All eyes on me?! Social anxiety and self-directed perception of eye gaze

To date, only little is known about the self-directed perception and processing of subtle gaze cues in social anxiety that might however contribute to excessive feelings of being looked at by others. Using a web-based approach, participants (n=174) were asked whether or not briefly (300 ms) presented facial expressions modulated in gaze direction (0°, 2°, 4°, 6°, 8°) and valence (angry, fearful, happy, neutral) were directed at them. The results demonstrate a positive, linear relationship between self-reported social anxiety and stronger self-directed perception of others' gaze directions, particularly for negative (angry, fearful) and neutral expressions. Furthermore, faster responding was found for gaze more clearly directed at socially anxious individuals (0°, 2°, and 4°) suggesting a tendency to avoid direct gaze. In sum, the results illustrate an altered self-directed perception of subtle gaze cues. The possibly amplifying effects of social stress on biased self-directed perception of eye gaze are discussed.

A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Implementation

BACKGROUND: Despite long-standing calls to disseminate evidence-based treatments for generalized anxiety (GAD), modest progress has been made in the study of how such treatments should be implemented. The primary objective of this study was to test three competing strategies on how to implement a cognitive behavioral treatment (CBT) for out-patients with GAD (i.e., comparison of one compensation vs. two capitalization models). METHODS: For our three-arm, single-blinded, randomized controlled trial (implementation of CBT for GAD [IMPLEMENT]), we recruited adults with GAD using advertisements in high-circulation newspapers to participate in a 14-session cognitive behavioral treatment (Mastery of your Anxiety and Worry, MAW-packet). We randomly assigned eligible patients using a full randomization procedure (1:1:1) to three different conditions of implementation: adherence priming (compensation model), which had a systematized focus on patients' individual GAD symptoms and how to compensate for these symptoms within the MAW-packet, and resource priming and supportive resource priming (capitalization model), which had systematized focuses on patients' strengths and abilities and how these strengths can be capitalized within the same packet. In the intention-to-treat population an outcome composite of primary and secondary symptoms-related self-report questionnaires was analyzed based on a hierarchical linear growth model from intake to 6-month follow-up assessment. This trial is registered at ClinicalTrials.gov (identifier: NCT02039193) and is closed to new participants. FINDINGS: From June 2012 to Nov. 2014, from 411 participants that were screened, 57 eligible participants were recruited and randomly assigned to three conditions. Forty-nine patients (86%) provided outcome data at post-assessment (14% dropout rate). All three conditions showed a highly significant reduction of symptoms over time. However, compared with the adherence priming condition, both resource priming conditions indicated faster symptom reduction. The observer ratings of a sub-sample of recorded videos (n = 100) showed that the therapists in the resource priming conditions conducted more strength-oriented interventions in comparison with the adherence priming condition. No patients died or attempted suicide. INTERPRETATION: To our knowledge, this is the first trial that focuses on capitalization and compensation models during the implementation of one prescriptive treatment packet for GAD. We have shown that GAD related symptoms were significantly faster reduced by the resource priming conditions, although the limitations of our study included a well-educated population. If replicated, our results suggest that therapists who implement a mental health treatment for GAD might profit from a systematized focus on capitalization models. FUNDING: Swiss Science National Foundation (SNSF-Nr. PZ00P1_136937/1) awarded to CF. KEYWORDS: Cognitive behavioral therapy; Evidence-based treatment; Implementation strategies; Randomized controlled trial

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

The Effects of Social Anxiety on the Development of Romantic Relationships in Adolescence

