Social Anxiety Among Adolescents: Linkages with Peer Relations and Friendships

This study examined the utility of modifying the Social Anxiety Scale for Children—Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.     

The effect of attentional focus on social anxiety

The aim of the present study was to examine the effect of attentional focus on social anxiety in a group of high and low blushing-anxious subjects. One hundred and fourteen psychology undergraduate students were screened using the Fear of Blushing subscale of the Blushing Questionnaire [B?gels, S. M., & Reith, W. (1999). Validity of two questionnaires to assess social fears: The Dutch social phobia and anxiety questionnaire and the blushing, trembling and sweating questionnaire. Journal of Psychopathology and Behavioral Assessment, 21, 51-66]. Those with the most extreme scores in the top and bottom 20% of the distribution were selected to form a high (n=22) and a low (n=22) blushing-anxious group. Subjects were randomly allocated to either a self-focused attention (SFA) condition or a task-focused attention (TFA) condition. They were asked to engage in a 5 min conversation with the first author, and were instructed to either self-focus (SFA condition) or task-focus (TFA condition). Levels of social anxiety and self-awareness were measured using visual analogue scales. Results suggest that the there was a significant condition by group interaction, with high blushing individuals showing considerably higher levels of social anxiety in the SFA condition compared to the TFA condition while low blushing individuals showed no significant difference across the two conditions.     

Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

The causal role of self-awareness in blushing-anxious,socially-anxious and social phobics individuals

This study examined the effect of attentional focus on social anxiety in three groups of subjects: high versus low blushing-anxious participants (n=48); high versus low socially anxious participants (n=60); and social phobic patients compared to patients with other anxiety disorders (n=48). Participants were asked to imagine two series of social situations, in which the hero was in the centre of others' attention. In the first series of stories, the type of feedback from the audience (positive, negative and neutral) and the direction of attention of the hero (self- versus task-focused) were manipulated, and in the second series of stories, the presence or absence of blushing and the direction of attention of the hero were manipulated. In line with the expectations, self-focused attention (SFA) led to more social anxiety than task-focused attention (TFA) in all the three experiments, and high blushing-anxious, socially anxious, and social phobic groups reported higher levels of self-awareness than their low-anxious comparison groups. No evidence was found for the idea that self-focusing is specifically detrimental for participants who are already socially anxious, blushing-anxious, or socially phobic. Also, attentional focus did not interact with the valence of social feedback. Finally, results provided some support for the hypothesis that fear of blushing is mediated by self-focusing. The results suggest that irrespective of trait social anxiety, and irrespective of the outcome of a social situation (positive, neutral or negative), SFA increases state social anxiety, or TFA decreases state social anxiety.     

Biases in Visual Attention in Children and Adolescents With Clinical Anxiety and Mixed Anxiety-Depression

Recent research has indicated that anxious adult and child patients and high trait-anxious adults selectively shift attention toward threatening stimuli. The present study extends this research and investigates the content-specificity of the effects in clinically anxious and mixed anxious–depressed children and adolescents. Twenty four generally anxious patients, aged 9 to 18, 19 mixed anxious–depressed patients, and 24 normal controls were comparable with respect to age, sex, verbal IQ, and vocabulary level. The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. The results showed that clinically anxious children, relative to controls, selectively allocated processing resources toward threat stimuli. However, mixed anxious–depressed children, relative to controls, did not show any attentional bias towards either threat- or depression-related stimuli. Preliminary data on age and gender differences are also presented. The results of this study are discussed in the light of previous research.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

The interaction of state and trait aspects of self-focused attention affects genital, but not subjective, sexual arousal in sexually functional women

In this study we investigated the effects of state and trait aspects of self-focused attention on genital and subjective sexual arousal of sexually functional, healthy women during presentation of audiovisual erotic stimuli. Psychophysiological sexual response was measured as vaginal pulse amplitude using a vaginal photoplethysmograph. Experiential aspects of sexual arousal were measured both during stimulus presentation and retrospectively after stimulus offset. Trait level of sexual self-focus was measured with the Sexual Self-Consciousness Scale. State self-focus was induced by switching on a TV camera that pointed at the participant's face and upper torso. A manipulation check revealed that both groups experienced equally elevated levels of self-focused attention of their physical appearance. Induction of state self-focus per se did not affect genital responses, but an interaction effect of self-focus and participants' level of trait sexual self-focus was revealed. Compared with women with low scores on this trait, women with high scores exhibited smaller genital responses when state self-focus was induced. Both groups did not differ when no self-focus was induced. Increase of state self-focus did not affect subjective sexual arousal, but participants with a high level of trait sexual self-focus reported stronger subjective arousal, compared with those with low trait level. The results were discussed with reference to previous work in this field. Some implications for treatment of sexual arousal disorder were discussed.     

