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ABSTRACT: One of the most significant changes since the publication of the first edition of this volume is the substantial increase in the treatment outcome literature for social anxiety disorder. Medication trials for adults have increased exponentially, allowing for a clearer picture of the role of pharmacological agents. Treatment trials for children with social anxiety disorder are also beginning to emerge. Empirical data are now available for various classes of pharmacological agents, primarily selective serotonin reuptake inhibitors (SSRIs), but also tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), beta-blockers, highpotency benzodiazepines, the atypical anxiolytic azapirone (Buspar), and anticonvulsants. In this chapter, the authors review the empirical literature related to social anxiety disorder, including data on predictors of treatment response, relapse rates, and the role of pretreatment attrition. In addition to the empirical review, the authors present information pertinent to clinicians working with adults and children who may be taking these medications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: This book describes the clinical presentation of social anxiety disorder, presents theoretical perspectives on its etiology, and examines the latest empirical data with respect to both pharmacological and behavioral interventions. Social anxiety disorder occurs in children, adolescents, and adults, but its manifestation and treatment differ depending on developmental factors. Drawing from a broad literature base as well as their extensive clinical experience, the authors illustrate the impact of developmental stage on all aspects of the disorder. They also provide practical implementation guidelines, enhanced by case examples; tips on patient management; lists of assessment instruments; and sample forms to use with clients. Since publication of the first edition in 1998, knowledge about social anxiety disorder has advanced on several fronts. The new edition includes information from new studies differentiating patterns of distress characteristic of social anxiety disorder versus shyness. It draws on more substantive data bases to support firmer conclusions about the presentation of social anxiety disorder among children and adolescents as well as across various ethnocultural groups. New assessment strategies reviewed in this book include neuroanatomical assessment using magnetic resonance imaging and well-validated self-report instruments and clinician rating scales. The authors review a greatly expanded literature addressing pharmacological treatment and psychosocial treatments. New case descriptions and clinical materials are also included. This highly informative and comprehensive volume will be illuminating reading for practitioners, researchers, and students. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: 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.
Journal of Psychopathology and Behavioral Assessment 04/2012; 29(1):46-53. · 1.55 Impact Factor
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ABSTRACT: To clarify the relationship between social phobia and shyness, this study examined the characteristics of highly shy persons with social phobia, highly shy persons without social phobia, and non-shy persons. Those with social phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without social phobia. About one-third of the highly shy without social phobia reported no social fears, highlighting heterogeneity of the shy. The social phobia group reported similar levels of anxiety as the shy without social phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The social phobia group performed less effectively across tasks than those without social phobia. All groups' perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of social phobia.
Journal of anxiety disorders 11/2008; 23(4):469-76. · 2.68 Impact Factor
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ABSTRACT: Based on findings from the adult literature, this study examined the role of negative self-images (NSI) in social phobia during adolescence. NSI was manipulated among 21 nonphobic (IMAG) adolescents (M age = 14.05 years, SD = 1.56) during two social tasks. Self and observer-rated anxiety and performance as well as co-occurring cognition were compared to 21 adolescents with social phobia (SOC) and 21 control adolescents not instructed to use self-imagery. Few differences in observer-rated anxiety or performance were found between the IMAG and control groups, whereas SOC adolescents were consistently rated as more anxious and poorer social performers. Nonsignificantly higher rates of anxiety were reported by the IMAG group compared to controls, but anxiety was not associated with decrements in performance or social skill. A significantly fewer number of on-task thoughts reported by IMAG adolescents suggests that inability to attend to the interaction itself, rather the presence of NSI, served to increase anxiety.
Journal of Clinical Child & Adolescent Psychology 05/2008; 37(2):327-36. · 1.92 Impact Factor
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ABSTRACT: To determine the efficacy of fluoxetine, pill placebo, and Social Effectiveness Therapy for Children (SET-C) for children and adolescents with social phobia.
Youths ages 7 to 17 were randomly assigned to one of the treatment conditions. Outcome was evaluated using self-reports, parent ratings, independent evaluator ratings, and behavioral assessment.
Both fluoxetine and SET-C were more efficacious than placebo in reducing social distress and behavioral avoidance and increasing general functioning. SET-C was superior to fluoxetine on each of these measures and was the only treatment superior to placebo in terms of improving social skills, decreasing anxiety in specific social interactions, and enhancing ratings of social competence. Furthermore, whereas fluoxetine appears to exert maximum effect by 8 weeks, SET-C provides continued improvement through week 12.
