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A cognitive model of social phobia. Social phobia: Diagnosis

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... Beyond the symptoms described in the DSM-5 [1], models of SAD suggest additional variables immanent to SAD [12][13][14][15]. One of the most prominent models of SAD, is the model by Clark and Wells (1995) [12]. ...
... Beyond the symptoms described in the DSM-5 [1], models of SAD suggest additional variables immanent to SAD [12][13][14][15]. One of the most prominent models of SAD, is the model by Clark and Wells (1995) [12]. The model assumes that individuals with SAD hold negative expectations regarding social situations. ...
... Beyond the symptoms described in the DSM-5 [1], models of SAD suggest additional variables immanent to SAD [12][13][14][15]. One of the most prominent models of SAD, is the model by Clark and Wells (1995) [12]. The model assumes that individuals with SAD hold negative expectations regarding social situations. ...
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Clark and Wells’ prominent model of social anxiety disorder (SAD) assumes that cognitive variables such as negative expectations or dysfunctional cognitions play a central role in the symptomatology of SAD. In contrast to adults, it is less clear how well the cognitive model can be applied to children and adolescents. A network analysis with seven nodes was conducted to explore the importance of cognitive variables and their interaction with symptoms of SAD based on N = 205 children and adolescents (8–18 years, M = 11.54 years). Cognitive variables had a high but differential impact within the positively connected network of SAD. Dysfunctional cognitions were most strongly connected within the network. Dysfunctional cognitions, as predicted by Clark and Wells’ model, seem to act as a hub affecting several symptoms. The association between negative expectations and avoidance indicates that negative expectations may particularly contribute to the maintenance of SAD.
... the Post-Event Rumination model (Clark & Wells, 1995) conceptualize rumination to be focused on negative inferences associated with stressful life events and social interactions respectively. As evident from the above, there appear to be a number of theories of rumination varying in their predictions of the content of ruminative thoughts. ...
... They scrutinized their relationships and interactions with a negative, self-focused outlook. This supports Clark and Wells' (1995) social model of rumination, which hypothesises that negative social situations, which can lead to feelings of loneliness, may result in brooding social incidents and relationships with a heavy focus on the past. Such brooding has also been theorized to give rise to feelings of inadequacy. ...
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The recent rise in the prevalence of loneliness, particularly among young adults, coupled with its deleterious effects on wellbeing, makes understanding the issue of pressing concern. As most research on loneliness has focused on older adults, this study explored how 48 young adults aged 18–24 subjectively experienced loneliness through free association‐based interviews. Participants were sampled from the four most deprived boroughs in London, as area deprivation has been associated with a higher prevalence of loneliness. This facilitates understanding of contributors and consequences of loneliness within this demographic group. In particular, the focus is on rumination arising from loneliness; while the link between the two is well‐established quantitively, research into rumination and the context of ruminative thoughts in the context of loneliness remains sparse. Thus, this study aimed to understand the subjective experience of rumination in young adults whilst they experienced loneliness. Thematic analysis of interviews using ATLAS.ti 9 revealed five themes capturing these experiences: ‘temporal experience of rumination’, ‘ruminating life and death’, ‘rumination related to others’, ‘outcomes of rumination’ and ‘coping with loneliness‐related rumination’. Based upon knowledge of the nature and content of rumination, further research could devise models of rumination and interventions targeted at rumination such as mindfulness meditation, journaling and engaging in prosocial behaviour, to mitigate the adverse effects loneliness can have on wellbeing.
... Social anxiety research has to face similar problems in the investigation of post-event processing, which can be defined "as an individual's repeated consideration and potential reconstruction of his performance following a social situation" (p. 891 29 ) and which is postulated to be a maintaining factor in social anxiety disorders 30 . However, studies in which participants are instructed to imagine hypothetical or recent personal situations [31][32][33] as well as experimental studies in which impromptu-speech tasks are used 34,35 show highly socially anxious individuals to be more prone to engage in post-event processing. ...
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We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.
... As a dysfunctional emotional regulation strategy, social withdrawal is associated with a loss of positive reinforcement and the latter seems to represent a significant cause and maintenance factor of depression (Lewinsohn, 1974). Regarding social anxiety disorder, individuals seem to show low reward expectations about social interactions (Clark and Wells, 1995), leading to the avoidance of such situations. As a significant cause and maintenance factor (e.g., Givon-Benjio et al., 2020), avoidance behavior will eventually result in social withdrawal and leave individuals with reward deficiency of social interactions. ...
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Trajectories of internalizing disorders and behavioral addictions are still largely unknown. Research shows that both disorders are highly comorbid. Previous longitudinal studies have focused on associations between internalizing disorders and behavioral addictions using screening instruments. Our aim was to develop and examine a theory-based model of trajectories, according to which internalizing disorders foster symptoms of Internet use disorders, mediated by a reward deprivation and maladaptive emotion regulation. We applied clinically relevant measures for depression and social anxiety in a prospective longitudinal study with a 12-month follow-up investigation. On the basis of an at-risk population of 476 students (mean age = 14.99 years, SD = 1.99), we investigated the predictive influence of clinically relevant depression and social anxiety at baseline (t1) on Internet use disorder symptoms at 12-month follow-up (t2) using multiple linear regression analyses. Our results showed that both clinically relevant depression and social anxiety significantly predicted symptom severity of Internet use disorders one year later after controlling for baseline symptoms of Internet use disorders, gender and age. These results remained robust after including both depression and social anxiety simultaneously in the model, indicating an independent influence of both predictors on Internet use disorder symptoms. The present study enhances knowledge going beyond a mere association between internalizing disorders and Internet use disorders. To our knowledge, this is the first study investigating clinically relevant depression and social anxiety to predict future Internet use disorder symptoms at 12-month followup. In line with our model of trajectories, a significant temporal relationship between clinically relevant internalizing disorders and Internet use disorder symptoms at 12- month follow-up was confirmed. Further studies should investigate the mediating role of reward deprivation and maladaptive emotion regulation, as postulated in our model. One implication of these findings is that clinicians should pay particular attention to the increased risk of developing behavioral addictions for adolescents with depression and social anxiety.
