Anxious Solitude and Clinical Disorder in Middle Childhood: Bridging Developmental and Clinical Approaches to Childhood Social Anxiety

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. 192 children provided self reports of social anxiety disorder symptoms on a questionnaire, and 76 of these children and their parent participated in clinical interviews. Results indicate that children identified by their peers as anxious solitary in the fall of 4th grade, compared to control children, were significantly more likely to receive diagnoses of social anxiety disorder, specific phobia, and selective mutism based on parent clinical interviews. Additionally, there was a tendency for these children to be diagnosed with generalized anxiety disorder and post traumatic stress disorder based on parent clinical interviews. Furthermore, children who had been identified as anxious solitary at any time in the 3rd or 4th grades were more likely than control children to report symptoms of social anxiety disorder that fell in the clinical range and to receive diagnoses of social anxiety disorder and dysthymia (both trends) and major depression (a significant effect) according to parental clinical interview.     

The relationship between comorbid personality disorders and treatment received in patients with anxiety disorders

Few studies have addressed the relationship between the presence of a comorbid personality disorder and the amount of psychiatric treatment received by patients with an Axis I disorder. This issue has not been studied in patients with anxiety disorders. In a prospective, naturalistic, longitudinal study of anxiety disorders, 526 subjects were assessed with the Personality Disorder Examination, and types of treatment received in 1991 and 1996 were identified. In 1991, compared to subjects without a personality disorder, subjects with a personality disorder were as likely to receive medication and they received a greater number of medications. Subjects with borderline personality disorder were more likely to receive heterocyclic antidepressants and interventions characteristic of psychodynamic psychotherapy and cognitive therapy; they also reported receiving a greater number of medications and types of psychosocial treatment than other subjects. In 1996, subjects with borderline personality disorder were more likely to receive psychodynamic interventions. These findings suggest that in patients with an anxiety disorder, the presence of a comorbid personality disorder is associated with receiving a greater number of medications but not with a greater likelihood of receiving pharmacologic or psychosocial treatment. However, the presence of borderline personality disorder is associated with a greater likelihood of receiving, and receiving a greater number of, certain types of somatic and psychosocial treatments.     

Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth in Children's Services

This study examined the psychiatric diagnoses and clinical characteristics of the 981 Asian American children enrolled in the first phase of the Comprehensive Community Mental Health Services for Children and Their Families Program. Asian Americans were less likely than non- Asian Americans to receive diagnoses of depression and ADHD and more likely to receive diagnoses of anxiety and adjustment disorder. As compared to non-Asians, Asian Americans were significantly more likely to be rated with severe functional impairment in community role performance, self-harmful behavior, and thinking. There was also a trend for fewer externalizing behavior problems. Implications for research and practice are discussed.     

Ruminative coping and post-event processing in social anxiety

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.     

Failure to capitalize on sharing good news with romantic partners: Exploring positivity deficits of socially anxious people with self-reports,partner-reports,and behavioral observations

Extending prior work on social anxiety and positivity deficits, we examined whether individual differences in social anxiety alter the ability to share and respond to the good news of romantic partners (i.e., capitalization support) and how this influences romantic relationship satisfaction and commitment. In this study of 174 heterosexual couples (average age of 21.5 with 58.3% identifying as Caucasian), greater social anxiety was associated with the provision and receipt of less supportive responses to shared positive events as measured by trait questionnaires, partner reports, and behavioral observations in the laboratory. In longitudinal analyses, individuals in romantic relationships with socially anxious partners who experienced inadequate capitalization support were more likely to terminate their relationship and report a decline in relationship quality six months later. As evidence of construct specificity, social anxiety effects were independent of depressive symptoms. Taken together, social anxiety influenced a person's ability to receive and provide support for shared positive events; these deficits had adverse romantic consequences. Researchers and clinicians may better understand social anxiety by exploring a wider range of interpersonal contexts and positive constructs. The addition of capitalization support to the social anxiety literature offers new insights into interpersonal approaches and treatments.     

The Adolescent Mattering Experience: Gender Variations in Perceived Mattering,Anxiety, and Depression

Individuals who perceive that they matter to others are likely to experience lower anxiety and depression levels. The effects of young adolescents' perceived mattering on their anxiety and depression levels were examined. Results indicated that female adolescents reported lower anxiety levels but greater depression levels than did male adolescents, perceived mattering was inversely related to adolescents' anxiety and depression levels, and the associations between mattering and anxiety and between mattering and depression varied by gender.     