The present study sought to investigate the ways in which social anxiety impedes the development of romantic relationships across adolescence. Previous research has demonstrated a natural progression for romantic associations during adolescence in which teens transition from same- to mixed-sex peer groups, and finally to dyadic relationships with romantic partners (Connolly, Furman, Konarski, 2000; Dunphy, 1963). This model of development was the basis for the present investigation. Social anxiety was examined in terms of how it impacted affiliations at the same- and mixed sex peer group levels, and ultimately the formation of romantic relationships. This project involved administering a series of questionnaires and rating scales to students enrolled in the 9th through \2l grades. Participants included 457 adolescents (196 males, 261 females) recruited from public high schools in the state of Maine. The questionnaires assessed social anxiety, peer acceptance, heterosocial competence, gender composition of adolescent peer networks, dating history, and relationship quality with significant others in the adolescent's life. Higher levels of social anxiety were expected to be associated with impairment at each of these three levels. Given the proposed developmental progression, the effects of anxiety were theorized to be most pronounced within the older cohort of adolescents. Moreover, gender was expected to affect the pattern of results. Social anxiety is most prevalent among females (LaGreca, 1998; LaGreca & Lopez, 1998), who are also thought to progress along the proposed developmental trajectory more quickly than their male counterparts. Therefore, social anxiety was expected to impact the females to a greater degree at each of the three levels. Correlation coefficients, multivariate analyses of variance, and regression analyses were used to evaluate the data. Overall, despite some discrepant findings, the results supported the hypotheses. Social anxiety was affiliated with problems in the same-sex peer group, the mixed-sex clique, and, for older adolescents, romantic relationships. As expected, social anxiety affected females the most at each level. There seems to be a maladaptive pathway that socially anxious teens are following that is markedly different than their non-anxious counterparts.

The Impact of Shyness on Loneliness, Social Anxiety, and School Liking in Late Childhood

Author: Charity M. Walker Title: THE IMPACT OF SHYNESS ON LONELINESS, SOCIAL ANXIETY, AND SCHOOL LIKING IN LATE CHILDHOOD Advisor: Maria T. Riva, Ph.D. Degree Date: August 2011 ABSTRACT Shyness is associated with several emotional, social, and academic problems. While there are multiple difficulties that often accompany shyness, there appear to be some factors that can moderate negative effects of shyness. Research has demonstrated that certain parenting factors affect the adjustment of shy children in early childhood, but there is minimal research illuminating the effect of parenting factors in older age groups. The first purpose of this study was to examine relationships between shyness and loneliness, social anxiety, and school liking. The second purpose was to investigate whether the quality of the relationship between a parent and a 10- to 15-year-olds child influences the amount of loneliness or social anxiety a shy child experiences or how the child feels about school. Parent-child dyads served as participants and were recruited from public and private middle schools and church youth groups in Colorado and Indiana. Child participants completed several self-report surveys regarding their relationship with a parent, shyness, loneliness, social anxiety, and their attitude toward school. Parents completed a survey about their relationship with their child and responded to questions related to their perceptions of their child's shyness. Data was analyzed with a series of correlation and regression analyses. Greater degrees of self-reported shyness were found to be associated with higher levels of loneliness and social anxiety and less positive feelings about school. Due to a problem with multicollinearity during data analysis, this study was not able to explore the effect of the parent-child relationship quality on the associations between shyness and adjustment factors. Overall, these findings imply that shyness remains an important issue as children approach adolescence. Further research is needed to continue learning about the potential importance of parent-child interactions in reducing maladjustment for shy children during late childhood.

Social anxiety and self-concept in adolescence

This study analyzes the relationships between social anxiety and dimensions of self-concept in a sample of 2022 (50.1% males) Spanish adolescents, ranging in age from 12 to 16 year-olds. The social anxiety was assessed by the Social Phobia and Anxiety Inventory (SPAI), and self-concept was measured with the Self-Description Questionnaire II (SDQ-II). Logistic regression analyses show that adolescents with social anxiety are more likely to negatively perceive their relationship with opposite sex peers and have lower scores in self-esteem than students without social anxiety. Furthermore, in most logistic models, students with social anxiety also show a higher probability of perceiving their relation with peers of the same sex in a negative way, considering worse student, less attractive and athletic, and more emotional instable than students without social anxiety. The relevance of sex and grade in the relationship between social anxiety and self-concept in adolescence is discussed.

Subclinical social anxiety and academic performance in adolescence: analysis of theoretical and practical implications

This study analyses the relationship between self-reported social anxiety and academic performance in a sample of 1,616 Spanish students (52.1% males) in compulsory secondary education, aged 12 to 16 years old. Social anxiety was assessed by the Social Phobia and Anxiety Inventory (SPAI) and academic performance was measured with school grades and failing grades. Results reveal that adolescents with social anxiety show a similar academic performance to adolescents without social anxiety. Although t tests found some significant differences in academic grades and number of failing grades, the effect size analysis showed that these differences had no empirical relevance. These findings are discussed considering the gender and grade levels and their theoretical and practical implication.