... (459-461) Fear of Negative Evaluation (FNE) is a concept used in CBT, especially within Social Anxiety Disorder, to describe cognitive contexts where individuals fear being negatively judged by others, often leading to problematic anxiety and shame (E.g. [25]), especially related to performance. In counselling, there are considered to be a range of correct responses to any particular therapeutic scenario, and as a result, there is much less judgement attached to any subsequent discussion of the intervention. ...
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Cognitive Behaviour therapy (CBT) relies on homogenous practice for it's evidence base. However training to an accreditable standard in the UK requires 3 years of "core professional" training in addition to 1 years CBT training for IAPT (Improving Access to Psychological Therapy, trained for primary care cases only) and 2 years for more complex roles. The core professional training has unique aspects which may differ between professional groups (Nursing, Counselling, Occupational Therapy, etc) have varied ideological standpoints and practice rituals, and have the potential to conflict with aspects of CBT. This study asks the question "How do (BACP accreditable) Counsellors and psychotherapists (Hereafter counsellors) in High Intensity IAPT roles practice CBT"? and achieves this through analysis of a focus group of 5 counsellors with at least 3 years CBT experience using a thematic analysis methodology. Five themes were identified-processes in transition, ongoing processes reconciling roles, Features retained from counselling practice, Features changed from counselling practice, and features of CBT resisted and not adopted. Results suggest a broad adaptation to CBT with some aspects of counselling (Responsiveness to the client, knowing the whole of the client) emphasised more or differently to conventional views on CBT Practice. Counsellors do not adopt, or try to avoid adopting, some of the more positivist aspects of CBT, and this remains an ongoing source of conflict in the application of CBT. Implications: Counsellors do not fully conform to the CBT model of practice. Further research is necessary to establish whether this affects outcomes.
... In the primary care context, CBT treatment and theory varies according to the condition treated, and disorder specific models and treatment approaches are used based on evidence for specific phobias (e.g. Ost, Salkovskis and Hellstrom 1993), depression (Teasdale, Fennell, Hibbert et al. 1984, Beck, Hollon, Young et al. 1985, panic disorder (Barlow, Gorman, Shear et al. 2000) social phobia (Heimberg, Liebowitz, Hope et al 1998, Clark andWells 1995) generalised anxiety disorder (GAD) (Borkovec and Ruscio 2001), post-traumatic stress disorder (PTSD) (Foa, Hembree, Cahill et al. 2005) and obsessive-compulsive disorder (OCD) (Freeston, Ladouceur Gagnon et al. 1997). These models and treatment approaches also form the learning competencies for the course under scrutiny in this research (Roth and Pilling 2008) and form the mainstay of primary care treatment. ...
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Original citation: Wilcockson, M.D (2017) "The Contribution of the Core Professions to the IAPT HIgh Intensity Role"
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Mental imagery has become a “hot topic” in psychology and cognitive neuroscience over the past decade. Mental images are sensory events that happen inside one's mind without a corresponding current stimulus coming from the outside world. We can “see with the mind's eye”, “hear with the mind's ear” and so on. In this article we first describe the impact and role of mental imagery for people experiencing a range of psychological difficulties. We then describe a variety of imagery-based psychological therapy techniques to treat distressing or dysfunctional imagery, and/or promote positive imagery. Finally, we discuss components of effective supervision of imagery-based interventions.
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Despite some evidence of the benefits of self-compassion training among socially anxious individuals, little is known about whether enhancing self-compassion prior to exposure therapy increases initial exposure engagement. Additionally, manipulations have relied on broad definitions of self-compassion, rendering it difficult to distinguish the impact of individual components. This study employed three experiential exercises designed to enhance one facet of self-compassion—common humanity. Socially anxious undergraduates (N = 63) were randomized in groups to 1) common humanity-enhanced exposure (n = 32) or 2) exposure alone (n = 31). In the common humanity condition, participants wrote self-compassionately, shared fears, and completed a common humanity-focused lovingkindness meditation. All participants then completed a speech exposure in front of live judges followed by an optional second exposure. Within the common humanity condition, positive self-responding to the speech exposure increased (b =.30, p =.026). Common humanity participants also remained in the first exposure longer, relative to exposure alone (b = -30.92, p =.002). Participants rated exercises as at least moderately helpful, with sharing fears rated most helpful. In sum, a brief group-based multi-modal common humanity induction represents a promising approach to improving initial engagement with feared contexts among socially anxious individuals.
