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Social Anxiety Disorder in Childhood and Adolescence: Current Status and Future Directions
Abstract
This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of "positive psychology" constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.
... Social anxiety disorder is described as a marked or intense fear or anxiety of social situations, often manifesting as extreme fear of negative evaluation by others in social settings and avoidance of social interaction (American Psychiatric Association, 2013;Maes et al., 2019;Miers et al., 2013). Comorbidity of social anxiety and other anxiety disorders, such as panic disorder and generalized anxiety disorder, is also high, as well as an increased risk of suicidal ideation and suicide attempts (Kashdan & Herbert, 2001;Maes et al., 2019;Miers et al., 2013). In addition, less than a third of individuals with social anxiety disorder seek treatment (Ruscio et al., 2008). ...
... Social anxiety has a profound impact on social participation and interaction, given the fear and avoidance of social situations and opportunities that social anxiety causes (Kashdan & Herbert, 2001;Maes et al., 2019;Miers et al., 2013). Social participation has been defined as taking part, participating, and engaging in, and doing activities and spending time with others. ...
... Consistent with the literature, the participants in this study reported difficulties in many areas of social participation, such as difficulties with large group interactions, small group and individual interactions, and interactions with new or unfamiliar people (Clarke & Fox, 2017;Kashdan & Herbert, 2001;Lipsitz & Schneier, 2000;Maes et al., 2019;Miers et al., 2013). The most frequently reported strategy to cope with social anxiety that was highlighted in the interviews was seeking out comfort from a peer or family member who is familiar to the participant ("comfort person"). ...
... After extracting a group of users that reported being in the correct age range of [13][14][15][16][17][18][19][20][21][22][23][24][25], we then proceeded to ensure the users reported having Social Anxiety Disorder. This was done in two ways: ...
... The copyright holder for this this version posted December 11, 2023 Table 3: Annotation results of reports of other comorbidities. The table contains the overall totals, the totals in each age group (Adolescents [13][14][15][16][17][18] and Young Adults [19][20][21][22][23][24][25]) and the totals when considering the certainty of a SAD diagnosis (user reports going to therapy or having a SAD diagnosis). Reports of Attention Deficit Disorder are clustered under Attention-deficit/hyperactivity disorder, and Asperger's under Autism Spectrum Disorder. ...
... Table 4: Annotation results of reports of use and abuse of drugs and/or alcohol. The table contains the overall totals for each revised label, the totals in each age group (Adolescents [13][14][15][16][17][18] and Young Adults [19][20][21][22][23][24][25]), and the totals when considering the certainty of a SAD diagnosis (user reports going to therapy or having a SAD diagnosis). ...
Background
Patients of certain diseases are less likely to approach the healthcare system but remain active in social media. Young Social Anxiety Disorder (SAD) patients, in particular, are a hard-to-reach population due to disease symptomatology, unmet need and age-related barriers, which makes obtaining first-hand access to patient perspectives challenging.
Objective
To create a curated cohort of patients from social media that report their age in the range of 13 to 25 years old and confirm having a SAD diagnosis or having received therapy for SAD, and to assess the value of the content posted by these users for observational studies of SAD.
Methods
We collected 535k posts by 118k Reddit users from the r/SocialAnxiety subreddit. We then developed precise regular expressions to extract age, diagnosis and therapy mentions. We manually annotated the full set of expressions extracted and double-annotated 5% of the age mentions and 10% of the diagnosis and therapy mentions. Using similar methodology, we identified mentions of comorbidities and substance use.
Results
Our validated cohort includes 37,073 posts by 1,102 users that meet the inclusion criteria. The age, diagnosis, and therapy mention detection had a precision of 68%, 31%, and 44%, respectively, with an inter-annotator agreement of 0.96, 0.96, and 0.78. Sixty-one percent of the users in the cohort report having one or more comorbidities on top of their SAD diagnosis (Fleiss’s Kappa=0.79) and 13% report a concerning use of drugs or alcohol (Fleiss’s Kappa=0.87). We compared the characteristics of our social media cohort to the published literature on SAD.
Conclusions
Patients with SAD post actively on Reddit and their perspectives can be captured and studied directly from these data. Extracting age, therapy, substance abuse and comorbidities (and potentially other patient data) can address realworld data source biases. Thus, social media is a valuable source to create cohorts of hard-to-reach patient populations that may not enter the healthcare system.
... Although this is less than the 41% (n = 51) reported in a previous sample of survivors of childhood and adolescent cancer, 13 this is more than double the lifetime prevalence of SAD (5%-13%) reported for the general AYA population. 15,16,[39][40][41] Additionally, five AYAs (19%) scored just below the cutoff for SAD, indicating that they may be at risk of developing clinically significant symptoms in the future. ...
... 15 Even among youth without a history of cancer, SAD remains one of the most underdiagnosed psychological disorders. 40 SAD symptoms are also likely to play into avoidance of help seeking as that requires meeting someone new, 39 as evidenced by the low rate of help seeking (20%) reported among 1621 individuals with SAD in an international study. 42 Consequently, it is possible that SAD symptoms may also impact AYAs' wider health behaviors, by increasing their anxiety sensitivity, or fear of anxiety-related symptoms. ...
Background
Childhood cancer survivors can face social difficulties on return to school after treatment. One such difficulty with significant consequences is bullying. This study aimed to describe the experiences of bullying among survivors of childhood cancer.
Methods
We recruited survivors aged 8–25 years, 1–10 years posttreatment and their parents. Participants completed a survey, and we conducted semistructured interviews about their experiences with bullying and other social experiences on return to school or work.
Results
A total of 73 survivors (52 children/adolescents and 21 young adults) and 61 parents (including 47 survivor-parent dyads) participated in a questionnaire. Nine survivors and 16 parents completed interviews. A large proportion of survivors experienced some form of bullying (44%) on survey, and one survivor and 7 parents reported experiencing some form of bullying during interview. There was low agreement between survivor self-reports and parent reports of bullying, with survivors more commonly reporting experiencing bullying. Bullying commonly included verbal teasing or social exclusion. Survivors and parents that reported bullying resulted from peer misunderstanding regarding survivors' physical or psychological differences or from survivors' poor social competence. Having proactive parents and close friendships were protective. Programs that increased peer understanding, facilitated friendships and directly targeted bullying reduced or prevented bullying of survivors.
Conclusions
A significant proportion of young survivors experienced bullying on return to school which was associated with poor social and emotional functioning. A coordinated approach between young survivors, their families, treating team and school, combined with opportunities for socialization and peer education, is needed to reduce bullying.
... Individuals with healthier selfesteem and emotional intelligence are found to manage social anxiety more e ciently. 36 Theme 5: social anxiety and di erences based on sex. Surprisingly, there are no signi cant di erences based on sex seen in social anxiety in Pakistan, China, and India as compared to the West. ...
... Having authoritarian parental constraints on a child's ability to make decisions encourages an overly dependent relationship with parents; impedes the growth of independence, selfhood, and ageappropriate mastery abilities; and sustains emotions of powerlessness and insecurity both inside and outside the home. 36 Additionally, in the current review, neglectful parenting is categorized as having a lack of empathy, care, and concern for a child's emotions and needs, a failure to spend time with a child, a lack of monitoring, and lax regulations. This leads to a diminished sense of control and acquired helplessness in the child, resulting in a lack of self-con dence, social hesitation, anxiety, and a detached demeanor in adolescents. ...
... Despite the growing body of research concerning the recognition of, evaluation of, and intervention with SAD, the disorder still seems to be neglected. Specifically, SAD presents one of the lowest rates of treatment seeking [16,17]. This may be associated with several factors: on the one hand, social anxiety seems to be underrecognized and elicit less concern and help-seeking recommendations by adolescents themselves [18]; additionally, social anxiety is perceived to be embarrassing to have, which in turn predicts (alongside other variables) how much others want to distance themselves from the socially anxious person [19]; finally (and paradoxically), experiencing SAD symptoms and being aware of the stigma associated with mental health in general has also been associated with less intention to seek help, particularly from peers and informal adults [20]. ...
... Because SAD is proposed to be more prevalent in females [49], we expect to replicate that finding in relation to adolescent SAD. Moreover, we expect to confirm previous indications that SAD presents one of the lowest rates of treatment seeking [16,17], but we are also interested in exploring the prevalence of who would be willing to receive treatment if offered, which has not been considered before. Finally, we are interested in exploring the intensity of different core social fears associated with SAD (i.e., observation, social interaction, and social performance). ...
Social fears arise when fearing to be judged in social events. When these fears are intense, persistent, and debilitating, the individual may suffer from social anxiety disorder (SAD), which has its most frequent onset during adolescence and tends to be chronic. Still, evidence on the prevalence of social fears and SAD in adolescence is scarce. This study analyzed the prevalence of social fears and of SAD in Portuguese adolescents. Of the initial sample (n = 1495), 26% presented with intense self-reported social fears. Of those, 53.9% accepted to be further assessed for diagnosis, resulting in a point-estimate prevalence of adolescent SAD of 9.4%; this is slightly higher than previously found. Social performance was the most feared social event. Of the adolescents with SAD, 12.9% were receiving psychological intervention, 12.1% refused intervention, and 92 (65.7%) accepted intervention. Findings confirm SAD as a highly prevalent mental disorder among adolescents, particularly girls, and additionally, that most of these adolescents did not seek treatment but are willing to receive help if made available. Hence, schools should be invested not only in identifying vulnerable adolescents but also in providing diverse intervention options, tailored to their needs, and directing them to successful developmental trajectories.
... Although social-evaluative fears typically increase during adolescence (Westenberg et al., 2004), clinically significant levels of social anxiety can emerge in early to middle childhood (Ollendick & Hirshfeld-Becker, 2002). Children with heightened levels of social anxiety demonstrate impairments engaging with their peer group, participating in extra-curricular activities, and may show refusal participating in classroom assessments (e.g., public speaking; Kashdan & Herbert, 2001). Further, social fears in childhood are likely to persist if left untreated and continue to pose functional impairments into adolescence and adulthood (Kashdan & Herbert, 2001). ...