Attention Bias Modification Treatment for Adolescents With Social Anxiety Disorder

Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.     

Change in gaze-based attention bias in adolescents with Social Anxiety Disorder

ABSTRACT

Although attention bias (AB) toward threat has been associated with Social Anxiety Disorder (SAD), concerns regarding the ability of current measures to detect change in AB following treatment exist. We sought to examine change in bias, as measured via eye-tracking, in adolescents with SAD receiving either attention-bias modification training (ABMT) or attention-control training (ACT). Gaze-based AB was associated (r?=??0.361) with symptoms of social anxiety prior to treatment, whereas there was no association between bias as measured via dot probe and social anxiety. Moreover, gaze-based bias to same-age face stimuli showed change following treatment. Large effects are seen for condition (ABMT or ACT) and for time, independent of treatment condition, in gaze-based AB to same-age stimuli. Findings suggest that further research on gaze-based bias, to assess stability over time outside of treatment and sensitivity to change following intervention, is warranted.     

Social Anxiety and Peer Relations in Early Adolescence: Behavioral and Cognitive Factors

This study investigated factors associated with social anxiety during early adolescence using multiple informants, including self and peer perspectives, teacher ratings, and direct observations. Negative social performance expectations, maladaptive coping strategies, and social skill deficits were examined as correlates of social anxiety and mediators linking social anxiety with poor peer relations. Participants were 84 middle school students (47 girls, 37 boys) over-sampled for elevated social anxiety. Analyses revealed correlations linking social anxiety with decreased peer acceptance and increased peer victimization. Path analysis indicated that negative social performance expectations and social withdrawal-disengagement accounted for the association between social anxiety and decreased peer acceptance. Social anxiety, self-directed coping strategies, and social withdrawal-disengagement were each directly linked with increased peer victimization for boys. The results replicate findings based on clinical samples, extend understanding of cognitive, social, and behavioral factors associated with social anxiety in middle school, and provide new information regarding gender differences in the correlates of social anxiety.     

Not self-focused attention but negative beliefs affect poor social performance in social anxiety: An investigation of pathways in the social anxiety-social rejection relationship

Patients with social anxiety disorder (SAD) not only fear negative evaluation but are indeed less likeable than people without SAD. Previous research shows social performance to mediate this social anxiety-social rejection relationship. This study studied two pathways hypothesized to lead to poor social performance in social anxiety: increased self-focused attention and negative beliefs. State social anxiety was experimentally manipulated in high and low-blushing-fearful individuals by letting half of the participants believe that they blushed intensely during a 5 min getting-acquainted interaction with two confederates. Participants rated their state social anxiety, self-focused attention, and level of negative beliefs. Two confederates and two video-observers rated subsequently likeability (i.e., social rejection) and social performance of the participants. In both groups, the social anxiety-social rejection relationship was present. Although state social anxiety was related to heightened self-focused attention and negative beliefs, only negative beliefs were associated with relatively poor social performance. In contrast to current SAD models, self-focused attention did not play a key-role in poor social performance but seemed to function as a by-product of state social anxiety. Beliefs of being negatively evaluated seem to elicit changes in behavioral repertoire resulting in a poor social performance and subsequent rejection.     

Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults With Social Anxiety Disorder

The rapid spread of COVID-19 and subsequent social distancing measures posed unprecedented challenges in providing mental health care and a swift transition of services to telehealth platforms. Social distancing measures create unique concerns for young people with social anxiety disorder who already struggle with social connection and isolation; therefore, the continuation of care via telehealth platforms is especially important for this population. To date, there is little literature regarding use of telehealth groups for this population and the current commentary aims to fill in this gap in the literature while also providing general guidelines for telehealth groups. The commentary discusses the delivery of an exposure-based cognitive behavioral therapy group for adolescents and young adults via telehealth and provides considerations, challenges, and benefits of conducting a group through a telehealth platform. In conjunction with clinically relevant examples and in-depth exposure discussions, we aim to provide guidance for youth-focused practitioners who are considering conducting groups in a telehealth format for a range of presentations.     