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Consciousness has been hypothesized to operate as a global workspace, which accesses and integrates multimodal information in a uni_ed manner, supports expectation violation monitoring and reduction, and the motivation, programming and control of action. One important yet open issue concerns how the subjective perspective at the core of consciousness, and subjective properties of manifestation of the environment in such perspective as an embodied experience, play a role in such process. We operationalised the concept of subjective perspective using the principles of the Projective Consciousness Model (PCM), based on the projective geometrical concept of Field of Consciousness. We show how these principles can account for documented relationships between appraisal and distance as an inverse distance law, yield a generative model of a_ective and epistemic drives based on purely subjective parameters, such as the apparent size of objects, and can be generalised to implement Theory of Mind, in a manner that is consistent with simulation theory. We used simulations of arti_cial agents, based on psychological rationale, to demonstrate how different model parameters could generate a variety of emergent adaptive and maladaptive behaviours that are relevant to developmental and clinical psychology: the ability to be resilient in the face of obstacles through imaginary projections, the emergence of social approach and joint attention behaviours, the ability to take advantage of false beliefs attributed to others, the emergence of avoidance behaviours as observed in social anxiety disorders, the presence of restricted interests as observed in autism spectrum disorders. The simulation of agents was applied to a speci_c robotic context, and agents' behaviours were demonstrated by controlling the corresponding robots. Our results contribute to advance the scienti_c understanding of the causal relationships between core aspects of the phenomenology of consciousness and its functions in human cybernetics.
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To date, it has been difficult to establish reliable biomarkers associated with specific forms of psychopathology. Social anxiety, for example, is associated with inconsistent biological responses to psychosocial stress on markers including cortisol and salivary alpha-amylase. Thus, it is critical that studies identify more reliable biomarkers that index patterns associated with social anxiety. Two potential candidates are the neuropeptides oxytocin and vasopressin, which have been implicated in stress responsivity across species. Studies have demonstrated a reliable increase in oxytocin, and a surrogate marker for vasopressin, following engagement in the most widely used lab-based psychosocial stress paradigm: the Trier Social Stress Test (TSST). However, no study has examined whether social anxiety moderates peripheral oxytocin or vasopressin reactivity to psychosocial stress. In 101 young adult participants, dimensionally assessed social anxiety was associated with greater plasma oxytocin, but not vasopressin, reactivity to the TSST. Results were maintained following the inclusion of depression as a covariate. Findings suggest that studying changes in peripheral oxytocin concentrations may be a method of differentiating individuals with higher levels of social anxiety.
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Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.
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Models of social anxiety propose that negative self-imagery is a maintenance factor of psychopathology, yet the mechanisms of this relationship are unclear. One proposed mechanism is attention towards self-images. However, self-image creation does not occur in isolation and is likely influenced by other mechanisms, such as anticipatory processing (AP). The current study aimed to investigate how trait social anxiety and AP influence motivated attention during self-imagery (i.e., late-positive potential; LPP). Participants (N = 40) with a mean age of 18.95 (SD = 1.22) completed AP manipulations and a self-imagery task. Results revealed that participants with high levels of social anxiety who engaged in AP demonstrated blunted LPP activity in the late time window (6000-10000ms) relative to those who engaged in Distraction. These results suggest that motivated attention towards self-imagery may be impacted by anticipatory processing, but less influenced by the valence of self-imagery. Given previous research has been limited in methodology, this study expands upon current research by documenting the neural mechanisms of self-imagery manipulations within social anxiety.
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Cognitive models of social anxiety propose that socially anxious individuals engage in excessive self-focusing attention when entering a social situation. In the present study, speech anxiety was induced to socially anxious and control participants. Event-related potentials were recorded while participants performed a perceptual judgment task using distinct or ambiguous stimuli, before and after social feedback. Disputed feedback led to more revisions and decreased levels of confidence, especially among socially anxious individuals. Prior feedback, greater occipital P1 amplitudes in both groups for ambiguous probes indicated heightened sensory facilitation to ambiguous information, and greater anterior N1 amplitudes for ambiguous stimuli in highly anxious participants suggested anticipation of negative feedback in this group. Post-feedback, P1, N1 and LPP amplitudes were reduced overall among socially anxious individuals indicating a reduction in sensory facilitation of visual information. These results suggest excessive self-focusing among socially anxious individuals, possibly linked to anticipation of an anxiety-provoking social situation.
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Purpose The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate. Methods A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis. Results There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations. Discussion This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.
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Depressogenic attributional style is the general tendency to attribute and infer the causes, consequences, and implications of stressful events in a negative way. Drawing on uncertainty reduction theory, this research examines how employees with a depressogenic attributional style are likely to react to negative workplace gossip. A moderated mediation model was proposed and tested by two online studies. Ordinary least squares regressions were performed. The results of a two-wave survey (N = 460) and a scenario experiment (intervention group versus control group; N = 203) reveal that negative workplace gossip induces employees' fear of negative evaluation, leading to more feedback-seeking behavior. In addition, this indirect relationship is more salient for employees with a depressogenic attributional style. The findings suggest that employees with a depressogenic attributional style tend to attain and maintain self-awareness and interpersonal acumen upon experiencing negative workplace gossip. Implications, limitations, and future directions are discussed.
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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.
