A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

Modification of Cognitive-Behavioral Techniques in the Treatment of a Five Year-Old Girl with Social Phobia

Social phobia is a debilitating anxiety disorder that often goes undetected in young children, but can be effectively treated with cognitive-behavioral interventions. For children and adolescents, treatment usually includes education, social skills training, cognitive restructuring, relaxation training, and exposure. However, for very young children who present with social phobia, it is necessary to adapt treatment to the developmental level of the child. A case illustration demonstrates the way in which cognitive behavioral treatment (CBT) was modified for the treatment of a five year-old girl with social phobia. Several modifications were made, including utilizing novel exposure techniques and emphasizing parent management training in order to promote generalization of treatment gains outside of session.     

Cognitive Correlates of Social Phobia Among Children and Adolescents

We examined different cognitive phenomena in relation to social phobia among children (aged 7 to 11) and adolescents (aged 12–16) separately. Fifty socially phobic youths were compared to 30 normal control children on measures of social anxiety, social expectation as well as self- and observer-rated performance during two social tasks involving a same-aged peer. Additionally, a video-mediated recall procedure was conducted immediately following the two behavioral tasks to examine specific types of self-talk. Results indicated that socially phobic youths had lower expectations of their performance and rated their actual performance worse than controls during a social interaction task, but not a read-aloud task. Self-ratings of decreased performance among socially phobic youths were corroborated by blind observers. Although differences in specific types of self-talk were found between the two groups, these findings were generally moderated by age. Furthermore, certain cognitive symptoms associated with the disorder were more commonly found among older socially phobic youths. The current findings highlight the importance of considering developmental factors in the presentation and treatment of social phobia in youths.     

Cross-Informant Agreement in the Assessment of Social Phobia in Youth

In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the children's social phobia symptoms as reported by children and as rated by clinicians. Examination of cross-informant agreement indicated little difference between mean parent and children ratings of the children's social fears. In contrast, there was a significant difference in parent and children ratings of the children's avoidance, with parents endorsing greater degrees of social avoidance. Children's report of social avoidance was negatively related to scores on a measure of self-presentational concerns (i.e., social desirability). Clinicians' determination of the severity of the children's social phobia was also influenced by the children's self-presentation as well as parent report of social avoidance and children's depression scores. Thus, this differential weighting by the clinician of parent versus child report may be related to the finding that children's self-reported social avoidance was negatively related to their concerns regarding positive self-presentation. Results suggest the need to consider the impact of social desirability when examining clinical characteristics of children and adolescents with social phobia.     

Social Phobia and the Experience of Shame: Childhood Origins and Pastoral Implications

While social phobia is typically diagnosed in adolescence, the roots of social phobia are found in childhood experiences of shame. When shame occurs because of a failure to meet a child’s need this creates a fundamental uncertainty which can become internalized in the form of self-contempt. Emotions such as sadness are sometimes forbidden by caregivers, and the expression of natural sexual drives are sometimes prohibited. Such experiences create shame and may keep the person from feeling emotions and drives because shame has displaced the real emotion. The fractures in early relationships can be restored through the healing presence of another. The pastor has access to persons with social phobia who may not be willing to seek psychiatric care and is in a unique position to bring the resources of the church to bear in the lives of persons with social phobia. To do so, she moves away from the extroverted frame of reference within which the church frequently operates.Philip Browning Helsel, a graduate of Princeton Theological Seminary, serves as a Chaplain Resident in the Clinical Pastoral Education program at Yuma Regional Medical Center in, Yuma, AZ     

The Social Phobia and Social Interaction Anxiety Scales: Evaluation of Psychometric Properties

The present investigations examined the factor structure and psychometric properties of two new self-report measures of social phobia, the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). A confirmatory factor analysis in Study I provided support for the fit of a two-factor model of the SIAS and SPS. Internal consistency estimates were high for the original two scales with a sample of 200 undergraduates. Also, using an item parceling procedure, the obtained internal consistency reliability indices for each parcel were acceptable. Results of the CFA in Study II provided support for the factorial stability of the model identified in Study I. Furthermore, multisample analyses showed invariant patterns for factor loadings and factor correlations across 138 men and 272 women. Gender differences were not observed in the mean SIAS and SPS scale and item scores. Both scales correlated negatively and significantly with measures of social desirability. Concurrent validity was established for the scales. The SPS was less specific than the SIAS to symptoms of social phobia.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Mindfulness and the Attenuation of Post-Event Processing in Social Phobia: An Experimental Investigation

