Effects of Analytical and Experiential Self-focus on Rumination After a Stress Induction in Patients with Social Anxiety Disorder: A Pilot Study

According to cognitive models, negative post-event processing rumination is a key maintaining factor in social anxiety disorder (SAD). Analogue research has supported the differentiation of self-focus into different modes of self-focused attention with distinct effects on rumination in depression and social anxiety. The purpose of this study was to replicate these effects with a sample of clients with SAD (N = 12) using (a) an experimental, cross-over design and (b) an evaluation situation (impromptu speech) prior to manipulation. Processing an identical list of symptoms, half of a sample was asked to successively adopt an analytic (abstract, evaluative) and an experiential (concrete, process-focused) self-focus; the other half employed the modes in the reversed order. Effects were assessed with a thought-listing (TL) procedure. As predicted, the two modes of self-focused attention affected cognitions differently; participants in the experiential condition showed a tendency for a decreased proportion of negative thoughts, whereas those in the analytical condition reported a decreased proportion of neutral thoughts. No difference was shown on positive cognitions. Furthermore, the participants' self-evaluation following the speech predicted their degree of subsequent negative thinking. After self-focus inductions, however, this effect was only seen in those participants who started by receiving the analytical self-focus induction. The results support previous findings that the analytical and the experiential self-focus modes affect cognitions differently, and that experiential processing may have beneficial effects on rumination in SAD. However, results need to be replicated in a larger sample.     

Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder

Distorted negative self-images and impressions appear to play a key role in maintaining Social Anxiety Disorder (SAD). In previous research, McManus et al. (2009) found that video feedback can help people undergoing cognitive therapy for SAD (CT-SAD) to develop a more realistic impression of how they appear to others, and this was associated with significant improvement in their social anxiety. In this paper we first present new data from 47 patients that confirms the value of video feedback. Ninety-eighty percent of the patients indicated that they came across more favorably than they had predicted after viewing a video of their social interactions. Significant reductions in social anxiety were observed during the following week and these reductions were larger than those observed after control periods. Comparison with our earlier data (McManus et al., 2009) suggests we may have improved the effectiveness of video feedback by refining and developing our procedures over time. The second part of the paper outlines our current strategies for maximizing the impact of video feedback. The strategies have evolved in order to help patients with SAD overcome a range of processing biases that could otherwise make it difficult for them to spot discrepancies between their negative self-imagery and the way they appear on video.     

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.     

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.     

生物反馈疗法对大学生考试焦虑的治疗作用

探讨生物反馈疗法对大学生考试焦虑的治疗作用。在某大学随机抽取学生1500名,采用考试焦虑量表进行筛查,选取焦虑组和对照组各30名。利用生物反馈疗法进行干预,采用脑电α波相对功率、肌电和皮电导联进行检测,每周2次,持续4周。结果表明：1.经过4周的干预,焦虑组干预前后各生理指标存在差异;2.生物反馈疗法干预考试焦虑在疗效上存在性别差异。结论：生物反馈疗法能有效降低大学生考试焦虑水平,对其治疗取得良好的效果。     

Skills for Social and Academic Success: A School-Based Intervention for Social Anxiety Disorder in Adolescents

This paper describes Skills for Academic and Social Success (SASS), a cognitive–behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their childs anxiety. Initial findings regarding the programs effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.     

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.     

Combining Exposure and Pharmacotherapy in the Treatment of Social Anxiety Disorder: A Preliminary Study of State Dependent Learning

State dependent learning (SDL) occurs when learning acquired in one context is not retrievable in a different context. Although traditionally SDL is thought of in the context of substance use, the role of SDL should be considered during combined medication and exposure treatment for anxiety disorders. Data are presented from a within-subjects, case-series design of four participants with social anxiety disorder. Participants engaged in a series of situational exposures while taking either alprazolam (0.75 mg), propranolol (40 mg), placebo or no medication. They returned 48 h later and engaged in the same situational exposure in an unmedicated state to determine retention of learning following the shift in drug context. Results suggest that SDL effects are possible when combining pharmacotherapy (alprazolam) with exposure therapy. Future research is needed determine the conditions under which SDL is most likely to occur and ways to facilitate transfer of learning across different contexts.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