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While attention to external visual stimuli has been extensively studied, attention directed internally towards mental contents (e.g., thoughts, memories) or bodily signals (e.g., breathing, heartbeat) has only recently become a subject of increased interest, due to its relation to interoception, contemplative practices and mental health. The present study aimed at expanding the methodological toolbox for studying internal attention, by examining for the first time whether the steady-state visual evoked potential (ssVEP), a well-established measure of attention, can differentiate between internally and externally directed attention. To this end, we designed a task in which flickering dots were used to generate ssVEPs, and instructed participants to count visual targets (external attention condition) or their heartbeats (internal attention condition). We compared the ssVEP responses between conditions, along with alpha-band activity and the heartbeat evoked potential (HEP) - two electrophysiological measures associated with internally directed attention. Consistent with our hypotheses, we found that both the magnitude and the phase synchronization of the ssVEP decreased when attention was directed internally, suggesting that ssVEP measures are able to differentiate between internal and external attention. Additionally, and in line with previous findings, we found larger suppression of parieto-occipital alpha-band activity and an increase of the HEP amplitude in the internal attention condition. Furthermore, we found a trade-off between changes in ssVEP response and changes in HEP and alpha-band activity: when shifting from internal to external attention, increase in ssVEP response was related to a decrease in parieto-occipital alpha-band activity and HEP amplitudes. These findings suggest that shifting between external and internal directed attention prompts a re-allocation of limited processing resources that are shared between sensory and interoceptive processing.
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Cognitive models of social anxiety give prominence to dysfunctional schemas about the social self as the key underlying factors in maladaptive self-processing strategies and social anxiety symptoms. In contrast, the metacognitive model argues that beliefs about cognition represent a central belief domain underlying psychopathology and cognitive schemas as products of a thinking style regulated by metacognition. The present study therefore evaluated the temporal and reciprocal relations between metacognitive beliefs, social self-beliefs, and social anxiety symptoms to shed light on possible causal relationships among them. Eight hundred and sixty-eight individuals gathered at convenience participated in a four-wave online survey with each measurement wave 6 weeks apart. Using autoregressive cross-lagged panel models, we found significant temporal and reciprocal relations between metacognition, social self-beliefs (schemas), and social anxiety. Whilst social self-beliefs prospectively predicted social anxiety this relationship was reciprocal. Metacognitive beliefs prospectively predicted both social interaction anxiety and social self-beliefs, but this was not reciprocal. The results are consistent with metacognitive beliefs causing social anxiety and social self-beliefs and imply that negative social self-beliefs might be a product of metacognition. The clinical implications are that metacognitive beliefs should be the central target in treatments of social anxiety.
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Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli. Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects. Results: Within the analysis sample ( n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group. Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.
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Background : Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19. Methods : In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes. Results : Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes. Limitations : Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear. Conclusions : The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.
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Background Social anxiety disorder (SAD) is characterized by a marked fear of negative evaluation in social situations and significant impairments. Even with the most effective treatments, remission rates are around 50%. An important reason for the limited effectiveness of treatments is the lack of evidence-based explanation of how treatments work and what their active ingredients might be. An approach to unpack the active ingredients and mechanisms of treatment is the factorial design. Objectives The study is a factorial trial aiming (1) to examine the main effects and interactions for the four main treatment components of internet-based cognitive-behavioral therapy (ICBT) for SAD (i.e., psychoeducation, cognitive restructuring, attentional training, and exposure) and (2) to examine whether and which change mechanisms mediate the relationship between treatment components and symptom reduction. Methods A total of 464 adults diagnosed with SAD will be randomized to one of 16 conditions containing combinations of the treatment components. The primary endpoint is SAD symptomatology at eight weeks. Secondary endpoints include symptoms of depression and anxiety, quality of life, and negative effects. Hypothesized change mechanisms are the increase of knowledge about SAD, the decrease of dysfunctional cognitions, the decrease of self-focused attention, and the decrease of avoidance and safety behaviors. Discussion A better understanding of the differential efficacy of treatment components and mechanisms of treatment underlying ICBT for SAD might inform clinicians and researchers to plan more potent and scalable treatments. Trial registration clinicaltrials.gov (NCT04879641) on June, 11th 2021. https://clinicaltrials.gov/ct2/show/NCT04879641.
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Social anxiety disorder has been widely recognised as one of the most commonly diagnosed mental disorders. Individuals with social anxiety disorder experience difficulties during social interactions that are essential in the regular functioning of daily routines; perpetually motivating research into the aetiology, maintenance and treatment methods. Traditionally, social and clinical neuroscience studies incorporated protocols testing one participant at a time. However, it has been recently suggested that such protocols are unable to directly assess social interaction performance, which can be revealed by testing multiple individuals simultaneously. The principle of two-person neuroscience highlights the interpersonal aspect of social interactions that observes behaviour and brain activity from both (or all) constituents of the interaction, rather than analysing on an individual level or an individual observation of a social situation. Therefore, two-person neuroscience could be a promising direction for assessment and intervention of the social anxiety disorder. In this paper, we propose a novel paradigm which integrates two-person neuroscience in a neurofeedback protocol. Neurofeedback and interbrain synchrony, a branch of two-person neuroscience, are discussed in their own capacities for their relationship with social anxiety disorder and relevance to the paradigm. The newly proposed paradigm sets out to assess the social interaction performance using interbrain synchrony between interacting individuals, and to employ a multi-user neurofeedback protocol for intervention of the social anxiety.