... Children with heightened levels of social anxiety demonstrate impairments engaging with their peer group, participating in extra-curricular activities, and may show refusal participating in classroom assessments (e.g., public speaking; Kashdan & Herbert, 2001). Further, social fears in childhood are likely to persist if left untreated and continue to pose functional impairments into adolescence and adulthood (Kashdan & Herbert, 2001). It is, therefore, important to understand if FNE and FPE can be reliably assessed, differentiated, and examined in relation to social anxiety in samples of children. ...
Social anxiety is characterized by fear, nervousness, and avoidance in social situations and can emerge as early as childhood. Recent theoretical models have proposed a two-factor model of social-evaluative concerns in social anxiety, including fear of negative evaluation (FNE), as well as fear of positive evaluation (FPE). Previous work in adolescents and adults has provided empirical support for this two-factor structure of social-evaluative fear, but it remains unclear whether FNE and FPE are distinct constructs in childhood. We collected parent-report of FNE, FPE, and social anxiety in 119 children (M = 8.84 years, SD = 0.44) and self-report of FNE, FPE, and social anxiety in 609 adults (M = 18.93 years, SD = 2.03). Confirmatory factor analyses revealed a two-factor structure of FNE and FPE in children and adults. Further, tests of measurement invariance across the child and adult samples were supported, suggesting psychometric equivalence across parent- and self-report of the FNE and FPE questionnaires. Finally, both FNE and FPE were each uniquely, positively related to social anxiety in children and adults. These findings provide evidence that FNE and FPE are distinct constructs in children and adults linked to social anxiety and illustrate that a two-factor structure of social-evaluative fear may be evident as early as childhood which is comparable to adult samples.
... Although this is less than the 41% (n = 51) reported in a previous sample of survivors of childhood and adolescent cancer, 13 this is more than double the lifetime prevalence of SAD (5%-13%) reported for the general AYA population. 15,16,[39][40][41] Additionally, five AYAs (19%) scored just below the cutoff for SAD, indicating that they may be at risk of developing clinically significant symptoms in the future. ...
... 15 Even among youth without a history of cancer, SAD remains one of the most underdiagnosed psychological disorders. 40 SAD symptoms are also likely to play into avoidance of help seeking as that requires meeting someone new, 39 as evidenced by the low rate of help seeking (20%) reported among 1621 individuals with SAD in an international study. 42 Consequently, it is possible that SAD symptoms may also impact AYAs' wider health behaviors, by increasing their anxiety sensitivity, or fear of anxiety-related symptoms. ...
Purpose: Adolescent and young adult (AYA) cancer survivors may be at risk of developing symptoms of social anxiety disorder (SAD) due to disruptions in social participation and functioning following a cancer diagnosis. This study aimed to explore (1) the proportion of Australian AYA-aged survivors of childhood and adolescent cancer who experience symptoms of SAD, (2) how symptoms of SAD are described by survivors as affecting their daily social functioning. Methods: A mixed-methods cross-sectional design was employed, inviting survivors, aged 13-25 years, who had completed treatment between one and ten years ago. Survivors completed a paper-based questionnaire, containing validated measures of SAD, and an optional semistructured interview assessing current social functioning and social anxiety. Results: Twenty-seven survivors aged 13-25 years participated (M = 19.15, 51.9% male, and 7 years post-treatment). Nine (33%) participants reported clinically significant symptoms of SAD. In interviews, survivors reported worries about how others perceived them and fears around meeting new people. Survivors described that this impacted their daily social functioning, leading them to avoid, or endure with distress, feared social situations. Conclusion: This study shows that clinically significant social anxiety may be a concern for a subset of survivors of childhood/adolescent cancer. Identifying which young people are at risk of SAD after cancer and how best to support this vulnerable cohort is critical.
... Many more adolescents will experience distressing and functionally impairing symptoms of social anxiety but do not meet full diagnostic criteria for SAD; girls are at high risk for increases in subclinical social anxiety symptoms around ages 14-15 years (Ranta et al., 2007). Social anxiety is associated with academic underachievement, smaller social networks, increased risk for suicide and substance use, and high levels of loneliness, dysphoria, and generalized anxiety (Beidel et al., 1999;Ginsburg et al., 1998;Kashdan & Herbert, 2001). Though efficacious treatments for SAD exist (e.g., Scaini et al., 2016), not all youth respond to such treatments, and treatment gains may not be maintained long (Kerns et al., 2013). ...
Recent theories suggest that for youth highly sensitive to incentives, perceiving more social threat may contribute to social anxiety (SA) symptoms. In 129 girls (ages 11–13) oversampled for shy/fearful temperament, we thus examined how interactions between neural responses to social reward (vs. neutral) cues (measured during anticipation of peer feedback) and perceived social threat in daily peer interactions (measured using ecological momentary assessment) predict SA symptoms two years later. No significant interactions emerged when neural reward function was modeled as a latent factor. Secondary analyses showed that higher perceived social threat was associated with more severe SA symptoms two years later only for girls with higher basolateral amygdala (BLA) activation to social reward cues at baseline. Interaction effects were specific to BLA activation to social reward (not threat) cues, though a main effect of BLA activation to social threat (vs. neutral) cues on SA emerged. Unexpectedly, interactions between social threat and BLA activation to social reward cues also predicted generalized anxiety and depression symptoms two years later, suggesting possible transdiagnostic risk pathways. Perceiving high social threat may be particularly detrimental for youth highly sensitive to reward incentives, potentially due to mediating reward learning processes, though this remains to be tested.
... the Philippines; Lai et al., 2015). Albeit one of the most prevalent disorders of childhood and adolescence (Kessler et al., 2012), SAD paradoxically remains one of the least recognized, understudied, and undertreated pediatric disorders (Kashdan & Herbert, 2001). Prior literature has shown that socially anxious children and adolescents produce inferior mental imagery of themselves (Chapman et al., 2020) and their peer relationships (Pickering et al., 2020). ...
Background
Interpretation bias (IB), pre- and post-event rumination are related to adolescent social anxiety (SA). However, although postulated theoretically, the mediating role of pre- and post-event rumination between IB and SA has not been examined in adolescents. In addition, post-event rumination was found to differ in varying social situations (e.g., speech vs. interaction). Therefore, by establishing social tasks, the current research investigated whether: (i) pre- and post-event rumination mediated the association between IB and SA among adolescents, and (ii) this mediation was moderated by situational type.
Methods
In Study 1, 31 socially anxious adolescents and 37 controls were recruited and then primed with a speech task. In Study 2, 61 socially anxious adolescents were randomly assigned to a speech (n = 31) or interaction (n = 30) task. In both studies, baseline IB and SA, state pre-event rumination before starting the social task, post-event rumination and SA after social task were measured.
Results
IB affected adolescents’ SA via pre- and post-event rumination; however, the mediation effect was found only in the speech task.
Conclusions
Findings provide potential approaches for reducing adolescent SA by targeting IB and rumination and showed the situational adaptability of the cognitive model of social anxiety disorder among adolescents.
... It is, therefore, essential to identify and examine intra-and extra-individual characteristics that promote or inhibit early deviations, or maintain or disrupt early adaptation and development. Most etiologic hypotheses for SAD assume that biological and psychological sensitivity characteristics interact, and are exacerbated by a cycle of unfavorable thoughts, feelings, and avoidance actions (Kashdan & Herbert, 2001). In addition, according to the theory of conditioning, traumatic experiences may also play a role in developing SAD (Stemberger et al., 1995). ...
Background: Early childhood abuse is associated with adverse effects among young adults, especially social anxiety disorder (SAD). This study investigated socio-demographic correlates of SAD among youth exposed to childhood abuse and examined different regression models among male and female youth in three childhood abuse groups, i.e. emotional abuse (EA), physical abuse (PA,) and sexual abuse (SA). Methods: A total of 117,769 young adults from 63 colleges in Jilin Province, China, participated in this cross-sectional study (from October to November 2021). Childhood abuse and SAD were measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF) and the social anxiety subscale of the self-consciousness scale (SASS-CS). Analyses were conducted to examine the relationship between childhood abuse and SAD, as well as the demographic correlates of SAD among male and female youth exposed to three forms of childhood abuse. Results: First, significant and positive relations were found between different forms of childhood abuse (EA, PA, SA) and SAD (p < .001). Second, subjective socioeconomic status and relationship with father/mother were associated with SAD in three childhood abuse groups (p < .001). When dividing these participants by gender, apart from the above factors, male participants from single-parent families, living in rural areas and with a lower father’s educational level were associated with higher SAD (p < .05). In contrast, female participants from left-behind and reconstituted families were also associated with higher SAD (p < .05). Conclusions: Several demographic correlates are vital for developing prevention efforts and reducing the incidence of SAD among college students exposed to childhood abuse. Existing policies, programs, and practices should be strengthened and new evidence-based ones should be developed for the primary prevention of SAD among these youth.
... Anxiety disorders: Alcohol is used for self-management by individuals with generalized anxiety disorder, specific phobias and panic disorders [120,123], to alleviate direct or associated symptoms and to ameliorate suffering [124,125]. Social anxiety disorders/social phobia (SAD) is a prevalent anxiety disorder that manifests with intense anxiety and panic in social situations already at a young age [126]. It may present in a weaker form as an adolescent personality trait, but later develop into a psychiatric disorder. ...
Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.
... Parents are hypothesized to affect the potentiality of SP in their young by either (a) a genetic predisposition or (b) familial environments that are rejecting, emotionally distant, or overprotective and possessive (25,26) . In agreement with that, the current study demonstrated significant association between SP from one side and family history of social phobia and having a problem with fathers from the other side, particularly among intermediated school students. ...
... This is in contrast to previous research: Individuals with interaction anxiousness can fall into a strong fear of how others perceive them (especially fear of embarrassment, criticism, or rejection). Then, they will have no sense of security, treat others unkindly and assume that peers automatically reject them, along with a negative emotional reaction (48). In this anxiety state, the positive subjective experience and hedonic activities of individuals in the real world will be reduced, and the expression of positive emotions will be inhibited (49,50). ...