Both fluoxetine and SET-C are efficacious for social phobia, although SET-C appears to provide added benefit by enhancing social skills.
Journal of the American Academy of Child & Adolescent Psychiatry 01/2008; 46(12):1622-32. · 6.44 Impact Factor
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ABSTRACT: 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.
Behaviour Research and Therapy 07/2007; 45(6):1181-91. · 3.30 Impact Factor
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ABSTRACT: An abbreviated version of the Social Phobia and Anxiety Inventory (SPAI) was developed using methods based in nonparametric item response theory. Participants included a nonclinical sample of 1,482 undergraduates (52% female, mean age = 19.4 years) as well as a clinical sample of 105 individuals (56% female, mean age = 36.4 years) diagnosed with either generalized (73%) or specific social phobia (27%). Twenty-three of the 45 SPAI items demonstrated good discrimination along the social anxiety continuum. In addition, option characteristic curves (OCCs) indicated that the SPAI's 7-point scale may generate errors in ranking individuals. Thus, options were collapsed to improve item performance. No gender differences emerged between any of the items' OCCs, suggesting that items function similarly among men and women. The abbreviated version also correlated highly with the original 45-item SPAI and exhibited similar patterns of correlations with measures of social anxiety. The SPAI-23 has considerable practical benefits, including a screening of both social and agoraphobic anxiety as well as decreased assessment and scoring time.
Psychological Assessment 04/2007; 19(1):133-45. · 2.99 Impact Factor
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ABSTRACT: Social Effectiveness Therapy for Children (SET-C) is a comprehensive behavioral treatment combining social skills training, peer generalization experiences, and individualized in vivo exposure for the treatment of social phobia in youth. SET-C results in positive treatment outcome and its effects are maintained at least 3 years later. In this investigation, maintenance of treatment gains 3, 4, and 5 years later was examined using a multidimensional assessment strategy consisting of self-report, parental report, clinician ratings, and direct behavioral assessment. Furthermore, the overall functioning of adolescents treated with SET-C 5 years earlier was compared with that of a group of adolescents who never suffered from psychological disorders. All posttreatment gains were maintained 5 years later, and the general functioning of SET-C treatment responders was not significantly different from those who never had a disorder. The data indicate that SET-C results in long-term positive effects for youth suffering from social phobia.
Behavior Therapy 01/2007; 37(4):416-25. · 2.43 Impact Factor
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ABSTRACT: Clinical observation suggests that sleep complaints are common among youth with anxiety disorders though empirical data documenting this co-occurrence of symptoms are generally unavailable.
Based on retrospective chart reviews, the current study examined rates of several types of parent-reported sleep complaints among a sample of (n=35) purely anxious children and adolescents (ANX). Sleep complaints were examined in terms of age (children versus adolescents) and type of anxiety diagnosis (generalized anxiety versus other anxious diagnoses). Rates of sleep complaints among anxious youth also were compared to those among (n=38) healthy control children and (n=33) children referred for sleep problems.
The presence of at least one intermittent sleep complaint was reported by 83% of parents of ANX, with almost half reporting at least one frequent sleep complaint. Rates of sleep complaints among anxious children versus adolescents were similar. Children with generalized anxiety disorder (GAD) had a significantly greater number of sleep complaints than children with other types of anxiety disorders, though rates for specific items varied. Although parents of sleep-referred children reported the highest rates of sleep complaints overall, the frequency of several specific types of sleep complaints was highly similar among ANX and sleep-referred children.
Findings indicate that certain sleep complaints are common among ANX. The need for appropriate assessment practices is discussed.
Sleep Medicine 10/2006; 7(6):467-73. · 3.40 Impact Factor
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ABSTRACT: 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.
Journal of Abnormal Child Psychology 05/2006; 34(2):189-201. · 3.09 Impact Factor
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ABSTRACT: Pretreatment attrition, the systematic self-exclusion of potential participants during the recruitment phase of a study, poses a significant threat to the external validity of randomized clinical trials. Very little is known about the factors that contribute to pretreatment attrition, especially among families seeking treatment for a child. The current study assessed pretreatment attrition in a randomized clinical trial of behavior therapy, fluoxetine, and placebo for child and adolescent social phobia. Reluctance toward medication treatment accounted for 44.7% of study refusals and was disproportionately common among ethnic minority families. Parents were particularly worried about the potential for side effects or physical/psychological dependency upon the medication. Results are discussed in terms of the implications for external validity in future psychopharmacological clinical trials.