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Personality can be explored hierarchically with higher- and lower-order factors. Recent research suggests the personality hierarchy is comprised of higher-order Big Five traits with two lower-order “aspects” for each Big Five trait. There appears to be a lack of research examining the relationship between these lower-order aspects and social anxiety (SA) severity. To better understand these relationships, 443 university undergraduate students (72.2 % female; mean age = 20.48, SD = 4.64) completed the Big Five Aspects Scale (BFAS) and the Social Phobia and Anxiety Inventory-23, and were retained following exclusionary criteria. Path analysis, covarying for sex, age, and general anxiety severity, was used to examine the relationship between social anxiety severity and the 10 aspect scores from the BFAS (i.e., volatility, withdrawal, compassion, politeness, industriousness, orderliness, enthusiasm, assertiveness, intelligence, openness). Significant relationships with SA severity were found for withdrawal (positive), orderliness (positive), enthusiasm (negative), and assertiveness (negative). Findings suggest that a unique pattern of lower-order personality is associated with SA severity. Further research is needed to clarify whether personality profiles differ according to diagnostic versus dimensional social anxiety.
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Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors for social anxiety. In particular, cost bias and avoidance behavior predict social anxiety. It has been shown that the enhancement of trait mindfulness improves these maintaining factors. This study examines the relationships among trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety, and clarifies whether they mediate the relationship between trait mindfulness and social anxiety. A cross-sectional design was used to examine the relationships among these variables. Participants were recruited from three universities in Japan (January 2019–December 2019). Undergraduate students (N = 367) completed a set of self-report measures assessing trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Results of path analyses revealed that the hypothesized model’s goodness-of-fit indices had high values. Trait mindfulness showed a direct negative association with self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Moreover, trait mindfulness was negatively associated with social anxiety via self-focused attention, cost/probability bias, and avoidance behavior. These findings indicate that mindfulness plays an important role in social anxiety and provide impetus for future research involving clinical studies of mindfulness-based interventions for social anxiety.
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Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.
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The present meta-analysis sought to assess the association between an emerging neurocognitive marker of psychopathology in attentional bias variability (ABV) and key psychological and health outcomes. A comprehensive literature review yielded 53 studies in 43 manuscripts (N = 5428). Overall, clinical and sub-clinical samples exhibited greater ABV than control samples (g =.462). Trauma samples showed significantly greater ABV than control samples (g =.782, medium-large effect), whereas social anxiety samples did not (g =.147). Similarly, ABV was associated with degree of trauma symptoms (r =.21 -.25). ABV was associated with some symptoms of depression and anxiety, although these were small and inconsistent. These findings suggest a specific relationship between ABV and post-traumatic stress symptoms, with evidence equivocal for other psychological difficulties (although also less research). Key recommendations for future research include investigating mechanisms underlying ABV and the importance of controlling for non-attentional processes, such as reaction time variability, to ensure the validity of ABV measures.
Chapter
The overall objective of the proposed chapter is to increase the reader's understanding of the role that social media plays in self-disclosing information about ourselves in the development of friendships and identity, as well as explore these themes in a clinical context. As such, readers will gain knowledge regarding the relations between self-disclosing on social media sites and the ensuing friendship and identity development that occurs, the extension of the research findings to clinical populations, and the questions that still remain unanswered. This information may be useful for the advancement of research, policy development, mental health programs, parenting, and education.
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Background and Aims Mobile phone addiction among college students has gained considerable research attention because of its adverse effects on their health and academic performance. However, little is known about the mechanisms underlying the relationship between shyness and mobile phone addiction among college students. Methods Four questionnaires were used to examine whether mobile phone addiction tendency was predicted by shyness and the mediating roles of social anxiety and self-control among 3,189 Chinese college students. Correlation and mediation analyses were conducted using Hayes PROCESS. Results The results showed that (1) social anxiety (indirect effect = 0.22, 95% CI = 0.18–0.26) and self-control (indirect effect = 0.23, 95% CI = 0.21–0.25) played a partial mediating role in the relationship between shyness and mobile phone addiction tendency; (2) social anxiety and self-control also mediated the link between shyness and mobile phone addiction tendency sequentially (indirect effect = 0.10, 95% CI = 0.09 to 0.12). Conclusion These results suggest that mobile phone addiction among shy college students could be eliminated by alleviating social anxiety and strengthening self-control.
Thesis
p>This thesis provides a different perspective into the study of paranoia. Literature on this field has studied paranoia under the light of the medical model and has used clinical populations. In contrast to this, it is argued in this thesis that paranoia lies in a continuum with normal experiences at one end and abnormal cognitions at the other. Thus, this thesis "normalises" paranoia, which has always been considered to be a symptom of a psychiatric disorder. In order to test the argument that says that paranoia is normal and is part of the natural responses to threat in the environment (Gilbert, 1998a), the research program starts with an exploratory study on the number of people from a sample in the normal population that report episodes of paranoia. This study not only for the first time measured the number of people in the normal population that reported paranoid experiences but it also provided in depth descriptions of those experiences. Another study explored the attentional mechanisms for threat in people that report trait like paranoia in a normal population. In this case, the methodologies for attentional biases in anxiety were for the first time applied to the study of attentional biases in paranoia. Both studies were part of fruitful research that proposes a new theoretical framework and research program to the study of paranoia. This thesis contributes to knowledge in the study of paranoia by providing a new theoretical framework that was based on two studies on paranoia in a normal population. The main achievement was evidence supporting the argument for paranoia as a normal process. Evidence was not clear in terms of the cognitive mechanisms present on paranoia in a normal population and more research is needed in this area. All in all, this thesis managed to open new perspectives into the study of paranoia with interesting and ground breaking results.</p
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A “person under train” (PUT) incident is a suicidal action involving a person throwing themselves at a moving train. This may cause trauma, including post-traumatic stress disorder (PTSD), to railroad drivers. This study investigated the experiences of railroad drivers of a PUT incident. Data were obtained from two drivers through in-depth interviews and personal narratives regarding their PUT experience and personal lives after the incident. Expressing thoughts through writing was an effective intervention that provided insights into their experience. Thus, an educational program combining mental health management and PTSD treatment is recommended for workers who experience such trauma.