Adolescents who face social distress in real life are often accompanied by interaction anxiousness. To avoid direct social activities, they prefer to indulge in social networks to satisfy their psychological needs for interpersonal communication. Sina Weibo, China's leading social media platform, has a markedly young user base. It provides a rich sample of adolescents with interaction anxiousness and conditions for real-time monitoring. In this study, various word categories, such as perception of spatial distance and positional relationships, morality, and emotion, showed a significant relationship with interaction anxiousness. Furthermore, prediction models were established based on the original Weibo data of 839 active Sina Weibo users through a variety of machine learning algorithms to predict the scores of users' interaction anxiousness. The results showed that the performance of the prediction model established by the fully connected neural network was the best, and both criterion validity and split-half reliability were good (rcriterionvalidity = 0.30, rsplit − halfreliability = 0.76). This study confirms the validity of the prediction model of interaction anxiousness based on social media behavior data, provides a feasible solution to examine adolescents' interaction anxiousness, and provides a scientific basis for more targeted mental health interventions.
... The trajectories show a class 3 (green line) characterized by persistent (and decreasing) high levels; and class 2 (red line) characterized by persistent (and increasing and decreasing) moderate levels; and a class 1 (blue line) characterized by persistent (and increasing) low levels stressful situations (Wadsworth, 2015). Also following previous research, we found that the prevalence of social anxiety diagnoses increased over time (Kashdan & Herbert, 2001), especially from 10 to 13 years, which was supported by increasing total score over time. ...
Background: Patterns of development and underlying factors explaining anxiety
disorders in children and adolescents are under‐researched, despite their high
prevalence, impact and associations with other mental disorders. We aimed to a]
understand the pattern and persistence of specific anxiety disorders; b] examine
differing trajectories of symptoms of specific anxiety disorders and; c] examine
socio‐demographic and health‐related predictors of persistent anxiety disorder-specific
symptoms, across middle childhood to early adolescence.
Methods: The current study used data from 8122 participants in the Avon Longitudinal
Study of Parents and Children birth cohort. The Development and Wellbeing
Assessment questionnaire was administered to parents to capture child and
adolescent anxiety total scores and DAWBA‐derived diagnoses. Separation anxiety,
specific phobia, social anxiety, acute stress reaction, and generalized anxiety at 8, 10
and 13 years were selected. Further, we included the following socio‐demographic
and health‐related predictors: sex, birth weight, sleep difficulties at 3.5 years,
ethnicity, family adversity, maternal age at birth, maternal postnatal anxiety,
maternal postnatal depression, maternal bonding, maternal socio‐economic status
and maternal education.
Results: Different anxiety disorders presented different prevalence and patterns of
development over time. Further, latent class growth analyses yielded a trajectory
characterized by individuals with persistent high levels of anxiety across childhood
and adolescence; for specific phobia (high = 5.8%; moderate = 20.5%; low = 73.6%),
social anxiety (high = 3.4%; moderate = 12.1%; low = 84.5%), acute stress reaction
(high = 1.9%; low = 98.1%) and generalized anxiety (high = 5.4%; moderate
= 21.7%; low = 72.9%). Finally, the risk factors associated with each of the
persistent high levels of anxiety disorders were child sleeping difficulties and
postnatal maternal depression and anxiety.
Conclusions: Our findings show that a small group of children and young adolescents
continue to suffer from frequent and severe anxiety. When considering
treatment strategies for anxiety disorders in this group, children's sleep difficulties
and postnatal maternal depression and anxiety need to be assessed as these may
predict a more prolonged and severe course of illness.
... Social anxiety (SA) is one of the most prevalent yet neglected psychological problems faced by children (Kashdan and Herbert, 2001;Li et al., 2019). The prevalence rate of SA amongst Chinese rural LBC is 36.1%, ...
The issue of left-behind children has become a key focus in China. In this study, we investigate the mediating role of social support between social anxiety and the subjective quality of life among left-behind children in China (N = 379, Mage = 13.65). A total of 710 junior high school students were recruited using clustering random sampling from five middle schools in China and investigated using the Social Anxiety Scale for Children, Social Support Rating Scale for Adolescents, and Inventory of Subjective Life Quality. The results show that social anxiety is negatively associated with social support and subjective quality of life, and social support is positively correlated with subjective quality of life. In addition, social support partially mediates the relationship between social anxiety and subjective quality of life. In conclusion, these findings provide new insights to improve the subjective quality of life of left-behind children. The focus should be on alleviating social anxiety and increasing social support in order to help left-behind children improve their subjective quality of life.
... SAD is characterized by an intense fear of embarrassment, humiliation, and negative evaluation, and avoidance of social situations in which these might occur (e.g., public speaking) (Guha, 2014). Unlike many other anxiety and mood disorders, SAD's onset is at a relatively early age with diagnosis as early as age 8 and a mean age of onset of 15.5 years-old (Kashdan & Herbert, 2001). In children, SAD is associated with social isolation, academic impairment and truancy, and the development of comorbid depression and substance abuse (Beidel et al., 1999). ...
Social Anxiety Disorder is highly prevalent among children and leads to poor long-term outcomes if left untreated. Theoretical models of anxiety differ in whether children with Social Anxiety Disorder experience objective social skills deficits, negative self-interpretation biases, or some combination of the two. This pilot study evaluated evidence in support of the “deficit” and “bias” models. Approval was obtained from the ethics committee of a large private university in Cambridge, MA, USA, and data collection was completed in 2015. We recruited 68 parent-child dyads for a study in which anxious children (with Social Anxiety Disorder) and non-anxious children underwent a child-adapted version of the Trier Social Stress Test. Children were aged 8-14, 67.6% male, and self-identified as 54.4% White, 7.4% Black, 4.4% Latinx, 13.2% Asian, 14.7% multiethnic, and 5.9% “other” or no response. Performance ratings were obtained from children, their parents, and external observers. We found evidence of both specific social skills deficits and self-appraisal biases in anxious children. Anxious children struggled with signs of physical discomfort but not with actual speech content. Although children were generally able to accurately evaluate their social performance, older anxious children were most self-critical. Parents were similarly accurate in appraisals of their children’s social performance. Anxious children responded favorably to positive feedback with improved self-evaluations of performance and decreased anxiety. Findings suggest that a comprehensive “integrated” theoretical model of Social Anxiety Disorder should include both skills deficits and self-appraisal biases.
... In addition to social anxiety, deficient self-regulation, negative mood, and affective disorders (e.g. anxiety and panic, distress, depression), psychosocial difficulties such as isolation, intense shyness, and consistent preference for online social interactions have been frequently associated with problematic online gaming [51,[59][60][61][62][63][64][65][66][67], especially among young individuals. Indeed, young people have been found typically engaged in high sensation-seeking and risky behaviors [68,69] and they have been defined as a vulnerable population for problematic online gaming, with potential negative outcomes for their psychological, social, and physical health [61,70]. ...
Purpose of Review
The present study aimed to review the literature concerning the relationship between problematic online gaming (POG) and social anxiety, taking into account the variables implicated in this relationship. This review included studies published between 2010 and 2020 that were indexed in major databases with the following keywords: Internet gaming, disorder, addiction, problematic, social phobia, and social anxiety.
Recent Findings
In recent years, scientific interest in POG has grown dramatically. Within this prolific research field, difficulties associated with social anxiety have been increasingly explored in relation to POG. Indeed, evidence showed that individuals who experience social anxiety are more exposed to the risk of developing an excessive or addictive gaming behavior.
Summary
A total of 30 studies satisfied the initial inclusion criteria and were included in the present literature review. Several reviewed studies found a strong association between social anxiety and online gaming disorder. Furthermore, the relationships among social anxiety, POG, age, and psychosocial and comorbid factors were largely explored. Overall, the present review showed that socially anxious individuals might perceive online video games as safer social environments than face-to-face interactions, predisposing individuals to the POG. However, in a mutually reinforcing relationship, individuals with higher POG seem to show higher social anxiety. Therefore, despite online gaming might represent an activity able to alleviate psychopathological symptoms and/or negative emotional states, people might use online gaming to counterbalance distress or negative situations in everyday life, carrying out a maladaptive coping strategy.
... Numerous authors [5,[11][12][13][14] have suggested that poorer treatment response for young people with SAD is likely due to significant causal and maintaining factors specific to SAD remaining unaddressed in generic CBT programs. For example, maladaptive thoughts about the self being deficient or flawed, attention biases such as self-focused attention and hypervigilance towards social threat, anticipatory anxiety and post-event rumination, and poor social skills and social competence that limit social success, appear to be important factors associated with the onset and maintenance of SAD [5,15,16], yet these are not addressed in generic CBT programs. ...
This study examined the preliminary acceptability and efficacy of an intensive, group-based, disorder-specific cognitive behavioural therapy (CBT) intervention for adolescents with social anxiety disorder (SAD). Fourteen Australian adolescents with SAD (78.6% female, M age = 13.93 years) and their parents completed the program plus measures of treatment satisfaction, and provided feedback. Clinical interviews and surveys were administered pre-treatment, post-treatment, and at 6-month follow-up to determine diagnostic status and assess related variables. Post-treatment satisfaction scores were very high for adolescents and parents. Post-treatment, 32.3% of participants no longer met criteria for SAD diagnosis, increasing to 42.9% at follow-up. Participants showed sizeable reductions in comorbid diagnoses, significant improvements in global functioning, social anxiety symptoms, and internalising symptoms from pre- to post-treatment (maintained at follow-up), and significant improvements in social skills and social competence from pre-treatment to follow-up. This study supports the use of an intensive CBT program for adolescents with SAD.
... PHQ-9: The PHQ is a self-administered version of the Primary Care Evaluation of Mental Disorder (PRIME-MD), developed in the mid-1990s by Spitzer et al. for Pfizer Inc, to detect 5 disorders: depression, anxiety, somatoform, alcohol and eating disorder with many versions. 15,16,17 The PHQ-9 is the depression scale from PHQ. It was modified for teens by the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) team. ...
