Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index

Frequent assessment during therapy can improve treatments and provide accountability. However, clinicians often do not monitor progress because of the time it takes to administer and score assessments. In response, the Social Anxiety Session Change Index (SASCI) was developed. The SASCI is a short, easily administered rating of subjective improvement that asks clients with social anxiety disorder how much they have changed since the beginning of therapy. Change on the SASCI was related to change in fear of negative evaluation, a core aspect of social anxiety, and to clinician-rated improvement, but not to ratings of anxiety sensitivity or depression. Because it is brief and easily interpretable, the SASCI can be used in a variety of clinical settings to monitor change across therapy. The SASCI is presented along with examples of how the information gathered from frequent administration can inform clinical practice.     

First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a “gender therapist,” only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.     

"Don't Ask, Don't Tell": The Influence of Stigma Concealing and Perceived Threat on Perceivers' Reactions to a Gay Target

This research examined reactions to a gay target who was either concealing or not concealing his sexual orientation under conditions of threat (HIV-positive) or no threat (healthy). When the target concealed his sexual orientation, participants were more willing to interact socially with him, but rated him as having more negative characteristics than when he was open about his sexual orientation. Participants rated a threatening target more negatively on a thermometer evaluation, perceived him to be more immoral, had more negative affective reactions, and desired more social distance than when the target was nonthreatening. The results are integrated with previous theoretical discussions and are considered in terms of the conflicting motivations of perceivers and targets.     

On models and vases: body dissatisfaction and proneness to social comparison effects

When and why do media-portrayed physically attractive women affect perceivers' self-evaluations? In 6 studies, the authors showed that whether such images affect self-evaluations depends jointly on target features and perceiver features. In Study 1, exposure to a physically attractive target, compared with exposure to an equally attractive model, lowered women's self-evaluations. Study 2 showed that body-dissatisfied women, to a greater extent than body-satisfied women, report that they compare their bodies with other women's bodies. In Study 3, body-dissatisfied women, but not body-satisfied women, were affected by both attractive models and nonmodels. Furthermore, in Study 4, it was body-dissatisfied women, rather than body-satisfied women, who evaluated themselves negatively after exposure to a thin (versus a fat) vase. The authors replicated this result in Study 5 by manipulating, instead of measuring, body dissatisfaction. Finally, Study 6 results suggested that body dissatisfaction increases proneness to social comparison effects because body dissatisfaction increases self-activation.     

Cross-language message- and word-level transfer effects in bilingual text processing

The present study examined the nature of the mental representations bilinguals form when reading a text and to what extent they are language specific. English-French bilinguals read five pairs of passages in succession while their eye movements were tracked. Dependent measures were overall reading times on second passages and fixation latencies on target cognates embeddedin second passages. The first passage w as (1) identical tothe second passage in the pair, (2) related in content only (i.e., a translation), (3) related in content and some words (i.e., translation with cognates), (4) related in words only (i.e., different content with the same cognates), or (5) unrelated. There was substantial cross-language facilitation for passages that shared meaning, but the amount of transfer was less than that for identical passages, indicating that memory representations are largely meaning based but do contain some information about surface form. Cross-language transfer for cognates was observed but depended on the skill of the bilinguals in their second language, the direction of transfer, and whether the passages shared meaning. These results are discussed in relation to Raney's (2003) model of text representation.     

The categorization effect in hedonic contrast: Experts differ from novices

Test stimuli are rated as less “good” when they follow very good context stimuli than when they are presented alone. This diminution in rating is called hedonic contrast. Contrast is attenuated if the context and the test stimuli are perceived as being in different categories. Because experts use as their basic-level categories what are the subordinate levels for novices, they will categorize when novices do not. Therefore, in the following studies, both experts and novices showed hedonic contrast when attractive context orchids preceded more neutral test orchids. However, only the novices showed hedonic contrast when attractive context irises preceded the test orchids. Novices viewed the irises and the orchids as “flowers” and therefore members of the same category, resulting in contrast. Experts, however, viewed the irises and the orchids as being in different categories; therefore, hedonic contrast did not occur.     

Working alliance for clients with social anxiety disorder: relationship with session helpfulness and within-session habituation

It has been suggested that a strong working alliance encourages clients to take risks during therapy (Raue, Castonguay, & Goldfried, 1993). This encouragement may be important for clients who fear negative evaluations as they engage in risk-taking elements of therapy. This study examined the relationship between working alliance, session helpfulness and measures of emotional processing in 18 clients undergoing cognitive behavior therapy (CBT) for social anxiety disorder. Results indicate a positive correlation between client-rated, but not observer-rated, working alliance and session helpfulness. Moderate levels of working alliance were associated with higher initial anxiety and deeper within-session habituation. Overall, a strong alliance was associated with clients engaging with the session and finding the session helpful. Implications for the use of CBT for social anxiety are discussed.     

Quality of social support in mental and physical health

The current study investigates the relationship between social support and mental and physical health. Results indicate that poor functional support (or quality of support) is related to physical health problems while structural support (or social network size) is not. Moreover, although both poor functional and structural support are related to depression and anxiety, functional support is more strongly related to these outcome variables, the strongest relationship being associated with depression. Depression and hostility are also related to social isolation, although the relationship is again stronger for depression. The results suggest that the quality of social relationships is more important than quantity for optimal mental and physical health. The clinical relevance of these findings is that the quality of social support in the lives of individuals is central to recovery and should be addressed in medical and mental health treatment planning whenever it is an etiological or maintaining factor. The author dedicates this paper to her beloved father, Charles VanderVoort and her colleagues Dr. Uwe Stuecher and Dr. Gay Barfield whom she describes as “natural altruists, the rarest and most loving type of people in the world.”