The effects of state and trait self-focused attention on sexual arousal in sexually functional and dysfunctional women

This study examined the effects of state self-focused attention on sexual arousal and trait self-consciousness on sexual arousal and function in sexually functional (n=16) and dysfunctional (n=16) women. Self-focused attention was induced using a 50% reflectant television screen in one of two counterbalanced sessions during which self-report and physiological sexual responses to erotic films were measured. Self-focused attention significantly decreased vaginal pulse amplitude (VPA) responses among sexually functional but not dysfunctional women, and substantially decreased correlations between self-report and VPA measures of sexual arousal. Self-focused attention did not significantly impact subjective sexual arousal in sexually functional or dysfunctional women. Trait private self-consciousness was positively related to sexual desire, orgasm, compatibility, contentment and sexual satisfaction. Public self-consciousness was correlated with sexual pain. The findings are discussed in terms of Masters and Johnson's [Masters, W. H. & Johnson, V. E. (1970). Human sexual inadequacy. Boston: Little, Brown) concepts of "spectatoring" and "sensate focus."     

Parenting and Anxiety: Bi-directional Relations in Young Children

Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6–7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6–7 while higher age 5 anxiety levels were associated with reductions in age 6–7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child’s anxiety symptoms.     

大学生自尊与网络过激行为的关系:社交焦虑和双自我意识的作用

本研究探讨了自尊与网络过激行为的关系,以391名大学生为被试,采用问卷法考察了社交焦虑在自尊与网络过激行为关系中的中介作用,以及该过程是否受到公我意识、私我意识水平的调节。结果发现：（1）在控制了性别、年龄后,自尊对网络过激行为具有负向预测作用;（2）社交焦虑在自尊和网络过激行为间起部分中介作用;（3）公我意识调节自尊对网络过激行为的直接作用。相对于公我意识水平高的大学生,直接效应对公我意识水平低的大学生更显著;（4）自尊对社交焦虑的作用还受到个体私我意识的调节,相对于私我意识水平低的大学生,间接效应对于私我意识水平高的大学生更显著。     

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N = 108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

自我聚焦对社交焦虑的影响：抽离与正念的调节作用

本文旨在探讨抽离和正念在自我聚焦对社交焦虑影响关系中的作用。两个研究分别采用相关法和实验法,探究自我聚焦内容（冗思、正念）和反思方式（浸入、抽离）对社交焦虑的交互影响。结果：问卷数据显示,抽离在自我聚焦注意影响社交焦虑的关系中起着调节作用,无论低抽离倾向还是高抽离倾向,自我聚焦注意都能预测社交焦虑,高抽离倾向减弱个体的社交焦虑感;实验结果表明,聚焦内容与反思方式两者交互作用于社交焦虑,浸入-聚焦冗思内容引发最强的社交焦虑,抽离-聚焦正念内容引发最弱的社交焦虑。结论：抽离和聚焦正念内容都最能有效缓解自我聚焦对社交焦虑的不良影响。     

Examining the Panic Attack Specifier in Social Anxiety Disorder

Panic attacks (PAs) are characterized by overwhelming surges of fear and discomfort and are one of the most frequently occurring symptoms in psychiatric populations. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM-5) allows for a panic attack (PA) specifier for all disorders, including social anxiety disorder (SAD). However, there is little research examining differences between individuals diagnosed with SAD with the PA specifier versus individuals diagnosed with SAD without the PA specifier. The current study examined social anxiety, mood, anxiety, and anxiety sensitivity social concerns, a risk factor for social anxiety in SAD-diagnosed individuals without (N = 52) and with (N = 14) the PA specifier. The groups differed only in somatic symptoms of anxiety. Result of the current study provides preliminary evidence that the presence of the PA specifier in social anxiety does not result in elevated levels of comorbidity or a more severe presentation of social anxiety.