DISCLOSURE All the authors declare no conflict of interest, finance or otherwise. ABSTRACT Background: Depressive disorders are the leading causes of ill-health and disability globally. Depression among adolescents is usually associated with a range of adverse later outcomes which include suicidality, and general poor physical and mental health. Objective: To determine and compare the prevalence of depressive disorders among in-school adolescents in urban and rural areas of Anambra State. Methodology: This was a cross-sectional analytical study of urban and rural in-school adolescents in Anambra State, Nigeria. A total of 1187 secondary school adolescents in government-owned schools in Anambra State was selected using multi-stage sampling technique. Patient Health Questionnaire-9 (PHQ-9) was the study instrument. Results: The mean age of the participants was 15±2 years. The overall prevalence of depression was 12.5%. The proportion of urban participants identified with depression was significantly higher than that of their rural counterparts (14.5% versus 9.6%). Multiple regression showed that increased odds of developing depression are associated with urban setting (p = 0.001), female gender (p=0.018), and late adolescence (p=0.025). Conclusion: This study showed that depressive disorders are prevalent among in-school adolescents in Anambra State, with some of the associated factors being urban setting, female gender and late adolescence. There is need for multi-sectoral intervention programs to address these identified factors.
... For example, children who have experienced frequent PV at age 13 are around three times more likely to receive a diagnosis of social anxiety disorder at age 18 (Stapinski et al., 2014), and retrospective reports of PV may have a stronger association with social anxiety in adulthood than with other forms of anxiety (McCabe et al., 2003). If untreated, social anxiety can be disruptive to children's daily functioning (Kashdan & Herbert, 2001) and increase risk of depression and suicide attempts (Stein et al., 2001). While it is clear that PV and social anxiety have serious and far-reaching consequences and a well-established association, it is less clear how this relationship develops. ...
Peer victimization has been associated with negative mental health outcomes in school-aged children, including social anxiety. It remains less clear how peer victimization influences children’s thinking about social situations and how parenting behavior may contribute to this relationship. The present study examined these questions in a sample of 178 fourth and fifth graders, who completed measures of peer victimization and maternal overcontrol at baseline and measures of social threat cognitions and social anxiety at baseline and one year later. Results indicated strong concurrent and longitudinal associations between peer victimization and social threat cognitions. Maternal overcontrol was found to moderate these relationships, such that peer victimization was associated with social threat cognitions at baseline and one year later only in students reporting high overcontrol. Social threat cognitions also mediated the relationship between peer victimization at baseline and social anxiety one year later, and this indirect effect was moderated by overcontrol. Findings may suggest that clinicians working with victimized students should identify and address negative perceptions of social situations and the role their parents may play in limiting their access to interactions with peers.
... B. durch Lehrkräfte) nicht hinreichend wahrgenommen werden können. Da sich Ängstlichkeit in der Regel nicht nur auf den behavioralen oder physiologischen, sondern primär auf den affektiven und kognitiven Ebenen ausdrückt und diese aus einer externen Perspektive nur bedingt wahrnehmbar sind, scheinen Kinder selbst die zuverlässigste Informationsquelle zur Diagnose sozialer Unsicherheit darzustellen (Essau, 2003;Fonseca & Perrin, 2011;Kashdan & Herbert, 2001). ...
Zusammenfassung. Soziale Unsicherheit bei Kindern zeichnet sich durch ein subjektives Unwohlsein in sozialen Situationen und die Sorge vor einer negativen Bewertung durch andere aus. Falls möglich, werden soziale Situationen vermieden oder auf ein Minimum beschränkt. Aufgrund der Unzuverlässigkeit von Fremdurteilen durch Erziehungsberechtigte oder Lehrkräfte haben Selbstbeurteilungsfragebögen in der Diagnostik von sozialer Unsicherheit einen besonderen Stellenwert. Die Social Anxiety Scale for Children (SASC-R-D; Melfsen & Florin, 1997 ) ist hierbei ein häufig eingesetztes Instrument, deren Validität bisher aber unzureichend untersucht wurde. Die vorliegende Studie untersucht daher anhand von Daten von 997 Kindern die Konstrukt- und Kriteriumsvalidität sowie Messinvarianz über das Geschlecht der Skala. Die Ergebnisse legen nah, dass es sich um ein valides Instrument handelt, wobei die differenzielle Nützlichkeit der einzelnen Subskalen fragwürdig bleibt. Die Ergebnisse und ihre Implikationen für die praktische Verwendung des Fragebogens werden diskutiert.
... Social anxiety disorder is amongst the most prevalent adolescent mental health disorders (Beesdo, Knappe, & Pine, 2009). Although social anxiety predicts subsequent problems (Burstein et al., 2011;de Lijster et al., 2018), it is often unrecognized, possibly due to comorbidity with other anxiety disorders such as generalized anxiety (Kashdan & Herbert, 2001). Despite their comorbidity, there is evidence showing that social anxiety and generalized anxiety are distinguishable and may predict differential outcomes (Pine, 2007). ...
Background
Social anxiety is amongst the most prevalent adolescent mental health problems; however, it is often unrecognized due to its comorbidity with other anxiety problems such as generalized anxiety. Thus, understanding the unique developmental pathways to social anxiety is critical for improving its prevention. We examined the pathway from maternal shyness, when children were 4 years old, to adolescents’ social anxiety at age 15 through social wariness at age 7. We hypothesized that childhood social wariness would mediate the association between maternal shyness and social anxiety in adolescence.
Methods
Participants (N = 291; 54% female) were followed from early childhood to adolescence. Mothers reported on their own shyness when children were 4 years old. Social wariness toward unfamiliar peers was observed in the laboratory at ages 4 and 7. Adolescent social anxiety and generalized anxiety were assessed via self‐report, parent‐report, and clinical diagnoses at age 15.
Results
Maternal shyness was positively associated with adolescent social anxiety but not generalized anxiety at age 15. Higher levels of maternal shyness at age 4 predicted greater social wariness at age 7, which in turn predicted greater social anxiety but not generalized anxiety at age 15. Social wariness at age 7 partially mediated the association between maternal shyness and adolescent social anxiety.
Conclusions
This study identifies a unique developmental pathway from maternal shyness to adolescent social anxiety. Findings suggest that childhood social wariness connects maternal shyness to adolescent social anxiety.
... Furthermore, a recent study at the genetic level with the help of neuro-imaging results the importance of Dopamine D2 receptor and Dopamine Transporter (DAT) implying that the social phobia and other anxiety defects may share common genetic components. [12], [13]. ...
Phobias are considered to be psychiatric disorders, also termed as fear or anxiety disorder which is associated with genes and could be inherited to the next generation. Among it, Social phobia is the anxiety disorder which shows similar symptoms with extreme anxiety in the social gathering. Numerous genetic epidemiologists' theories have been comprehended in the literature to define the molecular basis of the reason responsible for the phobia. However, based on the occurrence of stimulus, a phobia can be categorized into two types, i.e. Simple phobia and Social phobia. The current review discusses the different studies related to phobia.
... PHQ-9: The PHQ is a self-administered version of the Primary Care Evaluation of Mental Disorder (PRIME-MD), developed in the mid-1990s by Spitzer et al. for Pfizer Inc, to detect 5 disorders: depression, anxiety, somatoform, alcohol and eating disorder with many versions. 15,16,17 The PHQ-9 is the depression scale from PHQ. It was modified for teens by the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) team. ...
ABSTRACT Background: Depressive disorders are the leading causes of ill-health and disability globally. Depression among adolescents is usually associated with a range of adverse later outcomes which include suicidality, and general poor physical and mental health. Objective: To determine and compare the prevalence of depressive disorders among in-school adolescents in urban and rural areas of Anambra State. Methodology: This was a cross-sectional analytical study of urban and rural in-school adolescents in Anambra State, Nigeria. A total of 1187 secondary school adolescents in government-owned schools in Anambra State was selected using multi-stage sampling technique. Patient Health Questionnaire-9 (PHQ-9) was the study instrument. Results: The mean age of the participants was 15±2 years. The overall prevalence of depression was 12.5%. The proportion of urban participants identified with depression was significantly higher than that of their rural counterparts (14.5% versus 9.6%). Multiple regression showed that increased odds of developing depression are associated with urban setting (p = 0.001), female gender (p=0.018), and late adolescence (p=0.025). Conclusion: This study showed that depressive disorders are prevalent among in-school adolescents in Anambra State, with some of the associated factors being urban setting, female gender and late adolescence. There is need for multi-sectoral intervention programs to address these identified factors.
... PHQ-9: The PHQ is a self-administered version of the Primary Care Evaluation of Mental Disorder (PRIME-MD), developed in the mid-1990s by Spitzer et al. for Pfizer Inc, to detect 5 disorders: depression, anxiety, somatoform, alcohol and eating disorder with many versions. 15,16,17 The PHQ-9 is the depression scale from PHQ. It was modified for teens by the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) team. ...
Background: Depressive disorders are the leading causes of illhealth and disability globally. Depression among adolescents is
usually associated with a range of adverse later outcomes which
include suicidality, and general poor physical and mental health.
Objective: To determine and compare the prevalence of depressive
disorders among in-school adolescents in urban and rural areas of
Anambra State.
Methodology: This was a cross-sectional analytical study of urban
and rural in-school adolescents in Anambra State, Nigeria. A total
of 1187 secondary school adolescents in government-owned schools
in Anambra State was selected using multi-stage sampling
technique. Patient Health Questionnaire-9 (PHQ-9) was the study
instrument.
Results: The mean age of the participants was 15±2 years. The
overall prevalence of depression was 12.5%. The proportion of
urban participants identified with depression was significantly
higher than that of their rural counterparts (14.5% versus 9.6%).
Multiple regression showed that increased odds of developing
depression are associated with urban setting (p = 0.001), female
gender (p=0.018), and late adolescence (p=0.025).
Conclusion: This study showed that depressive disorders are
prevalent among in-school adolescents in Anambra State, with
some of the associated factors being urban setting, female gender
and late adolescence. There is need for multi-sectoral intervention
programs to address these identified factors.