Journal of Anxiety Disorders 02/2006; 20(8):1133-47. · 2.96 Impact Factor
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ABSTRACT: The clinical interview is critical in the diagnostic assessment undertaking in clinical settings, and cultural/ethnic influences have been shown to influence the outcome of this process. Specifically, a number of studies have reported that proportionally far more ethnic minorities than Caucasians are likely to be misdiagnosed when assessed for psychiatric disorders. This particularly is the case when open clinical interviews are used. Semistructured interviews, on the other hand, result in an increase in diagnostic accuracy with ethnic minorities. Parameters associated with bias in the clinical interview of ethnic minorities and its impact on assessment, diagnosis, and treatment decisions are examined. Although the current discussion focuses primarily on African Americans, many examples are provided that pertain to other ethnic groups. Strategies for addressing these issues are explored and recommendations for increasing cultural competence are made. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Psychotherapy Theory Research & Practice 01/2006; 43(1):50-64. · 0.98 Impact Factor
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ABSTRACT: This study investigated the relationship between selective mutism (SM), social phobia (SP), oppositionality, and parenting styles. Twenty-one children with SP, 21 children with SM and SP, and 21 normal children ages 7–15, and the mother of each child, participated in an assessment of psychopathological factors potentially related to SM. Children with SM did not endorse higher levels of social anxiety than did children with SP, although clinicians gave higher severity ratings to those who had both disorders. In addition, although a dimensional measure of oppositionality (Eyberg Child Behavior Inventory) did not reveal group differences, there were significantly more diagnoses of oppositional defiant disorder among children with SM (29%) in comparison to children with SP alone (5%). With respect to parenting styles, there were no significant differences among parents of children with SM and the other groups, except that children with SP reported significantly less warmth/acceptance from parents than normal children. These data replicate previous findings that children with SM do not report greater social anxiety than other children with a SP diagnosis. Furthermore, they suggest that oppositional behaviors may be part of the clinical presentation of a subset of children with SM. Depression and Anxiety 23:117–123, 2006. © 2006 Wiley-Liss, Inc.
Depression and Anxiety 12/2005; 23(3):117 - 123. · 4.18 Impact Factor
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ABSTRACT: Reactivity and habituation patterns were examined in the offspring of anxious and non-anxious parents. Although no differences emerged for magnitude of response to either fear-relevant visual or auditory stimuli, offspring of anxious parents displayed significantly more electrodermal activity during resting baseline and during the inter-trial intervals of these stimulus presentations. Differences also were observed for the number of children per group achieving habituation to the fear-relevant visual and auditory stimuli, where offspring of anxious parents were less likely to habituate to either stimuli. The same pattern of group differences emerged after excluding children diagnosed with an anxiety disorder, indicating that even offspring of anxious parents who did not have an anxiety disorder differ from offspring of normal controls with respect to their pattern of psychophysiological reactivity. It is hypothesized that these features might serve as an indication of anxiety proneness and risk for the development of anxiety disorders.
Behaviour Research and Therapy 11/2005; 43(10):1263-79. · 3.30 Impact Factor
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ABSTRACT: This study reports the results of a 3-year follow-up assessment of children and adolescents diagnosed with social anxiety disorder (social phobia) and treated with Social Effectiveness Therapy for Children (SET-C), a comprehensive behavioral treatment program combining social skills training, peer generalization, and individualized exposure. Among 32 children initially treated with the protocol, 29 completed the follow-up assessment and were evaluated with a multidimensional assessment strategy, including self-report, parental report, clinician ratings, and behavioral assessment. Results indicated that the majority of posttreatment gains were maintained at 3-year follow-up, and 72% of treated children continued to be free of a social phobia diagnosis 3 years later. These findings support the long-term efficacy of SET-C for children and adolescents suffering from social phobia.
Journal of Consulting and Clinical Psychology 09/2005; 73(4):721-5. · 4.85 Impact Factor
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ABSTRACT: To evaluate internal consistency and temporal stability trough test re-test reliability of the Portuguese version of the Social Phobia and Anxiety Inventory (SPAI) in a heterogeneous Brazilian sample.
