiety than with depression. Results are interpreted using a threshold and dose–response framework.     

Reliability of heterosocial skills measurement with sex offenders

The heterosocial skills of 79 sex offenders were assessed using two self-report inventories, the Social Anxiety and Distress Scale (SAD) and the S-R Inventory of Anxiousness (SRI). In addition, staff members rated the offenders on modified versions of the SAD and the Heterosocial Skills Behavior Checklist for Males (HSB). Twenty-one offenders were also videotaped during a brief interaction with a female confederate. The tapes were rated using the HSB. All ratings and videotapings were conducted twice within a two-week period. The two self-report scales showed good test-retest reliability (r=.88) and correlatedr=.63 with each other. However, the SAD correlated significantly with the Crowne-Marlowe Social Desirability Scale and showed significant change from first to second administrations. The SRI showed less reactivity to social desirability and changed less over time. The staff ratings showed higher test-retest (r=.72–.76) than interrater (r=.36–.43) reliability. They correlatedr=–.56 with each other and did not show a significant relationship to the Crowne-Marlowe. However, both staff-ratings changed significantly from test to retest. Inspection of correlations between staff and self-report measures indicated that these instruments may be strongly affected by rater variance. Different measures completed by the same person correlated higher than the same measure completed by different persons. The HSB showed high levels of interrater agreement (90–100%) and split-half reliability (r=.95–.97). However, test-retest reliability was poor for the overall score and for the category measuring form of conversation. Categories measuring voice and affect were moderately reliable over time (r=.53–.74). However, the voice category scores changed substantially from first to second videotaping. On almost all measures used in this study, the sex offenders' scores were similar to those derived from normal populations. Only the category measuring affect on the HSB seemed to differentiate this group from normals.     

Clinical validation of a sleep assessment device

We have previously reported on the use of a sleep assessment device (SAD) with non-insomniac subjects. The SAD works by generating a brief, soft tone about every 10 min throughout the night and tape recording verbal responses to these cues. The sleep patterns reconstructed from the night's tape recordings proved highly concordant with EEG records. The present study tested the SAD against the EEG standard in 20 nights of monitoring chronic insomniacs. No significant differences were found between the SAD and EEG records with respect to sleep latency, duration of awakenings during the night, total sleep time and sleep efficiency percentage. The EEG detected many more very brief awakenings during the night than did the SAD due to the continuous monitoring by the former. The SAD proved to be a non-intrusive measure of sleep according to three independent measures. The usefulness of the SAD as a measure of sleep in the natural environment was discussed.     

Heightened sensitivity to emotional expressions in generalised anxiety disorder,compared to social anxiety disorder,and controls

Few studies have examined potential differences between social anxiety disorder (SAD) and generalised anxiety disorder (GAD) in the sensitivity to detect emotional expressions. The present study aims to compare the detection of emotional expressions in SAD and GAD. Participants with a primary diagnosis of GAD (n?=?46), SAD (n?=?70), and controls (n?=?118) completed a morph movies task. The task presented faces expressing increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expressions. Participants used a slide bar to view the movie frames from left to right, and to stop at the first frame where they perceived an emotion. The frame selected thus indicated the intensity of emotion required to identify the facial expression. Participants with GAD detected the onset of facial emotions at lower intensity of emotion than participants with SAD (p?=?0.002) and controls (p?=?0.039). In a multiple regression analysis controlling for age, race, and depressive symptom severity, lower frame at which the emotion was detected was independently associated and GAD diagnosis (B?=?–5.73, SE?=?1.74, p?相似文献   

Psychometric Properties of a Social Skills Assessment using a Virtual Environment