... SAD affects mostly adolescents, although it can also begin in early childhood, so we focus on children at a young age in our research. Undiagnosed and untreated SAD can lead to isolation, depression and even suicides [7]. VR can be explained as an electronic system that produces an artificially generated 3D made-up environment [8]. ...
... Social anxiety disorder (SAD) is defined by an intense and distressing fear and avoidance of social situations with unfamiliar individuals, particularly those situations that provide the perceived opportunity to be scrutinized (American Psychiatric Association [APA], 2013). SAD is one of the most prevalent disorders among adolescents (Kashdan and Herbert 2001), and the 12-month prevalence rate of social anxiety among adolescents is comparable to rates seen among adults (Kessler et al. 2012;Ruscio et al. 2008). In fact, SAD's median age of onset is approximately 13 years and the prevalence of this disorder increases considerably during adolescence (Bandelow and Michaelis 2015;Kessler et al. 2005). ...
Adolescents who experience social anxiety often display distressing fears that unfamiliar individuals evaluate their performance in social settings. These fears typically manifest as fears of negative evaluation (FNE) and/or fears of positive evaluation (FPE). Two well-established survey measures were originally developed to assess these evaluative fears in adults (Brief Fear of Negative Evaluation Scale [BFNE]; Fear of Positive Evaluation Scale [FPES]), and recent work supports their psychometric properties when administered to adolescents and their parents. Yet, do these reports relate to how adolescents behave within anxiety-provoking social interactions germane to their clinical presentations, namely their interactions with unfamiliar peers? We tested this question in a mixed clinical/community sample of 105 adolescents and their parents. Both adolescents and parents completed reports about adolescents’ fears on the BFNE and FPES. Further, trained independent observers rated adolescents’ social anxiety and social skills during the Unfamiliar Peer Paradigm, a set of tasks designed to estimate how adolescents react to social interactions with unfamiliar peers. At the bivariate level, adolescents’ BFNE and FPES reports related to observed social anxiety and social skills, whereas parents’ FPES reports related to observed social anxiety. Further, both informants’ FPES reports demonstrated incremental validity in relation to observed social anxiety, relative to the other informant. Compared to their BFNE reports, adolescents’ FPES reports displayed incremental validity in relation to observed social skills; the reverse was not true for adolescents’ BFNE reports. These findings have important implications for screening and treatment planning assessments when delivering services to adolescents experiencing social anxiety.
... 1 In this case, where keeping away from or avoidance of social environments, the individual shows the avoidance behavior because he/ she thinks that he/she will be rejected by others. 2 Social evaluation anxiety is also a component of social anxiety; self-assertion theoricians argue that the expectation of interpersonal evaluation reveals social anxiety. 3,4 Socially anxious individuals have doubts about their interpersonal competence and ability to create positive impressions. 5 Researches have shown that although social anxiety is a common disorder, the age of onset becomes clear with adolescence. ...
Objectives:This study was conducted semi-experimentally to examine the effect of psychodrama on the level of social anxiety and empathy.Materials and Methods:The sample of the study consisted of nine volunteer students aged 13-17. The study took place between 05 March 2002 and April 2018. Psychodrama sessions consisted of 10 sessions in total, 2 days a week. Empathic Tendency Adolescent scale and Social Anxiety scale were used as data collection tools in the study.Results:When the total scores obtained from the Social Anxiety scale were examined, a statistically significant difference was found before and after psychodrama (p=0.029). When the total scores obtained from the Empathic Tendency scale were analysed, no statistically significant difference was found. However, after psychodrama, there was an increase in the average score of the Empathic Tendency scale.Conclusion:Psychodrama is an effective method for reducing social anxiety and developing empathic skills in adolescents.
... This means that discriminating between normal and clinical levels of social anxiety during adolescence may be difficult. Moreover, the nature of the core symptoms means that adolescents who develop clinical levels of social anxiety do not easily come to clinical attention (Kashdan and Herbert 2001). ...
Background
Social anxiety is negatively related to peer communication quality during adolescence, with detrimental consequences for social functioning. However, the research about the factors that may moderate this relationship is still limited, and no studies have yet explored the possible interaction role of empathy systems.Objective
The study investigated the effects of social anxiety and empathy dimensions on peer communication quality in adolescent boys and girls. A three-way interaction between social avoidance, empathic concern and perspective taking was hypothesized.Method
Participants were 372 Italian adolescents (Mage = 16.4; SDage = 1.56; age range 15–20; 189 boys and 183 girls). Self-report questionnaires administered at school assessed: fear of negative evaluations, general social avoidance, avoidance of new social situations, empathic concern, perspective taking and peer communication quality.ResultsFor girls, empathic concern and general social avoidance were significantly related to peer communication quality. Conversely for boys, we found significant associations for perspective taking, general social avoidance and avoidance of new situations, and a three-way interaction involving general social avoidance, empathic concern and perspective taking. In presence of low perspective taking and high empathic concern, social avoidance was negatively related to peer communication quality in boys. Conversely, for high levels of perspective taking and high versus low empathic concern, the same relationship was not significant.ConclusionsA specific dysfunctional pattern of empathy—low perspective taking and high empathic concern—significantly enhanced the negative relationship between social avoidance and peer communication quality in boys, suggesting that these adolescents are at risk in social functioning.
... First, the number of symptoms allows for dimensional assessment of SAD, which is in line with DSM-5 recommendation (American Psychiatric Association, 2013). Second, because our sample was a community sample and a diagnosis was not expected in more than 8% of the sample at this age (Kashdan & Herbert, 2001), we obtained more power for our analyses by assessing the disorder as a continuous variable. ...
Background
Self‐conscious emotional reactivity and its physiological marker – blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self‐conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood.
Methods
One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years.
Results
Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety.
Conclusions
That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self‐conscious emotional reactivity (i.e. blushing) in early childhood.
... Third, the current study only focused on a small age range. It is known that levels of social anxiety vary for different age groups (Grant et al., 2005) and that symptoms of social anxiety tend to increase during adolescence (Kashdan & Herbert, 2001). Therefore, for future research it is important to include children and adolescents from a broader age range. ...
The current study aimed to investigate the discrepancy between self‐reported and peer‐reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi‐informant measures when studying the relation between social anxiety and social functioning in children.
Social anxiety disorder (SAD) is characterised by an intense fear about negative appraisal in social situations and is globally impairing for many individuals. The disorder is maintained by unique and deeply interconnected mechanisms, yet responds well to cognitive-behavioural therapy (CBT) programs specifically designed to address these mechanisms. In efforts to increase treatment access, participant retention, and speed of remission, intensive treatment programs have been investigated. This chapter reviews these programs and includes a case study of the only intensive treatment protocol for adolescents to date. In doing so, aspects of treatment that seem to work well, and not so well, are discussed. There is considerable variability amongst intensive programs in program content and delivery, and the literature is limited by a lack of studies in youth and randomised-controlled trials. Though some of the potential benefits mentioned above are not supported by evidence, other encouraging findings do emerge; intensive programs seem to be as effective as standard delivery formats in alleviating symptoms, intensive programs are appealing to busy families and may increase access, and they offer unique advantages regarding key treatment processes (habituation) and components (exposure). Recommendations are made for practitioners and researchers regarding treatment and areas of future investigation.
Purpose: Social anxiety disorder (SAD) remains an understudied potential link between the cancer experience and adolescent and young adult (AYA) cancer survivors' poor psychosocial outcomes. We investigated the frequency and duration of, as well as factors associated with, symptoms of SAD among AYAs with cancer. Methods: This longitudinal, mixed-methods study involved online surveys (including a validated screening tool for SAD) at recruitment and 6 months later, and a structured clinical interview. Results: Twenty-eight AYAs (aged 12-30 years, <1-year postdiagnosis, 50% male) completed the first survey (M = 6 months postdiagnosis). About 32% reported clinically significant SAD symptoms. Fourteen completed the follow-up survey (M = 12 months postdiagnosis), of which 9 (62%) reported persistent or worse symptoms of SAD significantly associated with emotional distress, physical appearance concerns, negative social cognitions, and depression. Conclusion: A subset of AYAs with cancer may experience clinically significant SAD symptoms that can affect their psychosocial well-being. Further work on how to best identify and support AYAs with SAD is needed.
El objetivo de esta investigación fue analizar la ansiedad social en la población y determinar su impacto en la vida diaria. Se realizó un estudio transversal utilizando un cuestionario para evaluar la frecuencia y la intensidad de los síntomas de ansiedad social en diversas situaciones sociales. La muestra fue de 100 personas de entre 18 y 50 años, de ambos géneros y de diferentes niveles socioeconómicos. Los resultados indican que un alto porcentaje de personas experimenta ansiedad social en diversas situaciones cotidianas. En particular, hablar en público y hacer presentaciones son situaciones que generan un alto nivel de ansiedad en las personas encuestadas. Asimismo, se encontró que la ansiedad social afecta negativamente la capacidad de las personas para manejar situaciones sociales estresantes, y que muchos encuestados han evitado situaciones sociales por miedo o ansiedad. La ansiedad social es un problema importante que afecta a muchas personas en su vida diaria, limitando su capacidad para interactuar con los demás y desarrollarse en su trabajo y en su vida personal. Esta investigación destaca la importancia de identificar y tratar la ansiedad social, y sugiere que se necesitan más programas de prevención y tratamiento para abordar este problema.
The present study sought to examine the underlying mechanisms through which overprotective parenting relates to social anxiety symptoms in adolescents. Specifically, we tested whether the adolescents’ emotion regulation strategies of dysregulation, suppression, and integration, played an intervening role in the association between perceived maternal and paternal overprotection and social anxiety symptoms in adolescents. A sample of 278 Swiss adolescents filled out questionnaires assessing perceived overprotective parenting, social anxiety symptoms and emotion regulation. Results indicated that perceived overprotective parenting was significantly associated with adolescents’ social anxiety symptoms. Furthermore, structural equation modeling analyses indicated that emotional dysregulation, in particular, intervenes in the association between both maternal and paternal overprotection and social anxiety. These findings highlight emotion regulation difficulties as a potential mechanism underlying the association between parental overprotection and social anxiety, suggesting that adolescents’ maladaptive emotion regulation strategies as well as overprotecting parenting could be targeted when treating social anxiety symptoms.