Self-esteem,body-esteem,emotional intelligence,and social anxiety in a college sample: the moderating role of weight

To examine the relationships between self-esteem, body-esteem, emotional intelligence, and social anxiety, as well as to examine the moderating role of weight between exogenous variables and social anxiety, 520 university students completed the self-report measures. Structural equation modeling revealed that individuals with low self-esteem, body-esteem, and emotional intelligence were more likely to report social anxiety. The findings indicated that obese and overweight individuals with low body-esteem, emotional intelligence, and self-esteem had higher social anxiety than others. Our results highlight the roles of body-esteem, self-esteem, and emotional intelligence as influencing factors for reducing social anxiety.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

Behavioral Expression of Job Interview Anxiety

Purpose

The aim of this study was to investigate (a) the behavioral cues that are displayed by, and trait judgments formed about, anxious interviewees, and (b) why anxious interviewees receive lower interview performance ratings. The Behavioral Expression of Interview Anxiety Model was created as a conceptual framework to explore these relations.

Design/Methodology/Approach

We videotaped and transcribed mock job interviews, obtained ratings of interview anxiety and interview performance, and trained raters to assess several verbal and nonverbal cues and trait judgments.

Findings

The results indicated that few behavioral cues, but several traits were related to interviewee and interviewer ratings of interview anxiety. Two factors emerged from our factor analysis on the trait judgments—Assertiveness and Interpersonal Warmth. Mediation analyses were performed and indicated that Assertiveness and Interpersonal Warmth mediated the relation between interview anxiety and interview performance. Speech rate (words spoken per minute) and Assertiveness were found to mediate the relation between interviewee and interviewer ratings of interview anxiety.

Implications

Overall, the results indicated that interviewees should focus less on their nervous tics and more on the broader impressions that they convey. Our findings indicate that anxious interviewees may want to focus on how assertive and interpersonally warm they appear to interviewers.

Originality/Value

To our knowledge, this is the first study to use a validated interview anxiety measure to examine behavioral cues and traits exhibited by anxious interviewees. We offer new insight into why anxious interviewees receive lower interview performance ratings.

     

Attention, not anxiety, influences pain

Four hypotheses about the influences of anxiety and attention on pain impact were tested in a critical experiment: (1) anxiety increases pain; (2) anxiety decreases pain; (3) attention to pain increases pain; (4) only the combination of anxiety and attention to pain increases pain (interaction hypothesis). In a 2 x 2 design, anxiety (low vs high) and attention (attention vs distraction from the pain) were experimentally manipulated. Subjects received 20 electrically produced painful stimuli. Subjective pain experiences, skin conductance responses and heart rate responses gave no support for a pain impact increasing effect of anxiety. The anxiety-attention interaction hypothesis did not receive any support either. There was some support, only from the heart rate responses, that anxiety reduces pain impact. The critical factor appeared to be attention. Attention to the pain stimulus was related to a stronger pain impact (indicated by all measures) and to less subjective habituation, compared to distraction.     

Developmental Trajectories of Anxiety Symptoms in Early Adolescence: The Influence of Anxiety Sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M _age?=?11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.     

A comparison of children who receive and who do not receive permission to participate in research

In a study examining children's social competence in elementary school settings, the authors had the opportunity to compare children who received parental permission to participate to children who did not receive permission. Results indicated that children who were not involved in the study were more likely to be viewed by teachers as having unsatisfactory relationships with peers than children who were in the study. The present results suggest that investigators begin reporting the number of children who do not participate in a given study and begin examining whether minors who receive parental permission differ on important dimensions from minors who do not receive such permission. Ethical considerations of the present study are discussed.     

How does clients' method of payment influence psychologists' diagnostic decisions?

To what extent does payment method (managed care vs. out of pocket) influence the likelihood that an independent practitioner will assign a Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnosis to a client? When a practitioner does diagnose, how does payment method influence the specific choice of a diagnostic category? Independent practitioners responded to a vignette describing a fictitious client with symptoms of depression or anxiety. In half of the vignettes, the fictitious client intended to pay via managed care; in the other half, the fictitious client intended to pay out of pocket. Payment method had a very significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to receive diagnoses and more likely to receive adjustment disorder diagnoses in particular. We discuss implications involving informed consent and other ethical issues.     

Disclosure of anxiety in everyday life: Effects of social anxiety

The current study examined the likelihood of disclosing one’s anxiety to others during anxiety-provoking conversations, as reported by individuals high or low in social anxiety. It investigated to whom these disclosures are made, and the content and intended purposes of these disclosures. Undergraduate students and community members low (n = 79) or high (n = 81) in social anxiety completed the Anxiety Disclosure in Everyday Life questionnaire, as well as several other measures as part of another study. Analyses indicated that individuals high in social anxiety were significantly less likely to disclose their anxiety as compared to individuals low in social anxiety. The likelihood of disclosing one’s anxiety varied significantly depending on to whom one was speaking, with intimate partners being disclosed to the most. The content of the disclosures typically involved stating that one is feeling shy or nervous without offering an explanation, or attributing it to one’s personality traits (e.g., shyness), with the intended purpose often being to elicit assistance or reassurance from their conversation partner or to manage the impressions of others.     