Efficacy of sertraline in a 12-week trial for generalized anxiety disorder

Objective: Sertraline's efficacy and tolerability in treating generalized anxiety disorder were evaluated. Method: Adult outpatients with DSM-IV generalized anxiety disorder and a total score of 18 or higher on the Hamilton Anxiety Rating Scale were eligible. After a 1-week single-blind placebo lead-in, patients were randomly assigned to 12 weeks of double-blind treatment with placebo (N=188, mean baseline anxiety score=25) or flexible doses (50-150 mg/day) of sertraline (N=182, mean anxiety score=25). The primary outcome measure was baseline-to-endpoint change in the Hamilton anxiety scale total score. A secondary efficacy measure was the Clinical Global Impression (CGI) improvement score; response was defined as a score of 2 or less. Results: Sertraline patients had significantly greater improvement than placebo patients on all efficacy measures at week 4. Analysis of covariance of the intent-to-treat group at endpoint (with the last observation carried forward) showed a significant difference in the decrease from baseline of the least-square mean total score on the Hamilton anxiety scale between sertraline (mean=11.7) and placebo (mean=8.0). Significantly greater endpoint improvement with sertraline than placebo was obtained for mean scores on the Hamilton anxiety scale psychic factor (6.7 versus 4.1) and somatic factor (5.0 versus 3.9). The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). Sertraline was well tolerated; 8% of patients versus 10% for placebo dropped out because of adverse events. Conclusions: Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder.

RELAÇÃO ENTRE ANSIEDADE SOCIAL E EMPATIA

O transtorno de ansiedade social (TAS) pode ser descrito como o medo ou desconforto em situações nas quais o indivíduo acredita que seu desempenho esteja sendo avaliado por outros e onde tema comportar-se de forma humilhante ou embaraçosa. Este medo é acompanhado de sintomas autonômicos como suor, taquicardia e tremores e pode induzir a esquiva de tais situações. Um dos elementos essenciais deste tipo de sintoma é o julgamento que o indivíduo faz a cerca da opinião de outras pessoas. Uma das hipóteses envolvidas neste estudo é a de que este fenômeno patológico envolva mecanismos associados à empatia na medida em que envolve a atitude de colocar-se no lugar de outra pessoa e inferir, mesmo que de maneira distorcida, o que esta pessoa está pensando ou sentindo. Este projeto visa investigar a relevância da capacidade empática de pessoas com altos níveis de ansiedade social na gênese de seus sintomas. Para isso, serão aplicados dois questionários em voluntários adultos: A Escala de Ansiedade de Liebowitz e a Escala Multidimensional de Reatividade Interpessoal de Davis (EMRI), e serão estudadas as possíveis correlações entre a Ansiedade Social e a Empatia. A hipótese a ser testada é a de que indivíduo com altos níveis de ansiedade social teria uma atividade espelho mais acentuada e, com isso, um maior índice de empatia. Espera-se que este tipo de estudo possa contribuir para um melhor entendimento a respeito da fisiopatologia da ansiedade social e, consequentemente, contribuir para o desenvolvimento de formas de psicoterapia comportamentais mais eficazes para este tipo de problema clínico.

Medical conditions and depressive, anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder

OBJECTIVE: The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxiety disorder (GAD). METHOD: A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated. MEASUREMENTS: The measurements used for this study include: Brief Symptom Inventory-18, Mini International Neuropsychiatric Interview, and the Anxiety Disorders Interview Schedule. RESULTS: Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD. CONCLUSION: These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.

Examination of the overlap between DSM-111-R overanxious disorder and DSM-IV generalized anxiety disorder in childhood

Since DSM-III-R criteria for Overanxious Disorder (OAD) was subsumed under Generalized Anxiety Disorder (GAD) in DSM-IV, three studies have investigated the overlap between the diagnoses. Although two studies have identified children meeting both OAD and GAD criteria (OAD/GAD group), a third study has identified children who met criteria for OAD, but not GAD (OAD group). Based on finding these two groups of children, we examined whether children in the OAD group (n= 30) could be differentiated from children in the OAD/GAD group (n=81) based on self and parent report of anxious symptoms and level of functional impairment. Conditional probability rates were also calculated for each of the DSM anxious symptoms to determine their overall clinicalutility. Findings revealed that the OAD group of children experienced fewer anxious symptoms than children in the OAD/GAD group, though both groups showed some amount of impairment. The implications for research and practice are discussed.