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The study investigated the role of parental anxiety symptoms in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. Participants were 152 children between 7 and 18 years and their parents (146 mothers, 123 fathers). Anxiety was assessed pretreatment, posttreatment, and at three months and one year follow ups. There were no baseline differences in parental anxiety symptoms between the two groups. In both groups parental anxiety symptoms decreased from pretreatment to posttreatment, and only mothers’ anxiety symptoms decreased further from posttreatment to the one year follow up. Parental anxiety symptoms before the treatment were not related to the being free of all anxiety diagnoses in the children at posttreatment. However, some indications were found for greater improvements during treatment when parents had higher anxiety symptoms before treatment. Changes in parental anxiety symptoms were found to be related to changes in child anxiety symptoms. This was not found for the total clinical severity of all inclusion anxiety disorders. This relation was visible independently in fathers or mothers, or in groups of children with a primary social anxiety disorder or with another primary anxiety disorder. In conclusion, we did not find clear indications that parental anxiety symptoms explain the differences in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. More research with larger samples is needed to draw stronger conclusions.
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The COVID-19 pandemic is a chronically stressful event, particularly for youth. Here, we examine (i) changes in mood and anxiety symtpoms, (ii) pandemic-related stress as a mediator of change in symptoms, and (ii) threat processing biases as a predictor of increased anxiety during the pandemic. A clinically well-characterized sample of 81 youth ages 8–18 years (M = 13.8 years, SD = 2.65; 40.7% female) including youth with affective and/or behavioral psychiatric diagnoses and youth without psychopathology completed pre- and during pandemic assessments of anxiety and depression and COVID-related stress. Forty-six youth also completed a threat processing fMRI task pre-pandemic. Anxiety and depression significantly increased during the pandemic (all ps < 0.05). Significant symptom change was partially mediated by pandemic stress and worries. Increased prefrontal activity in response to neutral faces pre-pandemic was associated with more intense parent-reported anxiety during the pandemic (all Fs(1.95,81.86) > 14.44, ps < 0.001). The present work extends existing knowledge on the mediating role of psychological stress on symptoms of anxiety and depression in youth.
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Background: Risk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown. Aims: This systematic review explores how periods of COVID-19 lockdown impacted women's perinatal mental health. Methods: Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020-25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized. Findings: Sixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention. Conclusion: Developing resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.
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Paranoid ideas are the most common abnormal beliefs in the schizophrenia spectrum, are also prevalent in non-clinical populations, and are highly correlated with other mental health problems such as anxiety, depression and low levels of well-being. Two previous studies with the same British population sample used confirmatory factor analysis and network analysis to show that the spectrum of paranoid beliefs is made up of four factors or dimensions (i.e., interpersonal sensitivity, mistrust, ideas of reference and ideas of persecution). The aims of this study are: 1) to explore the distribution and the structure of paranoid beliefs in a Spanish general population by applying the network approach and 2) to use network analysis to explore for the first time whether specific domains of paranoid ideation (i.e., dimensions) are specifically associated with mental health correlates such as depression, anxiety, loneliness, and well-being. We found a continuous distribution of paranoid beliefs among the 1328 individuals constituting the sample (e.g., 29,2 % did not endorse any items, 4.6 % endorsed half of the items, while 0.8 % endorsed all paranoid items). Paranoid ideas form three dimensions; interpersonal sensitivity, mistrust, and ideas of persecution (ideas of reference did not form a separate factor). The network model showed that loneliness has a pivotal role in connecting paranoid ideation with general psychopathology measures (i.e., depression, anxiety, loneliness and well-being). Research and clinical implications derived from our findings are also discussed.
Article
Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioural therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.
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Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.
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Social anxiety disorder (SAD) is a common psychological disorder associated with broad interpersonal impairment. Most previous studies have examined nonverbal behavior in SAD using human coders. However, one recent study utilized a machine-based analysis of nonverbal behavior and dyadic synchrony in SAD (Asher, Kauffmann, & Aderka, 2020). In the present study, we compared human and computer assessments of nonverbal behavior in social anxiety to enhance our knowledge about their commonalities and unique differences in capturing nonverbal behavior in the context of SAD. Specifically, the present study included 152 individuals: 38 individuals diagnosed with SAD and 114 individuals without SAD. Participants formed 76 opposite-sex interaction dyads comprising either two individuals without SAD (n = 39 control dyads) or one individual with SAD and one individual without SAD (n = 37 SAD dyads). All participants underwent a getting-acquainted task and were videotaped during the conversation. Half of the interactions were small talk interactions and half were closeness-generating interactions that required significant self-disclosure. We found that both types of coding were associated with self-reported social anxiety but that machine-based coding was superior in capturing social anxiety in closeness-generating contexts. Implications for research on nonverbal behavior in SAD are discussed.