Over the past 20 years ambulatory assessment (AA) became an important component of the methodological repertoire in clinical psychological research of childhood and adolescence. AA allows to repeatedly assess behaviors and subjective experiences in the everyday lives of children, adolescents and their families. The popularity of the method stems from the fact that AA captures (dys)functional behavioral and experiential patterns along with corresponding triggers analogous to clinical theory. In other words, context-dependent dynamic processes within a child or adolescent can be empirically tested, such as when and under which circumstances specific symptoms are expressed in daily family or school life. That way, AA contributes to increased generalizability of the acquired data to typical behavioral spectra of the participants. This article illustrates how AA can contribute to more accurate and more truthful descriptive models of mental disorders in childhood and adolescence and how AA may aid empirical tests of clinical theories in psychotherapeutic research and practice. The article concludes with a discussion of the potential utility of AA for individualized interventions in the everyday lives of affected children, adolescents, and their families.
Over the past 20 years, ambulatory assessment (AA) has become an important part of the methodological repertoire of clinical psychological research. AA allows to repeatedly assess behaviors and subjective experiences in peoples’ everyday lives. The popularity of the method stems from the fact that AA facilitates modeling (dys)functional behavioral patterns consistent with clinical theory as an ensemble of contextualized dynamic within-person processes, such as under what circumstances and how relevant socio-affective responses may become disrupted or how specific symptoms are expressed in daily life. Because data collected via AA closely mirrors peoples’ typical behavioral spectra, data collected via AA are characterized by increased generalizability. In this paper, we illustrate how AA can contribute to more accurate and ecologically valid descriptive models of developmental psychopathology. With this in mind, we describe the utility of AA for empirically tests of clinically established etiological and maintenance models of developmental psychopathology and conclude with a discussion of the potential utility of AA for individualized interventions in the everyday lives of affected children, adolescents, and their families.
Although the mean age of onset of social anxiety disorder (SAD) is during adolescence, we know relatively little about the neurodevelopmental correlates of subsyndromal social anxiety in early adolescence before SAD manifests. Here we examined frontal EEG alpha/delta ratio (a putative proxy of brain maturation) in relation social anxiety symptoms across early adolescence. Resting regional EEG spectral power measures were collected continuously for 4 min (2 min eyes-open, 2 min eyes-closed) in slow (i.e., delta) and fast (i.e., alpha) frequencies at Time 1, and self-reported social anxiety measures were collected concurrently at Time 1 and then prospectively approximately one year later (Time 2) in 103 typically developing 12- to 14-year-olds (46.6% female, Mage = 12.91 years, SDage = 0.81 years). Using a latent class growth curve analysis, stable high and stable low social anxiety classes were derived from the two assessments. Controlling for children's age, sex, and pubertal development, we found that youth in the stable high social anxiety class were more likely to exhibit a relatively lower frontal alpha/delta ratio, reflecting ostensibly less brain maturation relative to youth in the stable low social anxiety class. Results were specific to social anxiety and did not extend to symptoms of generalized anxiety. Findings are discussed in terms of the putative functions of less brain maturation in understanding individual differences in complex human social behavior.
Kecemasan sosial adalah perasaan dan pengalaman kognitif yang muncul karena adanya persepsi bahwa seorangindividu dievaluasi negatif oleh orang lain. Persepsi tersebut membuat individu menjadi sensitif terhadap kritik orang lain dan juga sering mengkritik diri secara negatif saat mengalami kegagalan. Perilaku evaluasi diri negatif dan mengkritik diri sendiri juga merupakan ciri self-compassion yang rendah. Self-compassion adalah keadaan menerima kegagalan dengan tetap memperlakukan diri sendiri dengan baik, memahami diri sendiri dengan tidak memberikan penilaian negatif pada ketidaksempurnaan diri, dan memandang pengalaman negatif yang dialami sebagai pengalaman yang umum terjadi. Penelitian ini dilakukan mengingat belum terdapat penelitian yang menghubungkan kecemasan sosial dengan self-compassion, khususnya pada anak sekolah dasar (8-12 tahun), dimana kecemasan sosial sudah dapat ditetapkan diagnosisnya pada usia tersebut. Pemilihan responden menggunakan metode cluster random sampling, dengan karakteristiknya adalah anak usia 8-12 tahun di Kota Bandung, jumlah responden 403 orang (laki-laki= 41,9%, perempuan= 58,15%). Alat ukur yang digunakan adalah Self-compassion Scale (SCS) dan Liebowitz Social Anxiety Scale for Children (LSAS-C). Hasil uji reliabilitas untuk LSAS-C, adalah 0,911 dan SCS adalah 0,871. Analisis statistika korelasi dilakukan dengan menggunakan korelasi Pearson. Hasil dari uji korelasi menunjukkan adanya korelasi negatif antara self-compassion dan kecemasan sosial (r= -0,025). Semakin rendah self-compassion maka semakin tinggi kecemasan sosial.
Anxious reactions can range from mild to severe. Anxiety disorders occur when anxiety becomes so severe that it interrupts and/or disrupts the child's ability to function. This chapter gives an overview of anxiety in children and adolescents, focusing on normal development, epidemiology, theories of etiology, and the types of anxiety disorders that children and adolescents present when seen in pediatric primary care. It is challenging for advanced practice registered nurses (APRNs) to differentiate anxiety that is a normal part of development from that which has the potential to disrupt functioning. Comorbid conditions and evidence‐based assessments and interventions are presented, along with the role differentiation between APRNs focused on psychiatric treatment versus those focused on primary care management. Implications for advanced nursing practice, education, and research are discussed.
The study was conducted to determine the process of social anxiety among male high school students with prescribed internalized shame. In order to carry out the purposes of research, the study set a model that supposes that perfectionistic self-presentation is a mediator between internalized shame and social anxiety. A total of 382 high school students participated in the study. The results of the study are as follows: First, the results of this study showed that the internalized shame and social anxiety appear to have a significant static correlation. In particular, the sense of inadequacy, which is a subordinate concept of the internalized shame, was correlated with social anxiety. Second, perfectionistic self-presentation showed a partially mediated relationship between internalized shame and perfectionistic self-presentation. These results should be studied not only in cognitive factors contributing to social anxiety but also in the individual inner workings of psychological factors.
Terrorism is one of the biggest challenges of the world and it is difficult to specify its reasons and impacts. It is a fear inducer among masses, and victimize people physically (directly) and psychologically (indirectly). Pakistan is one of those countries of the world in which such cruel acts i.e. suicide blasts, target killing and serial bombings, happen repeatedly. Experts believed that in such circumstances people might have high death anxiety, and social interaction anxiety. Presented study was aimed to explore these variables during the time of threat. Study was completed in two phases, Phase I was the time when institutions were under the threat of terrorist attack and phase II was when they come out of high alerts (A-B design).
The life plans of young people are an important factor affecting the future socio-economic development of our country. In this regard, a study of the prevalence of migration moods as one of the forms of realization of personal life plans of representatives of the younger generation is particularly relevant, since the results of a number of sociological studies tend to increase this kind of moods at the present time. The purpose of this article lies in studying the main factors that influence the choice of life strategies of the three main groups of young people (high school students, students, and representatives of working youth). The empirical basis of the study was formed by a questionnaire survey of students concerning the identification of the level of concern about the future of Russia and ways to overcome this concern by choosing future life trajectories. The IBM SPSS Statistics 23 program was used to process the received data. The study has found that most representatives of all youth groups are concerned about the future of Russia. However, the respondents who consider themselves competitive are more concerned about the future of the country than those who have a low estimate of their competitive potential. At the same time, with age, there was a decrease in the proportion of young people who are characterized by the manifestation of opposition moods. About a third of the respondents from various youth groups consider moving to another country as an option to overcome their concerns about their future. The predominant motivation of respondents who show emigration moods is to improve their living conditions, while the focus on education and professional self-realization are secondary factors. As a result of the study, it was noted that the desire to move to another country decreases with increasing the age of respondents and a high assessment of personal competitive potential. The results obtained could be useful for researchers who study youth issues, for the representatives of executive and legislative bodies of state power, for the authorities involved in the development of youth policy, as well as for the representatives of interested public associations and organizations.
The validity of the social phobia subtype distinction was examined in a large sample of carefully diagnosed social phobics (N=89). Generalized and specific subtypes were diagnosed reliably, and the generalized subtype showed a consistent pattern of greater symptom severity than dit the specific subtype. In addition, generalized social phobics with and without avoidant personality disorder were compared, and a difference was found for only 1 of 4 parameters. The results are discussed in terms of the validity of subtyping in social phobia and the diagnostic boundary between social phobia and avoidant personality disorder
Using outpatients with anxiety and mood disorders (N = 350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression); Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders.
The Social Phobia and Anxiety Inventory for Children (SPAI–C) has shown initial promise to assess childhood social fears. In this study, convergent validity was determined by comparing scores on the SPAI–C to daily diary ratings of social distress. Social phobic children scored significantly higher on the SPAI–C, reported more distressing events, and rated these events as more distressful when compared with normal peers. A positive relationship was found between SPAI–C scores and daily diary ratings. Discriminative validity was determined by comparing SPAI–C scores of social phobic children with normal controls and children with externalizing disorders. The SPAI–C successfully differentiated children with social phobia from those with externalizing disorders or no disorder. Finally, internal consistency and factor analytic outcome data are presented. Results are discussed in terms of the SPAI–C's usefulness as a clinical and research tool.