Exploring rates of transgender individuals and mental health concerns in an online sample

Background: Prevalence estimates of adults identifying as transgender are scarce, particularly in the United States. Method: The current study endeavored to estimate the prevalence of individuals identifying as transgender in a large online sample of adult U.S. residents (n = 6,727) and compare the prevalence of common mental health disorders (depression, anxiety, attention-deficit/hyperactivity disorder) and the age of onset for individuals identifying as men or women versus those identifying as transgender. Results: The prevalence estimate of individuals identifying as transgender was 0.8%. Individuals identifying as transgender were significantly more likely than individuals identifying as men or women to report having had a single diagnosis or co-occurring diagnoses for all three disorders examined. Additionally, transgender individuals were more likely than individuals identifying as men or women to receive a diagnosis of anxiety or depression at a younger age. Conclusion: Given the prevalence of transgender individuals and the associations with common mental health conditions, clinicians must be informed and competent to care for their clinical needs. This study introduces online crowdsourcing resources as a potentially fruitful option for reaching and researching gender diversity.     

Sudden Gains in Depressed Cancer Patients Treated With Behavioral Activation Therapy

Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M = 11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.     

What role does neuroticism play in the association between negative job characteristics and anxiety and depression?

Many studies have established an association between job characteristics and anxiety and depression and noted that personality characteristics such as neuroticism likely play a role in creating or modifying these associations. Few studies, however, have explicitly tested or compared these possible alternative roles. In this study, we tested several specific hypotheses about neuroticism and its effects on job characteristics, anxiety and depression and their association in a series of structural equation models. Participants (N = 372) completed the Big Five Inventory, Job Contents Questionnaire and General Health Questionnaire. We tested (a) whether neuroticism is likely to be an important confounder of the association between job characteristics and anxiety and depression and (b) whether neuroticism moderates the association between job characteristics and anxiety and depression. Results indicated large attenuations by neuroticism of the association between job characteristics and anxiety and depression but there remained significant effects of psychological demands on anxiety, and social support on depression independent of neuroticism. Evidence was also found for interaction effects between neuroticism and decision latitude, with those lower in neuroticism being at higher risk for depression under conditions of low control.     

The role of attachment to God and spiritual self-awareness in predicting evangelical Christians’ appraisals of suffering

The present study examined how attachment to God and spiritual self-awareness are related to evangelical Christians’ appraisals of suffering. Specifically, we were interested in whether attachment anxiety and attachment avoidance with God were related to the appraised meaning of stressful life experiences as transformational and whether spiritual self-awareness mediated this relationship. A national sample (N?=?988) of students from Christian institutions completed an online survey. The results indicated that individuals with high levels of attachment anxiety or attachment avoidance with God were less likely to view suffering as a means of spiritual growth and connection with God. Mediation analyses also showed that higher levels of avoidant attachment to God were related to lower levels of spiritual self-awareness, which in turn were related to reduced ability to appraise suffering as transformational. Clinical implications and directions for future research are discussed.     

A longitudinal investigation of anxiety sensitivity in adolescence

This investigation sought to expand existing knowledge of anxiety sensitivity in a sample of high school students (N = 2,365) assessed over 4 years. The stability of anxiety sensitivity levels across assessment periods was examined, and cluster analyses were used to identify different developmental pathways in levels of anxiety sensitivity. Groups of adolescents with stable low, stable high, and escalating anxiety sensitivity levels were identified. Adolescents with stable high or escalating anxiety sensitivity were significantly more likely to report experiencing a panic attack than individuals with stable low anxiety sensitivity. Results also indicated that Asian and Hispanic adolescents tended to report higher anxiety sensitivity but that their anxiety sensitivity was less strongly associated with panic than that of Caucasian adolescents.     

Benefits of humor in reduction of threat-induced anxiety

The benefits of humor in reducing anxiety were investigated in a laboratory study, in which subjects were falsely led to believe that they would receive a shock in 12 min. Participants were 53 undergraduate students with either high or low sense of humor as measured by the Situational Humor Response Questionnaire of Martin and Lefcourt (1984). During the anticipatory period, subjects listened to either a humorous tape, a nonhumorous tape, or no tape. Dependent variables were repeated measures of self-reported anxiety, heart rate, and zygomatic facial activity. Anxiety increased over the anticipatory period, as predicted. A significant interaction between condition and time indicated that subjects from the humor condition consistently rated themselves as less anxious and reported less increase in stress as the shock approached. A three-way interaction concentrating on the final 3 min. indicated a tendency for subjects with low sense of humor to have higher heart rates in the no-tape condition than in the humorous or nonhumorous tape conditions. Analysis for zygomatic activity indicated more smiling by subjects with high sense of humor and by subjects in the humor condition. Also, the humorous tape elicited more smiling by subjects with high sense of humor.