Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial

Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.     

Changes in Anxiety Control Beliefs Following a Brief CBT Treatment and Their Association With Anxiety Symptom Reduction

Anxiety control beliefs (i.e., beliefs regarding one’s ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.     

The role of empathy and social anxiety in Latinx adolescents' indirect peer aggression during the transition to high school

The primary purpose of this study was to evaluate the relationship between decreased empathy (i.e., cognitive and affective) and indirect and cyber peer aggression among Latinx adolescents during their transition to high school. Further, we examined the degree to which social anxiety moderated this relationship. Participants were 469 Latinx ninth graders, ages 13–17 years (M = 14.52, SD = 0.58; 58% girls). Adolescents completed the Revised Peer Experiences Questionnaire, Cyber Peer Experiences Questionnaire, Basic Empathy Scale, and Social Anxiety Scale for Adolescents at two different time points, 3 months apart. Hierarchical linear regression analyses revealed concurrent and prospective relationships between lower cognitive empathy and the perpetration of both indirect and cyber aggression. In addition, social anxiety moderated the concurrent associations between both types of empathy and both types of aggression perpetration. Results suggest that interventions that facilitate cognitive empathy and decrease social anxiety may help to reduce adolescents' indirect and cyber aggression toward peers throughout the high school transition.     

Human social defeat and approach–avoidance: Escalating social-evaluative threat and threat of aggression increases social avoidance

Basic research on avoidance by Murray Sidman laid the foundation for advances in the classification, conceptualization and treatment of avoidance in psychological disorders. Contemporary avoidance research is explicitly translational and increasingly focused on how competing appetitive and aversive contingencies influence avoidance. In this laboratory investigation, we examined the effects of escalating social-evaluative threat and threat of social aggression on avoidance of social interactions. During social-defeat learning, 38 adults learned to associate 9 virtual peers with an increasing probability of receiving negative evaluations. Additionally, 1 virtual peer was associated with positive evaluations. Next, in an approach–avoidance task with social-evaluative threat, 1 peer associated with negative evaluations was presented alongside the peer associated with positive evaluations. Approaching peers produced a positive or a probabilistic negative evaluation, while avoiding peers prevented a negative evaluation (and forfeited a positive evaluation). In an approach–avoidance task with social aggression, virtual peers gave and took money away from participants. Escalating social-evaluative threat and aggression increased avoidance, ratings of feeling threatened and threat expectancy and decreased ratings of peer favorableness. These findings underscore the potential of coupling social defeat and approach–avoidance paradigms for translational research on the neurobehavioral mechanisms of social approach–avoidance decision-making and anxiety.     

Psychometric Properties of Two Implicit Associations Tests measuring Adult Attachment

Adult attachment style has consequences for mental health, interpersonal functioning and emotion regulation. This occurs partly deliberately, also referred to as explicit, and partly on an automatic level outside of conscious awareness, also referred to as implicit. Whereas explicit adult attachment can be assessed with self-report instruments, measurement of implicit adult attachment requires indirect methods. This paper describes the psychometric properties of two Implicit Association Tests measuring general adult attachment in a population sample. The study evaluated the reliability and the validity of the Avoidant Attachment IAT (ANX-IAT) and the Anxious Attachment IAT (AVOID-IAT). Validity was evaluated against self-report measures of adult attachment style (RQ), psychopathology (SQ-48), and well-being (MHC-SF). The split-half reliabilities of both IATs were good; the test-retest reliability of the ANX-IAT was adequate; however the AVOID-IAT had low test-retest reliability. Both IATs did not explain variance in psychopathology additional to explicit measures. The AVOID-IAT showed added value over explicit measurement of avoidant attachment in explaining variance in well-being, particularly regarding emotional and psychological well-being. The ANX-IAT did not explain variance in any measure of well-being additional to the explicit measure of anxious attachment. Our findings provide a basis from which more valid IATs measuring general adult attachment can be developed. Furthermore, they suggest that implicit avoidant attachment might be related to well-being, particularly emotional and psychological well-being. However, further research is needed to investigate the role of implicit general adult attachment in mental health and to optimize the two IATs in terms of validity before clinical use is recommended.     

述情障碍与中学生人际关系:有调节的中介模型

为明确述情障碍与中学生人际关系间关系的内在机制,采用中学生人际关系量表、多伦多述情障碍量表、社交焦虑量表及领悟社会支持量表调查了北京市、石家庄市、佳木斯市三所中学7至11年级共998名学生,根据述情障碍的筛查标准,最终获得218份有效数据。结论如下：（1）述情障碍与社交焦虑呈显著正相关,与人际关系、社会支持呈显著负相关;人际关系与社交焦虑呈显著负相关,而与社会支持呈显著正相关;社交焦虑与社会支持呈显著负相关;（2）社交焦虑在述情障碍与中学生人际关系间起中介作用;社会支持在述情障碍与中学生人际关系间起调节作用;（3）"述情障碍→社交焦虑→中学生人际关系"这一中介路径的前半段,受到社会支持的调节。与高社会支持个体相比,述情障碍对低社会支持个体的社交焦虑影响更大。     

Fear and Anxiety in COVID-19: Preexisting Anxiety Disorders

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.     

Inhibitory control and set shifting describe different pathways from behavioral inhibition to socially anxious behavior

Individuals with a behaviorally inhibited (BI) temperament are more likely to develop social anxiety. However, the mechanisms by which socially anxious behavior emerges from BI are unclear. Variation in different forms of top‐down control, specifically executive functions (EF), may play distinct roles and characterize differential pathways to social anxiety. Here 291 children were assessed for BI in toddlerhood (ages 2 and 3), parent‐reported inhibitory control and set shifting during middle childhood (age 7), and multidimensional assessment of socially anxious behavior completed during late childhood and early adolescence (ages 9 and 12). Structural equation modeling revealed that early variation in BI predicted the development of socially anxious behavior through either higher levels of parent‐reported inhibitory control or lower levels of parent‐reported set shifting. These data reinforce the notion that top‐down control does not uniformly influence relations between temperament and socially anxious behavior. These data suggest novel approaches to thinking about the role of EFs and social anxiety outcomes as children approach adolescence.