After informed consent, the translated and adapted version of the SPAI Portuguese was tested and re-tested at a 14-day interval in a sample of 225 university students, both genders, from 4 different undergraduate courses. After double data entry, statistical analysis included Cronbach's alphas, Pearson and intra-class correlation coefficients.
The studied sample consisted of 213 students from 4 sub-samples: 95 law students, 31 social communication students, 54 civil engineering students and 33 dental medicine students. The mean age was 23 (+/-6) years and 110 (51.6%) were female. The Cronbach' alpha was 0.96, no difference for both genders. The differential (total) score of the SPAI Portuguese showed Pearson coefficient 0.83 (95% CI 0.78-0.87) and Intra-class coefficient 0.83 (95% CI 0.78-0.86). There was no statistical difference in Pearson coefficients between genders (p = 0.121) and the 4 sub-samples (p = 0.258).
The results do not ensure validity, however, the SPAI Portuguese version presented a good content homogeneity with satisfactory level of internal consistency. The temporal stability evaluated was substantial. The results showed that the Portuguese SPAI presents perfectly acceptable reliability for both genders and suggest that it can be used in Brazilian populations.
Revista Brasileira de Psiquiatria 07/2005; 27(2):124-30. · 1.20 Impact Factor
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ABSTRACT: Posttraumatic stress disorder(PTSD) is a severe and chronic mental disorder that is highly prevalent within Veterans Affairs (VA) Medical Centers. A severe psychiatric disorder, combat-related PTSD is typically accompanied by multiple comorbid psychiatric disorders, symptom chronicity, and extreme social maladjustment. Thus, PTSD is a complex psychiatric disorder resulting in considerable emotional distress and impaired social functioning and often constitutes a significant treatment challenge. Although a range of psychotherapeutic strategies for chronic PTSD have been advanced, behavioral treatments emphasizing various methods of exposure therapy have been the most carefully studied and show the most promise. However, chronic PTSD exposure alone does not appear to have a significant effect on the negative symptoms of PTSD (e.g., avoidance, interpersonal difficulties) or anger control. This may be because exposure is more focused on anxiety and fear reduction and does not address basic skill deficits, help reestablish impaired relationships, or teach anger control. Therefore, we developed a multicomponent treatment program to complement exposure by targeting those areas of the clinical syndrome (e.g., social skills) not found to be helped by exposure alone. This treatment program, trauma management therapy (TMT), has showed good preliminary results in an open trial. In this article, we describe the treatment program, including elements of education, individually administered exposure therapy, programmed practice (i.e., homework), and group-administered social and emotional skills training. The appendix includes a detailed description of how to implement the social and emotional skills training components on a session-by-session basis; the full TMT treatment manual is available on request.
Behavior Modification 02/2005; 29(1):39-69. · 1.70 Impact Factor
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ABSTRACT: In this study we examined the psychopathology and behavioral treatment of White and African American preadolescent children with social phobia. The comprehensive assessment strategy, including semistructured diagnostic interviews, clinician ratings of impairment, behavioral observations, parental ratings, and self-report inventories, did not reveal differences in symptomatic presentation between African American and White children. Whereas all children improved from pre- to posttreatment, there were no significant differences based on race. The results are discussed in terms of the applicability of models 0of social phobia and treatment outcome across these 2 ethnic groups.
Journal of Clinical Child & Adolescent Psychology 07/2004; 33(2):260-8. · 1.92 Impact Factor
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ABSTRACT: The lifetime prevalence of posttraumatic stress disorder (PTSD) is about 8%-14% in the general population, and trauma victimization (51%-98%) and PTSD (up to 42%) are even more prevalent among persons treated within public-sector mental health clinics. Despite this, individuals with PTSD and severe mental illness (SMI) who are treated within the public sector tend to receive inadequate mental health services. In addition, treatments for PTSD for this population remain undeveloped, with virtually no available empirical treatment outcome data to guide clinicians. We propose a model for a comprehensive, multicomponent cognitive-behavioral treatment program for this target population that includes elements of consumer education, anxiety management training, social skills training, exposure therapy, "homework" assignments, and long-term follow-up care. Special considerations for public-sector consumers with PTSD and SMI are addressed, as are directions for future research.
Journal of Psychiatric Practice 02/2004; 10(1):26-38. · 2.16 Impact Factor