The present experimental study examined the ability of metacognitive strategies to reduce the distress associated with post-event processing (PEP). Individuals with DSM-IV generalized social phobia (N = 57) were randomly allocated to receive brief training in mindfulness, distraction, or no training (control group). Next, they underwent an experimental PEP induction. Following the induction, they were instructed to apply the metacognitive strategy (mindfulness or distraction) they were taught or to continue thinking about the social event the way they typically would following such an event (control). Participants rated their distress on a visual analogue scale prior to the PEP induction, and then every minute for 5 min while applying the metacognitive strategy. They also rated their affect immediately after applying the metacognitive strategy. Results suggest that mindfulness reduces distress significantly over the post-event period and results in significantly more positive affect than when receiving no training. In contrast, distraction does not reduce distress over the post-event period performs comparable to receiving no training. The results of this experimental investigation suggest that mindfulness has the potential to reduce distress associated with PEP and provide further support for the clinical utility of mindfulness in the treatment of generalized social phobia.     

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.     

Psychopathology of Adolescent Social Phobia

Sixty-three adolescents with social phobia and 43 with no psychiatric disorders were compared across a number of clinical variables. In addition to clinically impairing social fear, adolescents with social phobia had significantly higher levels of loneliness, dysphoria, general emotional over-responsiveness and more internalizing behaviors than normal controls and 57.1% of socially phobic adolescents had a second, concurrent diagnosis, 75% of which were other anxiety disorders. In addition, adolescents with social phobia were significantly less socially skilled. Though similar in some respects to childhood social phobia, adolescent social phobia has a unique clinical presentation. The importance of developmental differences on the development of age-appropriate interventions is discussed.     

The Social Phobia and Anxiety Inventory: Reliability and Validity in an Adolescent Spanish Population

The objective of this study is to examine the factor structure and psychometric properties of the SPAI in a sample of adolescent Spaniards. The results obtained support the use of the correlated two-factor SPAI subscales and indicate high coefficient alpha values for the SPAI subscales. The results provide support for the use of the SPAI in an adolescent population in a non-English-speaking country. Both exploratory and confirmatory factor analyses of the Social Phobia subscale showed a four-factor structure, instead of a five-factor dimension, as suggested by previous studies. Effects for gender and age and gender interaction were found. Limitations and suggestions for future research are discussed.     

社交焦虑个体外显与内隐自尊的研究

社交恐惧图式理论、社交恐惧模式、和社交恐惧认知行为模式等认知理论,都认为社交恐惧产生于不良的自我图式。为了探讨社交恐惧个体是否具有不良的自我图式,要求40名高社交恐惧个体和30名低社交焦虑个体完成了自尊量表和内隐联想任务。结果发现：高社交恐惧个体在自尊量表上的得分显著低于低社交恐惧个体,但在内隐自尊上,他们都有着积极的自尊,且无显著差异。这一研究结果不支持社交恐惧的认知理论。根据自我呈现理论讨论了研究结果。     

Development of a Brief Version of the Social Phobia Inventory Using Item Response Theory: The Mini-SPIN-R

The Social Phobia Inventory (SPIN) is a widely used measure in mental health settings and a 3-item version (mini-SPIN) has been developed as a screening instrument for social anxiety disorder. In the present study, we examined the psychometric properties of the SPIN and developed a brief version (mini-SPIN-R) designed to assess social anxiety severity using item response theory. Our sample included 569 individuals with social anxiety disorder who participated in 2 clinical trials and filled out a battery of self-report measures. Using a nonparametric kernel smoothing method we identified the most sensitive items of the SPIN. These 3 items comprised the mini-SPIN-R, which was found to have greater internal consistency, and to capture a greater range of symptoms compared to the mini-SPIN. The mini-SPIN-R evidenced superior convergent validity compared to the mini-SPIN and both measures had similar divergent validity. Thus, the mini-SPIN-R is a promising brief measure of social anxiety severity.