Article
An important aim of basic research in Clinical Psychology is to improve clinical practice (e.g., by developing novel interventions or improving the efficacy of existing ones) based on an improved understanding of key mechanisms involved in psychopathology. In the first part of this article, we examine how frequently this translation has happened in the past by reviewing all 40 evidence-based psychological interventions recommended in current clinical guidelines for five important (groups of) mental disorders. Results show that only 23% of treatments showed a very strong link between basic research and the development of the intervention, and further 20% showed a strong link. These findings thus suggest that the route from basic research to clinical innovation may not be as strong historically as is commonly assumed. Important challenges for translational research in clinical psychology are reviewed, leading to the introduction of a new framework, and a discussion of possible solutions to overcome these challenges. Suggestions include increased attention to robust and replicable research findings, a stronger focus on experimental psychopathology research to establish causality of psychopathological mechanisms, a more systematic structural integration of basic and applied research in clinical psychology, a stronger emphasis on mechanisms of change and moderators of clinical interventions, increased attention to clinical subgroups, and emphasizing improvements to existing interventions over the development of novel interventions.
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There are preliminary findings that repetitive thinking on social situations (post-event processing; PEP) is associated with impaired cortisol recovery after experiencing social evaluative stressors. However, no studies have examined the effect of experimental manipulation of PEP on cortisol recovery among socially anxious individuals. The aim of the present study was to examine the effect of distraction on cortisol recovery following a social-evaluative stressor in individuals with subclinical social anxiety symptoms. A total of 40 participants, who scored >30 on the Liebowitz Social Anxiety Scale, completed a standardized stress test (the Trier Social Stress Test; TSST). They were then randomized to complete either a 10-min distraction or PEP induction task. Subjective anxiety and salivary cortisol levels were assessed at −20, −10, 0, +10, +20, +30, +40, and +50 min, with respect to the TSST offset. Contrary to the hypothesis, no difference in cortisol recovery was observed between distraction induction and PEP induction. These findings suggest that short-term distraction induction may not be sufficient to promote cortisol recovery in individuals with elevated social anxiety.
Article
Background Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning, identifying aspects of social cognition that may be impaired can increase our understanding of the development and maintenance of social anxiety disorder. However, to date, studies examining associations between social anxiety and social cognition have resulted in mixed findings. Methods The aim of this systematic review was to summarize the literature on the association between social anxiety and social cognition, while also considering several potential moderators and covariates that may influence findings. Results A systematic search identified 48 studies. Results showed mixed evidence for the association between social anxiety and lower-level social cognitive processes (emotion recognition and affect sharing) and a trend for a negative association with higher-level social cognitive processes (theory of mind and empathic accuracy). Most studies examining valence-specific effects found a significant negative association for positive and neutral stimuli. Limitations. Not all aspects of social cognition were included (e.g., attributional bias) and we focused on adults and not children, limiting the scope of the review. Conclusions Future studies would benefit from the inclusion of relevant moderators and covariates, multiple well-validated measures within the same domain of social cognition, and assessments of interpersonal functioning outside of the laboratory. Additional research examining the moderating role of attention or interpretation biases on social cognitive performance, and the potential benefit of social cognitive skills training for social anxiety could inform and improve existing cognitive behavioral interventions.
Article
Eating disorders (EDs) are serious mental illnesses that are highly comorbid with depressive and anxiety disorders. However, the underlying psychological mechanisms of this comorbidity are not yet clearly delineated. One such mechanism is self-criticism (i.e., harsh and overly critical self-evaluation). In this review, we summarize the literature investigating self-criticism as a transdiagnostic maintenance factor of EDs, depression, and anxiety to formulate a theoretical model of self-criticism as a transdiagnostic mechanism of comorbid EDs, depression, and anxiety. We also point to potential limitations of the current literature and outline future research directions needed to investigate and refine the proposed theoretical model. Future research investigating self-criticism as a transdiagnostic mechanism of psychiatric comorbidity among the EDs may lead to the development an evidence-based model of self-criticism as a transdiagnostic mechanism of psychiatric comorbidity and transdiagnostic treatment protocols that simultaneously improve outcomes for multiple psychiatric conditions.
Article
To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.
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Background Research is needed to determine the extent to which internet-delivered psychological therapies are effective when delivered in countries and cultures outside of where they were developed. Objective This waitlist-controlled study evaluated the efficacy of a UK-developed, therapist-guided internet Cognitive Therapy programme for Social Anxiety Disorder (iCT-SAD) when delivered in Hong Kong by local therapists. Methods Patients were randomized to iCT-SAD (n = 22) or a waitlist control group (n = 22). Assessments took place at weeks 0, 8, and 15 (posttreatment/postwait), with a further 3-month follow-up assessment for the iCT-SAD group. The primary outcome measure was the Liebowitz Social Anxiety Scale (self-report), and posttreatment/postwait diagnostic assessments were completed by independent assessors blind to condition. Trial Registration: ISRCTN11357117. Results Compared with the waitlist group, iCT-SAD significantly reduced social anxiety symptoms (adjusted difference at posttreatment 55.36, 95%CI 44.32 to 66.39, p < 0.001; dCohen 2.41). The treatment was also superior to waitlist on all secondary outcome measures. 86% of the iCT-SAD group demonstrated remission from SAD based on the LSAS, compared to 5% of the waitlist group. 73% no longer met diagnostic criteria at posttreatment, compared to 9% of the waitlist group. The gains made by the iCT-SAD group were maintained at three-month follow-up. Conclusions iCT-SAD showed strong efficacy for the treatment of SAD in Hong Kong. As the clinical outcomes were similar to UK studies, this suggests the dissemination of the treatment into a different cultural setting did not result in a substantial loss of efficacy.
