Behavioral assessment of public-speaking anxiety using a modified version of the Social Performance Rating Scale

The current study aimed to extend the evaluation of the utility of the Social Performance Rating Scale (SPRS) [Behav. Res. Ther. 36 (1998) 995]. We examined the utility of a modified SPRS for the behavioral assessment of public-speaking anxiety among patients with social phobia (n = 49). The videotaped performance of public-speaking fearful patients in a public-speaking task was rated using four of the five SPRS ratings and was compared to global ratings by patients and observers, as well as to self-report and clinician-administered measures of social anxiety. The pattern of correlations with criterion measures of social anxiety provided evidence for the convergent and divergent validity of this modified SPRS for the behavioral assessment of public-speaking anxiety.     

Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.     

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.     

Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population

Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n?=?180) and in a normal population (n?=?614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.     

Measurement of social-evaluative anxiety in junior high school students

This paper provides some initial normative and validity data on the Social Avoidance and Distress (SAD) and the Fear of Negative Evaluation (FNE) scales for junior high school students. Findings indicated: the level of social-evaluative anxiety does not significantly vary during the junior high school years or between sexes, junior high school students report similar levels of FNE to college students but less SAD, a significant positive correlation between treatment subjects' SAD scores and peer sociometric ratings of social-evaluative anxiety, and subjects treated for social anxiety reported significantly less SAD and FNE at follow-up assessment. Recommendations for future research and clinical use of the SAD and FNE are offered.     

Social anxiety disorder in childhood and adolescence: descriptive psychopathology

Although the presentation of social anxiety disorder (SAD) in adults is well documented, less is known about its clinical manifestation in children and adolescents. To date, most studies have included combined samples of children and adolescents despite the fact that this age range represents an extensive period of growth and development. This study compares and contrasts the clinical presentation of SAD among children (ages 7-12) and adolescents (ages 13-17). One hundred and fifty children (n=74) and adolescents (n=76) with a primary diagnosis of SAD participated in the study. The assessment battery included clinical ratings and behavioral observation as well as parental and self-report. The results indicate that, although the symptom presentation of children and adolescents with primary SAD shares many features, children tend to present with a broader pattern of general psychopathology, while adolescents have a more pervasive pattern of social dysfunction and may be more functionally impaired as a result of their disorder. These findings suggest that interventions for SAD need to carefully consider clinical presentation of the disorder as it manifests in childhood and adolescence.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design

Background & objectives: Social anxiety disorder (SAD) is a debilitating condition, and approximately half of adults who stutter have SAD. Cognitive-behavioral therapy (CBT) has shown promise in decreasing social anxiety symptoms among adults who stutter, but exposure, arguably the essential component for successful CBT for SAD, has been understudied and underemphasized. Aims of this study were to develop an exposure therapy protocol designed specifically for people who stutter and have SAD and evaluate its potential efficacy in reducing social anxiety and stuttering severity using a multiple baseline design.Methods: Six participants received ten sessions of exposure therapy. Participants reported daily social anxiety, and social distress and stuttering severity were evaluated at major assessment points.Results: There were substantial reductions in social anxiety and considerable improvements in affective, behavioral, and cognitive experiences of stuttering. No consistent change was observed for stuttering frequency. Gains were mostly maintained after six-months.Conclusions: Results suggest that the novel exposure approach may decrease social distress, but not necessarily influence speech fluency. These findings underscore the importance of the assessment and treatment of SAD among adults who stutter and suggest that the integration of care between clinical psychologists and speech-language pathologists may prove beneficial for this population.     

Self-representation in social anxiety disorder: linguistic analysis of autobiographical narratives

Cognitive models of social anxiety disorder (SAD) posit aberrant beliefs about the social self as a key psychological mechanism that maintains fear of negative evaluation in social and performance situations. Consequently, a distorted self-view should be evident when recalling painful autobiographical social memories, as reflected in linguistic expression, negative self-beliefs, and emotion and avoidance. To test this hypothesis, 42 adults diagnosed with SAD and 27 non-psychiatric healthy controls (HC) composed autobiographical narratives of distinct social anxiety related situations, generated negative self-beliefs (NSB), and provided emotion and avoidance ratings. Although narratives were matched for initial emotional intensity and present vividness, linguistic analyses demonstrated that, compared to HC, SAD employed more self-referential, anxiety, and sensory words, and made fewer references to other people. There were no differences in the number of self-referential NSB identified by SAD and HC. Social anxiety symptom severity, however, was associated with greater self-referential NSB in SAD only. SAD reported greater current self-conscious emotions when recalling autobiographical social situations, and greater active avoidance of similar situations than did HC. These findings support cognitive models of SAD, and suggest that autobiographical memory of social situations in SAD may influence current and future thinking, emotion, and behavioral avoidance.     