Examined the factor structure, internal reliabilities, and concurrent validity of a revised form of the Social Anxiety Scale for Children (SASC-R) with fourth through sixth graders (N = 587). Factor analysis on a subsample (n = 459) yielded three factors: Fear of Negative Evaluation From Peers, Social Avoidance and Distress Specific to New Situations, and Generalized Social Avoidance and Distress. Confirmatory factor analysis with another subsample (n = 128)revealed a good fit for the three-factor model of social anxiety. In addition, high-socially-anxious children perceived their social acceptance and global self-worth to be low. Neglected and rejected children reported more social anxiety than accepted classmates. The data support the reliability and validity of the SASC-R.
The development, reliability, and discriminative ability of a new instrument to assess social phobia are presented. The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived instrument incorporating responses from the cognitive, somatic, and behavioral dimensions of social fear. The SPAI high test–retest reliability and good internal consistency. The instrument appears to be sensitive to the entire continuum of socially anxious concerns and is capable of differentiating social phobics from normal controls as well as from other anxiety patients. The utility of this instrument for improved assessment of social phobia and anxiety and its use as an aid for treatment planning are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
338 3rd and 5th graders completed a sociometric questionnaire and 3 instruments designed to assess their feelings of loneliness, social anxiety, social avoidance, and their attributions for social outcomes. Results show that children's feelings and attributions varied as a function of peer status, gender, and grade. For example, compared with peers, rejected children reported higher levels of loneliness and were more likely to attribute relationship failures to external causes. Children's feelings were also significantly related to their attributions about social events. Popular, average, and controversial status children who were socially distressed exhibited a non-self-serving attributional style, whereas distressed rejected children exhibited a self-serving attributional pattern. Neglected children who were distressed exhibited elements of both of these attributional styles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The development, reliability, and validity of a new instrument, the Social Phobia and Anxiety Inventory for Children (SPAI-C), is described. The results indicate that the SPAI-C has high test–retest reliability and internal consistency. In addition, an assessment of concurrent and external validity indicates statistically significant correlations with commonly used self-report measures of general anxiety and fears and parental reports of children's anxiety and social competence. The results of a factor analysis indicate that the scale consists of three factors: Assertiveness/General Conversation, Traditional Social Encounters, and Public Performance. Finally, scores on the SPAI-C successfully differentiate socially anxious and non-socially-anxious children. The instrument appears to be a reliable and valid measure for childhood social anxiety and fear and may prove useful for improving clinical assessment and documenting treatment outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
About 15% of Caucasian children in the second year of life are consistently shy and emotionally subdued in unfamiliar situations, whereas another 15% are consistently sociable and affectively spontaneous. A majority of the children in these two groups retain these profiles through their eighth year. In addition, the two groups differ in physiological qualities that imply differential thresholds in limbic sites, especially the amygdala and the hypothalamus, suggesting that the two temperamental groups are analogous to closely related strains of mammals. However, the behavioral profiles of the children are influenced in a major way by environmental conditions existing during the early years of life. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Posted 12/21/1999. A brief and inexpensive cognitive–behavioral prevention program was given to university students at risk for depression.
At risk was defined as being in the most pessimistic quarter of explanatory style. 231 students were randomized into either an 8-wk prevention workshop that met in groups of 10, once per week for 2 hr, or into an assessment-only control group. Ss were followed for 3 yrs and the authors report the preventive effects of the workshop on depression and anxiety. First, the workshop group had significantly fewer episodes of generalized anxiety disorder than the control group and showed a trend toward fewer major depressive episodes. The workshop group had significantly fewer moderate depressive episodes but no fewer severe depressive episodes. Second, the workshop group had significantly fewer depressive symptoms and anxiety symptoms than the control group, as measured by self-report but not by clinicians' ratings. Third, the workshop group had significantly greater improvements in explanatory style, hopelessness, and dysfunctional attitudes than the control group and these were significant mediators of depressive symptom prevention in the workshop group. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
202 2nd, 4th, and 7th graders evaluated story characters who were either highly or less motivated to impress an audience and had either high or low expectations of being able to accomplish their self-presentational goals. As predicted according to a self-presentation model of social anxiety, both factors were related to judgments of the character's social anxiety, especially for the older Ss. For all age groups, actors who expected to do poorly rather than well were regarded as more anxious, as more likely to exhibit nervous responses and to have communication difficulties, and as less likely to be successful in accomplishing their goal; they were also evaluated less favorably. The actor's motivation had different effects on younger and older Ss; 2nd graders attributed less anxiety to highly motivated actors, whereas older Ss attributed greater anxiety to them. For all age groups, high motivation was expected to have a channeling effect on behaviors that would increase interpersonal effectiveness. A finding that was consistent with the literature on social-cognitive development was that older Ss displayed greater differentiation in their cause–effect inferences and that they better appreciated the complex implications of social anxiety. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Sixty-seven children (ages 8 and 12) with social phobia were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for social phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with social phobia and the durability of treatment effects.
The quality of social relationships is a strong predictor of later adjustment. Thus, it is crucial to identify those environmental factors that lead to appropriate versus deficient childhood social relations. Parent-child interaction is one important context to examine due to the crucial role that the family environment plays in children's social development. This article reviews the parental factors associated with social anxiety, integrating the literature from various fields within psychology. Methodological limitations of this research are discussed, pointing to ambiguous constructs, limited assessment procedures, lack of research integration, and reliance on cognitive interpretations. Finally, suggestions are made for future investigations to clarify the definition of constructs and allow for more precise specification of the parental behaviors associated with social anxiety.
ABSTRACT: In Study One the nature of peer bullying among 353 Australian primary
school children from years three to seven was studied with a view to understanding the
anxiety generated by victimisation. Over one-third of the sample reported feeling unsafe
from bullying at school and over half of the sample believed that the reason children
did not ask for help from bullying was that they were too afraid. In Study Two
114 primary school students from a second school were assessed for social-evaluative
anxiety associated with peer victimisation at school. The findings indicated that victimisation
was associated with fear of negative evaluation amongst males and females
and social avoidance amongst females
Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy.
Seventy-two social phobics were Tandomly assigned to behavioral (flooding) or drug treatment with atenolol or placebo. Treatment was administered over a 3-month period of time, and duration of treatment effects was determined at a 6-month follow-up assessment. Multiple measures of outcome were used, including self-report, clinician ratings (including assessment by independent evaluators), behavioral assessment, and performance on composite indexes. The results indicated that flooding consistently was superior to placebo, whereas atenolol was not. Flooding also was superior to atenolol on behavioral measures and composite indexes. Those subjects who improved during treatment maintained gains at the 6-month follow-up regardless of whether they received flooding or atenolol. The variability of outcome on different measures in social phobia research is discussed, and the need for broad-based treatment strategies to address the pervasive deficits associated with social phobia is noted.
202 2nd, 4th, and 7th graders evaluated story characters who were either highly or less motivated to impress an audience and had either high or low expectations of being able to accomplish their self-presentational goals. As predicted according to a self-presentation model of social anxiety, both factors were related to judgments of the character's social anxiety, especially for the older Ss. For all age groups, actors who expected to do poorly rather than well were regarded as more anxious, as more likely to exhibit nervous responses and to have communication difficulties, and as less likely to be successful in accomplishing their goal; they were also evaluated less favorably. The actor's motivation had different effects on younger and older Ss; 2nd graders attributed less anxiety to highly motivated actors, whereas older Ss attributed greater anxiety to them. For all age groups, high motivation was expected to have a channeling effect on behaviors that would increase interpersonal effectiveness. A finding that was consistent with the literature on social-cognitive development was that older Ss displayed greater differentiation in their cause–effect inferences and that they better appreciated the complex implications of social anxiety. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The publication of this volume is somewhat ironic. It exposes the concept of shyness to the merciless scrutiny of a large group of strangers—the very situation that shy individuals find most distressing. Whether this scrutiny uncovers new aspects of shyness, or results in its further retreat, may depend on our strategy in approaching this elusive construct. In this chapter, we propose that shyness may be cautiously but productively approached as a specific quality of emotion experience.
This chapter reviews the principles and premises of operant conditioning, before exploring the utility of these principles in understanding the onset and maintenance of phobic and anxiety disorders. It examinesthese principles and their utility in the treatment of these disorders, and explores developmental issues associated with operant factors in the onset,maintenance, and treatment of these disorders.
Social anxiety is a universal phenomenon. When the level of anxiety, avoidance, and impairment in functioning reaches clinical proportions, a diagnosis of social anxiety disorder (SAD) (also known as SP)-and possibly APD-is made. The assessment methods described in this chapter can be used for assessing subdiagnostic social anxiety as well as SAD per se. Assessment measures for social anxiety have typically been divided into two broad groups: behavioral assessment methods, which include role-playing procedures and self-monitoring, and cognitive assessment procedures, including thought-listing and information-processing paradigms. Primary among these is the fact that whether any given measure is considered a behavioral or a cognitive assessment procedure is more a function of one's theoretical perspective than of the measure itself. The chapter elects various assessment procedures to organize according to the methodology of the procedure. Many of the tools described can be used for different purposes depending on one's goals (e.g., treatment planning in a clinical context, psychopathology research) and one's theoretical orientation (e.g., behaviorist, mediational, cognitivist). The chapter begins by describing a clinical interview, with particular attention to structured clinical interviews. This is followed by a review of the most commonly used self-report questionnaires for social anxiety. Role-playing procedures are then described, followed in turn by self-monitoring and thought-listing techniques. Finally, psychophysiological assessment is discussed briefly.
In this study, 338 3rd and 5th graders completed a sociometric questionnaire and 3 instruments designed to assess their feelings of loneliness, social anxiety, social avoidance, and their attributions for social outcomes. Results showed that children's feelings and attributions varied as a function of peer status, gender, and grade. For example, compared with peers, rejected children reported higher levels of loneliness and were more likely to attribute relationship failures to external causes. Children's feelings were also significantly related to their attributions about social events. Popular, average, and controversial status children who were socially distressed exhibited a non-self-serving attributional style, whereas distressed rejected children exhibited a self-serving attributional pattern. Neglected children who were distressed exhibited elements of both of these attributional styles.