Article
Background Diminished olfactory functioning has been reported in depression, whereas evidence in anxiety disorders is still controversial. Olfactory meta-cognitive abilities (i.e., olfactory awareness, imagery and reactivity, and the importance of odors) are essential in shaping olfaction. Few studies examined these meta-cognitive abilities in relation to depressive, anxiety, and social anxiety symptoms, and none of them considered the awareness of social odors (i.e., body odors). Methods This pre-registered study examined the relationship between olfactory meta-cognitive abilities and symptoms of depression, general anxiety, and social anxiety in 429 individuals. Self-report measures of symptoms of depression, general anxiety, and social anxiety, along with self-report olfactory meta-cognitive scales, were collected using an online survey. Results Linear regression analyses revealed that olfactory awareness and importance of common odors were significantly directly predicted by symptoms of general anxiety, while affective importance to odors was negatively predicted by symptoms of depression. Regarding social odors, higher symptoms of depression and lower symptoms of social anxiety predicted increased awareness. Limitations Higher prevalence of women and narrow age range of the participants. Depressive and anxiety symptoms were assessed only with self-report questionnaires. Conclusions Symptoms of anxiety seem to be associated with higher levels of common odor awareness, corroborating the importance of olfactory functions in anxiety. In addition, results on social odors seem to reflect dysfunctional social behaviour that characterized symptoms of depression and social anxiety. Hence, the assessment of meta-cognitive abilities may represent a useful tool in the prevention and assessment of depressive, anxiety, and social anxiety symptoms.
Article
Background Alexithymia can lead to problematic mobile phone use (PMPU). However, the underlying mechanisms remain unclear. Methods Drawing on the Interaction of Person-Affect-Cognition-Execution model, the present study tests the mediating effects (parallel and serial) of social interaction anxiety (SIA) and core self-evaluations (CSE) on the relationship between alexithymia and PMPU. We obtained 1267 valid responses from adolescent students (mean age, 20.36, standard deviation, 0.97) from southeast China who completed the Mobile Phone Addiction Index, Toronto Alexithymia-20 Scale, Social Interaction Anxiousness Scale, and Core Self-Evaluation Inventory. Results After controlling for demographic variables (i.e., gender) as covariates, the results revealed that: (1) alexithymia had a positive predictive effect on PMPU in adolescent students; (2) SIA and CSE mediated the association between alexithymia and PMPU; and (3) a series of indirect pathways (i.e., from alexithymia to PMPU via SIA and CSE) were detected. Thus, alexithymia can directly affect (parallel mediation) PMPU by increasing SIA and lowering CSE simultaneously. However, alexithymia can also indirectly affect (serial mediation) PMPU by increasing the level of SIA by decreasing CSE. Limitations Data were collected by participant self-report. This method may lead to recall bias. Further, we adopted a cross-sectional rather than an experimental design, thus precluding causal conclusions. Lastly, it would be useful to validate our findings with other age groups outside southeast China. Conclusions The current study findings are conducive to understanding the relationship between alexithymia and PMPU and inspire the prevention and intervention of PMPU.
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The pursuit of relationship goals is critical to the wellbeing of young adults. This study investigated different achievement goals toward social competence as potential predictors of social anxiety and depression symptoms. It proposed that self-esteem may function as a mediator on the pathway from endorsing social achievement goals to undergraduates' concurrent and longitudinal social anxiety and depression symptoms. Social achievement goal theory proposes three types of goals: social mastery goals (striving to improve one's social competence), social performance-approach goals (striving to prove one's social competence and win positive evaluation), and social performance-avoid goals (striving to avoid incompetent social behaviors and negative evaluation). One hundred and eighty-five Chinese undergraduates aged from 18 to 23 (50% female) completed this study across two-time points. Path analyses indicated that social mastery (marginally) and performance-approach goals were positively associated with self-esteem, whereas social performance-avoid goals were negatively associated with self-esteem; self-esteem was negatively associated with the concurrent social anxiety and depression symptoms and the longitudinal depression symptoms. The proposed mediation effects of self-esteem on the links from three types of social achievement goals to the concurrent and longitudinal social anxiety and depression symptoms were significant except on the links from social mastery goals and social performance-approach goals to the subsequent social anxiety symptoms. Self-esteem and the baseline social anxiety and depressive symptoms have a chain mediating effect between social achievement goals and the longitudinal symptoms of social anxiety and depression. These findings suggest that the pursuit of social mastery goals and performance-approach goals in initiating and maintaining social relationships boosts undergraduates' self-worth and reduces their concurrent and longitudinal depression experiences. However, the strivings to hide inadequacy and avoid negative evaluation in social contexts impede one's self-worth and increase concurrent and longitudinal social anxiety and depression symptoms. Implications and limitations are discussed.
Article
Fear of driving is common in clinical practice, while its treatment programs are understudied. This is the first randomized controlled trial to evaluate a newly developed protocol for cognitive behavior therapy (CBT) for driving fear compared with a wait list and to use specific assessment scales. 34 participants (30 women, 4 men) in an outpatient psychotherapy clinic were randomly allocated to either 18 sessions of CBT or a wait list (n = 17 each). After treatment, CBT was significantly more efficacious than the wait list with large effect sizes on the Instrument for Fear of Driving (IFD) (Cohen’s d = 2.58) and on the Driving Cognitions Questionnaire (DCQ) (Cohen’s d = 2.14). Driving fear is a condition treatable by CBT and the suggested protocol is safe, feasible and acceptable. Further studies with larger samples and active controls (e.g., virtual reality therapy) are required to draw generalizable conclusions on effect sizes.
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