Validity of the social avoidance and distress and fear of negative evaluation scales

The Social Avoidance and Distress Scale (SAD) and the Fear of Negative Evaluation Scale (FNE), two commonly accepted measures of social anxiety, were administered to a large group of patients diagnosed as having Agoraphobia with Panic Attacks, Agoraphobia without Panic Attacks, Social Phobia, Simple Phobia, Generalized Anxiety Disorder, Panic Disorder and Obsessive-Compulsive Disorder. On the SAD and FNE, social phobies did not differ significantly from the other major anxiety disorders, with the exception of simple phobies. Performance on the SAD and FNE was significantly correlated with measures of anxiety, depression and general emotional distress. The lack of discriminative validity of the SAD and FNE is discussed.     

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.

     

Racial bias in behavioral assessment of children's social skills

The social skills of 20 second- and sixth-grade students were assessed by 20 trained raters using the Social Skills Test for Children (SST-C). Rater and child characteristics were examined to determine whether differences in social skills ratings were due to the race of the rater or the race of the children being rated or due to the interactive effects of these characteristics, which would suggest racial bias in the ratings procedure. The results showed that the race of the rater did affect some behavioral observations. Black raters gave higher scores than white raters on four behavioral categories: response latency, appropriate assertion, effective assertion, and smiling. White raters gave higher scores for head position and gestures. The results of this study replicated earlier findings of significant differences in social skills ratings due to the race and age of the child being rated. The results also showed modest racial bias effects in that black and white raters scored black and white children differentially on two behavioral categories: overall skill ratings and smiling. These results suggested that most behavioral categories of the SST-C were not systematically affected by racial bias. However, the most subjective rating, overall skill, did evidence racial bias effects. This finding is consistent with previous data showing that subjective ratings may be most affected by racial bias.     

Conversation skills training for socially isolated children

A social skills training program consisting of instructions, modeling, behavior rehearsal, performance feedback, and programmed generalization set was used to teach conversational behavior to four socially isolated children. Effects of training were assessed in a multiple-baseline analysis across behavior. Subjects were selected on the basis of peer sociometric ratings, a behavioral role-playing task, naturalistic observation, and teacher ratings. All subjects demonstrated noticeable improvement in the target behavior as well as in overall conversational ability. However, these gains were maintained unequally in the children at follow-up probe administrations (4-and 8-weeks). Generalization assessment revealed some transfer of treatment effects to the school setting for all children. Results are discussed in terms of the complexity of social isolation in children and factors which influenced generalizability of the treatment program.     

Social interactions as predictors of children's likability and friendship patterns: A multiple regression analysis

The concurrent and predictive validity of four qualitative behavioral classes of social interaction (initiating and receiving positive and negative social interaction) was investigated using sociometric measures of peer acceptance (ratings) and friendship (nominations). Correlational analyses showed significant relationships between behavioral and sociometric measures supporting previous work with preschool populations. Stepwise multiple regression analyses suggested that receiving social interaction from peers best predicted overall acceptance, whereas initiating social interactions best predicted children's friendship patterns. Tentative implications for the behavioral assessment of children's social skills were discussed.The current data were gathered as part of a larger research project concerning social skills assessment and training in children.     

Multimedia Field Test Thinking About Exposures? There’s an App for That!

Anxiety Coach is a smartphone application (“app”) for iOS devices that is billed as a self-help program for anxiety in youth and adults. The app is currently available in the iTunes store for a one-time fee of $4.99. Anxiety Coach is organized around three related content areas: (a) self-monitoring of anxiety symptoms, (b) learning about anxiety and its treatment, and (c) guiding users through the development of a fear hierarchy and completion of exposure tasks. Although the app includes psychoeducation about anxiety as well as information regarding specific skills individuals can use to cope with anxiety (e.g., cognitive restructuring), the primary focus of the app is on exposure tasks. As such, the app includes a large library of potential exposure tasks that are relevant to treating common fears and worries, making Anxiety Coach useful to clients and clinicians alike. Additionally, Anxiety Coach prompts users to provide fear ratings while they are carrying out an exposure task and displays a message instructing users to stop the exposure once fear ratings drop by half. These features work together to create an app that has the potential to greatly increase the reach of exposure-based cognitive behavioral therapy for anxiety.     