目标定向与进步反馈对优差生写作成绩影响的实验研究

本研究以24名优生和24名学习困难学生(以下简称差生或学困生)为被试,通过实验探讨了目标定向与进步反馈对优差生写作成绩的影响。结果表明：(1)目标定向和反馈对优生的写作成绩影响不显著;(2)在成绩目标定向时,接受进步反馈的差生其作文成绩显著优于无进步反馈的差生;在掌握目标定向时,进步反馈对差生的影响不显著;(3)在无进步反馈时,掌握目标定向的差生其写作成绩显著优于成绩目标定向的差生;在给予进步反馈时,目标定向对差生的影响不显著。     

Impact of Exposure to Community Violence on Anxiety: A Longitudinal Study of Family Social Support as a Protective Factor for Urban Children

In a longitudinal study, we examined the relationship between exposure to community violence and anxiety, and the extent to which family social support moderated this relationship within a predominantly African American sample of 385 children in an urban public school system. Children reported notably lower anxiety levels compared to normative data for African American children. A high percentage reported witnessing a variety of violent acts. Cross-sectional results indicated that among girls exposure to violence was significantly correlated with total, physiological, and concentration anxiety. Among boys violence exposure was not associated with anxiety. Hierarchical regression analyses indicated that after controlling for gender, exposure to violence at Time 1 did not significantly predict changes in anxiety. A significant interaction was found for gender and exposure to violence on concentration anxiety; girls who reported higher initial violence exposure reported greater increases in subsequent concentration anxiety than boys. Whereas findings from our study did not support a moderating relationship of family social support on children's exposure to violence and anxiety, a strong negative relationship was found between anxiety and family support. Among children with initially low worry anxiety, those with low family social support showed greater increases in subsequent worry anxiety.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users: A psychometric evaluation and cross-sectional study

Research on the association between social anxiety and social media usage remains inconclusive: despite the preference for computer-mediated communication there is currently no clear empirical support for social anxiety being associated with longer duration of social media use. Self-report measures for social anxiety that are adapted for the context of social media could facilitate further research. The current study aimed to develop a Swedish version of the recently developed Social Anxiety Scale for Social Media Users (SAS-SMU), evaluate its psychometric properties, and explore associations between different uses of social media and social anxiety. Three factors were retained for SAS-SMU with excellent internal consistency. SAS-SMU evidenced convergent validity with measures of social anxiety, negative convergent validity with satisfaction with life, and divergent validity with measures of obsessive-compulsive disorder, depression and generalized anxiety disorder. Results indicated that higher levels of social anxiety were associated with passive and active use as well as longer duration of social media use in general, which is at odds with a previous study where passive use remained the only significant predictor for social anxiety.     

Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature

Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.     

Internet-Delivered CBT for Children with Specific Phobia: A Pilot Study

Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8–12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.     

Importance of Therapist Use of Social Reinforcement with Parents as a Model for Parent-Child Relationships: An Example with Parent-Child Interaction Therapy

ABSTRACT

This paper focuses attention on the therapeutic relationship in parent-child therapy by using social reinforcement with parents and children as it relates to Parent-Child Interaction Therapy (PCIT). As in other therapy contexts, it is argued that having the therapist serve as a mediator of social reinforcement facilitates client change, After discussing different aspects of PCIT, we discuss the therapeutic relationship as viewed through other theoretical frameworks. This is followed by a discussion of the role of social reinforcement in the parent-child relationship. We then discuss at methodological and applied levels, the importance of therapist accuracy and consistency in the delivery of reinforcement as a means of changing the parent-child relationship. Next, this is followed by a discussion of the therapist-to-parent-to-child sequential chain of behaviors involved in PCIT. Finally, suggestions for future empirical studies are considered.