Social phobic patients who fear most or all social interaction situations are labeled generalized social phobics in DSM-III-R. Thirty-five patients who met this criterion were compared with 22 social phobic patients whose fears were restricted to public speaking situations. Generalized social phobics were younger, less educated, and less likely to be employed, and their phobias were rated by clinical interviewers as more severe than those of public speaking phobics. Generalized social phobics appeared more anxious and more depressed and expressed greater fears concerning negative social evaluation. They performed more poorly on individualized behavioral tests and differed from public speaking phobics in their responses to cognitive assessment tasks. The two groups showed marked differences in their patterns of heart rate acceleration during the behavioral test. The implications of these findings for the classification and treatment of social phobic individuals are discussed.
The 1956 adaptation for children of Taylor's Manifest Anxiety Scale, the Children's Manifest Anxiety Scale, was revised to meet current psychometric standards. A 73-item revision draft was administered to 329 school children from grades 1 to 12. Based on item-analysis criteria for rbis greater than or equal to .4 and .30 less than or equal to p less than or equal to .70, 28 anxiety items were retained along with 9 of the original 11 Lie scale items. A cross-validation sample of 167 children from grades 2, 5, 9, 10, and 11 produced a KR20 reliability estimate of .85. Anxiety scores did not differ across grade or race. Females scored significantly higher than males. For the Lie scale, significant differences appeared by grade and race. No sex differences were obtained on the Lie scale. The resulting scale appears useful for children in grades 1 to 12 and may aid in future studies of anxiety as well as assisting the clinician in the understanding of individual children.
Although potentially important for understanding children's peer relationships, the construct of social anxiety in children has received very limited attention. The present study reports on the development of the Social Anxiety Scale for Children (SASC), a 10-item self-report measure. A total of 287 second through sixth graders completed the SASC and a self-report measure of trait anxiety (Revised Children's Manifest Anxiety Scale) and were assessed on their peer status using peer nomination and peer rating sociometric measures. Factor analysis yielded two factors for the SASC: fear of negative evaluation (FNE) and social avoidance and distress (SAD). These factors were evaluated with respect to internal and test-retest reliability. Girls reported greater FNE than boys, and children in the lower grades reported more SAD than those, in the upper elementary school grades. Significant correlations between trait anxiety and the FNE and SAD factors were obtained. In addition, the peer status groups (neglected, rejected, average, popular, and controversial differed in their reports of social anxiety, as anticipated. In particular, neglected children were found to report the greatest social anxiety, controversial children the least. These findings provide preliminary Support for the reliability and validity of the SASC.
Used an information-processing task to investigate cognitive biases associated with trait anxiety in children. Participants were presented with ambiguous situations requiring them to generate interpretations and behavioral plans, The influence of parents on children's interpretations was also assessed by administering the ambiguous-situations questionnaire (ASQ) before and after a family discussion of those same situations. Results demonstrated a high correlation between trait anxiety scores and anxious responses during the ASQ (p < .01). In addition, parents' intervening discussion appeared to be related to changes in children's anxious responding. Although preliminary, the findings imply that cognitive biases related to anxiety in children are similar to those found in adults, and that parents might play a role in influencing the degree of these biases.
Examined relationships over time between social anxiety, friendship qualities, and rejection experiences for 68 early adolescents who had recently relocated. Prospective analyses provide evidence consistent with the view that social anxiety influences the emergence of companionship and intimacy in newly formed friendships but does not play a significant role in determining the frequency of rejection events. Social anxiety also appears to change over time in response to the degree of companionship and intimacy in friendships and to the frequency of rejection experiences.
Most interventions currently being tested for children with phobic and anxiety disorders are individual child-focused treatments in which family members generally play little or no direct role in the therapeutic process. Although this approach to treatment is generally efficacious, involving family members more centrally in the therapeutic process is one important way to enhance treatment effectiveness and maintenance. A framework to help guide researchers and clinicians in the task of devising and implementing interventions that more centrally involve family members is presented. In addition, research on family factors associated with childhood anxiety is summarized and how such factors may influence treatment outcome and maintenance is discussed. Based on a “transfer of control” model of change, an innovative intervention designed to target both individual and family factors is described.
Research on the etiology of social phobia is virtually nonexistent in part because relevant theories about family and childhood antecedents have not been advanced. The present study was designed to assess the relevance of Buss' (1980) formulations regarding antecedents of social evaluative fears for understanding the development of social phobia. Social phobic patients' perceptions of early parental and childhood characteristics presumed to be associated with social evaluative concerns were compared to those of agoraphobic patients. Social phobics perceived their mothers as more avoidant of social phobic situations, their parents as seeking to isolate them, their parents as overemphasizing the opinions of others, and their parents as deemphasizing family sociability. Social phobics also reported greater self-consciousness and fewer dating partners during adolescence. A discriminant function analysis revealed that these criterion variables accurately classified 91% of social phobics and 77.3% of agoraphobics.
Social phobia has become a focus of increased research since its inclusion in DSM-III. However, assessment of social phobia has remained an underdeveloped area, especially self-report assessment. Clinical researchers have relied on measures that were developed on college populations, and these measures may not provide sufficient coverage of the range of situations feared by social phobic individuals. There is a need for additional instruments that consider differences in the types of situations (social interaction vs. situations involving observation by others) that may be feared by social phobics and between subgroups of social phobic patients. This study provides validational data on two instruments developed by Mattick and Clarke (1989): the Social Interaction Anxiety Scale (SIAS), a measure of anxiety in social interactional situations, and the Social Phobia Scale (SPS), a measure of anxiety in situations involving observation by others. These data support the use of the SIAS and SPS in the assessment of individuals with social phobia.
The development and validation of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) two companion measures for assessing social phobia fears is described. The SPS assesses fears of being scrutinised during routine activities (eating, drinking, writing, etc.), while the SIAS assesses fears of more general social interaction, the scales corresponding to the DSM-III-R descriptions of Social Phobia—Circumscribed and Generalised types, respectively. Both scales were shown to possess high levels of internal consistency and test–retest reliability. They discriminated between social phobia, agoraphobia and simple phobia samples, and between social phobia and normal samples. The scales correlated well with established measures of social anxiety, but were found to have low or non-significant (partial) correlations with established measures of depression, state and trait anxiety, locus of control, and social desirability. The scales were found to change with treatment and to remain stable in the face of no-treatment. It appears that these scales are valid, useful, and easily scored measures for clinical and research applications, and that they represent an improvement over existing measures of social phobia.
Introduction 1. Recent advances in the study of peer rejection S. R. Asher Part I. Behavioural Characteristics of Peer Rejected Children: 2. Peer group behavior and social status J. D. Coie, K. A. Dodge and J. Kupersmidt 3. Children's entry behavior M. Putallaz and A. Wasserman 4. Preschooler's behavioral orientations and patterns of peer contact: predictive of peer status? G. R. Ladd, J. M. Price and C. H. Hart Part II. Parent-Child Relations and Peer Rejection: 5. Social withdrawal in childhood: developmental pathways to peer rejection K. H. Rubin, L. J. Lemare and S. Lollis 6. Parent-child interaction M. Putallaz and A. H. Heflin Part III. Social-Cognitive Process: 7. Issues in social cognition and sociometric status K. A. Dodge and E. Feldman 8. Reputational bias: view from the peer group S. Hymel, E. Wagner and L. J. Butler Part IV. Consequences of Peer Rejection: 9. Peer rejection and loneliness in childhood S. R. Asher, J. T. Parkhurst, S. Hymell and G. A. Williams 10. The role of poor peer relationships in the development of disorder J. Kupersmidt, J. D. Coie and K. A. Dodge Part V. Issues in Intervention Research: 11. Adapting intervention to the problems of aggressive and disruptive rejected children J. D. Coie and G. K. Koeppl 12. Toward the development of successful social skill training for preschool children J. Mize and G. W. Ladd Conclusion: 13. Toward a theory of peer rejection J. D. Coie.
examine the concept of human autonomy as it relates to both normal and psychopathological development / set forth a definition of autonomy that is informed by philosophical and clinical analyses, and that differentiates it from closely related constructs such as independence and detachment / explore how autonomy is intertwined with the developmental processes of intrinsic motivation, internalization, and emotional integration [and regulation during childhood], paying particular attention to how conditions in the social context either support the motivational and emotional bases of normal development or, alternatively, undermine these bases and contribute to psychopathology
examine how the development of individual autonomy is intertwined with issues in attachment and the development of interpersonal relatedness, and how both autonomy and relatedness represent critical aspects of the development of self / discuss the dynamics of autonomy and relatedness with regard to varied clinical disorders of a psychological nature, which we view as outcomes of nonoptimal developmental antecedents (PsycINFO Database Record (c) 2012 APA, all rights reserved)
the Child and Adolescent Anxiety Disorders Program / social phobia from a cognitive-behavioral perspective / cognitive-behavioral group treatment for social phobic adolescents (CBGT-A) [issues and goals, assessment methods, treatment measures, treatment components and procedures, session plans] / treatment effectiveness / outcomes (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this book is to describe and explain methodology and research design in clinical psychology. The book elaborates the methods of conducting research and the broad range of practices, procedures, and designs for developing a sound knowledge base. It also focuses on the underpinnings, rationale, and purposes of these practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the Social Anxiety Scales for Children and Adolescents. A background on the development of the measure, as well as a description and various psychometric studies, is presented. The measure's validity and reliability are examined, and an overview of select findings is made. Future uses of the scales are also noted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes the clinical presentation of social phobia, discusses theoretical perspectives on etiology, and surveys empirically supported treatments used to treat the disorder.
Although social phobia occurs in children and adults, its manifestation and treatment differ in various age groups. The authors describe the similarities and differences in the syndrome across all ages. Drawing from the clinical, social, and developmental literatures, as well as from their own extensive clinical experience, the authors illustrate the impact of developmental stage on phenomenology, diagnoses, and assessment and treatment of social phobia. Within the different age groups, issues of etiology, prevalence, and clinical management are presented. The volume includes many case illustrations and practical information.
This book will be useful for practitioners, researchers, and students. (PsycINFO Database Record (c) 2012 APA, all rights reserved)