Liar, liar: internet faking but not frequency of use affects social skills, self-esteem, social anxiety, and aggression.

Misuse of the Internet can affect various aspects of children's social lives. It was predicted that children who misrepresent themselves on the Internet would have less well-developed social skills, lower levels of self-esteem, and higher levels of social anxiety and aggression. The frequency of Internet use was also assessed. Students aged 11-16 years were recruited for the study from classes after obtaining consent. Questionnaires included a query of Internet behaviors, the Matson Evaluation of Social Skills with Youngsters Appropriate Social Skills and Inappropriate Assertiveness subscales, Rosenberg Self-esteem Scale, and the Social Anxiety Scale for Children-Revised. It was found that children who reported the most faking behavior on the Internet (e.g., pretending to be older) had poorer social skills, lower levels of self-esteem, higher levels of social anxiety, and higher levels of aggression. Frequency of use, however, did not affect these factors in the current study.     

Mindfulness and Acceptance-Based Group Therapy for Social Anxiety Disorder: An Open Trial

Mindfulness and Acceptance-Based Group Therapy (MAGT) for Social Anxiety Disorder (SAD) is based largely on Acceptance and Commitment Therapy (ACT; Hayes et al., 1999), with enhanced mindfulness mostly from Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002). The purpose of this study was to assess the feasibility and initial effectiveness of MAGT for the treatment of SAD. Forty-two SAD patients were invited to take part in an open trial of MAGT. Participants completed measures of social anxiety, mindfulness and acceptance, depression, and rumination at pretreatment, midtreatment (6 weeks), posttreatment (12 weeks), and at a 3-month follow-up session. Twenty-nine participants completed the treatment and these participants reported that the treatment was helpful. Effect sizes for treatment completers ranged from 1.00 to 1.17 for the social anxiety symptom measures at follow-up. Intent-to-treat analyses revealed significant reductions in social anxiety, depression, and rumination and significant increases in mindfulness and acceptance, with effect sizes ranging from .65 to .76 on the social anxiety measures. This study demonstrates that MAGT is feasible and acceptable to SAD patients and provides further support for the use of mindfulness and acceptance-based interventions for the treatment of SAD.     

Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.     

Cognitive Factors that Maintain Social Anxiety Disorder: a Comprehensive Model and its Treatment Implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post‐event rumination, which leads to further social apprehension in the future. Possible disorder‐specific intervention strategies are discussed.     

Development and Preliminary Evaluation of a 1-Week Summer Treatment Program for Separation Anxiety Disorder

Numerous clinical trials have demonstrated the efficacy of cognitive behavior therapy (CBT) for the treatment of childhood Separation Anxiety Disorder (SAD) and other anxiety disorders yet additional research may still be needed to better access and engage anxious youth. In this study, we investigated the acceptability and preliminary utility of a group cognitive-behavioral intervention for school-aged girls with SAD provided within an intensive, 1-week setting. The development of the proposed treatment strategy, a 1-week summer treatment program, was predicated on evidence supporting the need for childhood treatments that are developmentally sensitive, allow for creative application of intervention components, incorporate a child's social context, and ultimately establish new pathways for dissemination to the community. The summer treatment program for SAD was pilot-tested using a case-series design with 5 female children, aged 8 to 11, each with a principal diagnosis of SAD. For 4 of the 5 participants, treatment gains were evidenced by changes in diagnostic status, significant reductions in measures of avoidance, and improvements on self- and parent-report measures of anxiety symptomology. Specifically, severity of SAD symptoms decreased substantially at posttreatment for each participant and, 2 months following treatment, none of the participants met diagnostic criteria for the disorder. A fifth participant experienced substantive improvement in diagnostic status prior to the onset of treatment and, though she evidenced continued improvements following treatment, the role of the intervention in such improvements is less clear.