Social Anxiety Disorder (SAD) is a marked and persistent fear of social and/or performance situations in which embarrassment or scrutiny from others may occur. One form of behavioral assessment is a Role Play Task (RPT). However, RPTs often are not feasible in clinical settings due to the common obstacles in implementation. Thus, the current study examines the feasibility, acceptability and psychometric properties of a virtual environment based social skills assessment compared to the traditional RPT. Forty-six children, ages 7 to 14, participated in two assessment conditions: RPT and a virtual environment behavioral assessment (VE BAT). Participants reported self-ratings of anxiety and acceptability, while blinded observers rated social skills and overall social anxiety. An ANCOVA, covarying for age, revealed (a) no significant task difference for voice volume, speech latency, number of words spoken, effectiveness, and SAM ratings; (b) that the VE BAT was more feasible to implement in terms of personnel time and costs and; (c) more overall anxiety during the RPT task than during the VE BAT task. In addition, the VE BAT demonstrated moderate concurrent validity when correlating the self-report ratings of anxiety with the Social Phobia and Anxiety Inventory for Children (SPAI-C). The current study addresses many of the impediments to conducting RPTs in a clinical setting and, overall, supports the utilization of VE BATS as a viable alternative for the behavioral assessment of social skills in children. Further implications address the potential for the armamentarium for social skills training with children with SAD.     

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n?=?30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

     

Homotypic Versus Heterotypic Continuity of Anxiety Symptoms in Young Adolescents: Evidence for Distinctions Between DSM-IV Subtypes

Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. Results: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. Conclusions: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs. An erratum to this article can be found at     

A Randomized Trial of Attention Training for Generalized Social Phobia: Does Attention Training Change Social Behavior?

The use of attention training protocols for the treatment of generalized social anxiety disorder (SAD) is undergoing increased examination. Initial investigations were positive but more recent investigations have been less supportive of the treatment paradigm. One significant limitation of current investigations is overreliance on self-report. In this investigation, we expanded on initial investigations by using a multimodal assessment of patient functioning (i.e., including behavioral assessment). Patients with a primary diagnosis of SAD (n = 31) were randomly assigned to eight sessions of attention training (n = 15) or placebo/control (n = 16). Participants were assessed at pre- and posttreatment via self- and clinician-report of social anxiety as well as anxious and behavioral response to two in vivo social interactions. Results revealed no differences between groups at posttreatment for all study outcome variables, suggesting a lack of effect for the attention training condition. The results are concordant with recent investigations finding a lack of support for the use of attention training as an efficacious treatment for patients with SAD.     

Sleep quality and treatment of social anxiety disorder

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment.

Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs.

Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment.

Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety.

Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.     

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child–parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers’ behavior and affect (free play) and toddlers’ self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.     

Social anxiety disorder in veterans affairs primary care clinics

To examine the prevalence and correlates of social anxiety disorder (SAD) in veterans, 733 veterans from four VA primary care clinics were evaluated using self-report questionnaires, telephone interviews, and a 12-month retrospective review of primary care charts. We also tested the concordance between primary care providers’ detection of anxiety problems and diagnoses of SAD from psychiatric interviews. For the multi-site sample, 3.6% met criteria for SAD. A greater rate of SAD was found in veterans with than without post-traumatic stress disorder (PTSD) (22.0% vs. 1.1%), and primary care providers detected anxiety problems in only 58% of veterans with SAD. The elevated rate of comorbid psychiatric diagnoses and suicidal risk associated with SAD was not attributable to PTSD symptom severity. Moreover, even after controlling for the presence of major depressive disorder, SAD retained unique, adverse effects on PTSD diagnoses and severity, the presence of other psychiatric conditions, and suicidal risk. These results attest to strong relations between SAD and PTSD, the inadequate recognition of SAD in primary care settings, and the significant distress and impairment associated with SAD in veterans.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.     

Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls

Cognitive distortions refer to cognitive processes that are biased and therefore yield dysfunctional and maladaptive products (e.g., interpretation bias). Automatic aspects of information processing need to be considered and investigating these aspects requires forms of assessment other than self-report. Studies focussing on the specificity of cognitive biases across different types of anxiety disorders in childhood are rare. Thus, a forced choice reaction time paradigm with picture stimuli was used to assess the interpretation bias in anxious children online. The study investigated disorder-specific interpretation bias in 71 children with separation anxiety disorder (SAD), 31 children with social phobia, and 42 children without mental disorders, aged 5–13 years. Results indicated that children with SAD rated ambiguous separation pictures as significantly more unpleasant and more arousing than nonanxious children. However, no support was found that children with SAD and social phobia interpret ambiguous separation or social pictures in a more negative way than nonanxious children. Furthermore, no group differences were found in reaction times to all picture categories.     

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.     

Effects of sleep on positive,negative and neutral valenced story and image memory

During sleep, emotional memories are preferentially strengthened. However, most studies on sleep and emotional memory focus on comparing negative valence with neutral valence stimuli. This study compared the sleep-dependent memory effects for stories and images, each comprising negative, neutral, and positive stimuli. It was hypothesized that a sleep effect would be seen for negatively and positively valenced stimuli. A novel story memory task (comprising three stories), and photographs from the Nencki Affective Picture database were presented for learning to 61 healthy adults (ages 18–25). They were tested for memory on the two tasks immediately, and then again after either a 2-hr nap (n = 31; 17 women, 14 men) or 2-hr wake period (n = 30; 13 women, 17 men). At second testing, the sleep condition had significantly better recall compared to the wake condition on both tasks. There was a relationship with valence only for the story task, with better performance for the sleep condition on the negatively and positively valenced texts, but not on the neutral text. There were no significant relationships between memory measures and sleep-stage duration and EEG power variables. The story memory findings support the hypothesis that memory consolidation prioritizes emotional memory, whether positively or negatively valenced.     

An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.     

The Effect of Training with Music on Happiness Recognition in Social Anxiety Disorder

The process of emotion recognition is thought to be negatively biased in social anxiety disorder (SAD). Ways to change this bias are needed. Forty one individuals afflicted with moderate SAD and 39 healthy controls were recruited to participate in this study. All subjects performed a vocal improvisation recognition task and half of them underwent training in happiness recognition in musical improvisations. The four groups (trained SAD, untrained SAD, trained controls and untrained controls) were then compared in terms of the extent of precise identification of one of five basic emotions (happiness, fear, anger, sadness and surprise) in spoken language. Subjects with SAD demonstrated less accurate identification of happiness in spoken language as compared to the healthy controls. However, subjects with SAD trained to recognize happiness demonstrated an improved ability to identify happiness in spoken language (in a female’s voice), similarly to that of the healthy controls. Our findings demonstrate that a brief training in happiness recognition improves the ability of individuals with SAD to recognize happiness in spoken language. Additional studies are needed to support and refine our intervention and to examine its impact on individuals with SAD over longer periods of time.     

Effects of gender role self-discrepancies and self-perceived attractiveness on social anxiety for women across social situations

Background and objectives: Psychosocial factors, such as gender role norms, may impact how social anxiety disorder (SAD) is experienced and expressed in different social contexts for women. However to date, these factors have not been examined via experimental methodology. Design: This was a cross-sectional, quasi-experimental controlled study. Methods: The current study included 48 highly socially anxious (HSA) women (70.9% meeting criteria for SAD) and examined the relationships among psychosocial factors (i.e. gender role self-discrepancies and self-perceived physical attractiveness), self-perceived social performance, and state anxiety, across two in vivo social tasks (i.e. conversation and opinion speech). Results: On average, participants reported belief that they ought to be less feminine for the speech task and more masculine for both the conversation and speech tasks. Also, for the conversation task, only lower self-rated attractiveness predicted poorer self-perceived performance and greater post-task state anxiety, above gender role self-discrepancies and confederate gender. For the speech task, only greater self-discrepancy in prototypical masculine traits predicted poorer performance ratings, and it was related to greater state anxiety in anticipation of the task. Conclusion: For HSA women, psychosocial factors may play different roles in social anxiety across social contexts.     

Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial

Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n = 64) or CBGT (n = 62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD.