Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for Social Anxiety Disorder: A Test of Temporal Precedence

Given the putative importance of maladaptive self-beliefs in cognitive models of social anxiety, there is growing interest in the construct’s influence on social anxiety reduction in treatment. The present study sought to examine whether maladaptive self-beliefs reduce over a 12-week course of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), and whether change in self-beliefs is an indicator of later change in social anxiety symptom severity within treatment. Participants were 77 individuals with SAD who completed measures of maladaptive self-beliefs every 2 weeks of the treatment protocol and measures of social anxiety each week. Using a dynamic bivariate latent difference score framework, results indicated that maladaptive self-beliefs reduced during CBT for SAD, and that change in maladaptive self-beliefs was a significant predictor of later change in social anxiety symptom severity. Reductions in social anxiety was not a significant predictor of later change in self-beliefs. Findings underscore the importance of maladaptive self-beliefs in the maintenance of social anxiety and in treatment for SAD. Moreover, they permit inferences about the temporal sequence of change processes in therapy and are consistent with CBT therapeutic models suggesting that cognitive change precedes symptom change.     

Memory for Physiological Feedback in Social Anxiety Disorder: The Role of Fear of Bodily Sensations

This study examined whether individuals with social anxiety disorder have a memory bias for bodily sensations associated with anxiety. Using a false feedback paradigm, 33 individuals with social anxiety disorder (SAD) and 34 non-anxious control (NAC) participants completed a performance task while monitoring stimuli they were told provided feedback on whether their physiological response was changing or stable. On measures of free recall and recognition for their feedback no differences were found between SAD and NAC individuals. However, among SAD participants only, fear of bodily sensations was significantly associated with enhanced memory for stimuli associated with physiological responses. Results suggest that research and treatment may benefit from considering not only fear of social situations, but also the focus of those fears, such as bodily sensations, when examining memory biases in social anxiety.     

Role of ethnicity in social anxiety disorder: A cross-sectional survey among health science students

AIM: To investigate the influence of ethnicity in social anxiety disorder (SAD), and the relationship with symptom severity, depression and substance use or abuse, in health sciences'' students .METHODS: This was a cross-sectional survey of 112 1^st, 2^nd and 3^rd year students from the Faculty of Medicine and Health Sciences at Stellenbosch University, Cape Town, South Africa. The self-reported Social Anxiety Spectrum questionnaire was used to assess for SAD. The Social Phobia Inventory (SPIN) was adapted to a version called the E-SPIN (Ethnic-SPIN) in order to evaluate the effects of ethnicity. Two sub-questions per stem question were included to assess whether SAD symptoms in social interactions were ethnicity dependent. Substance use was assessed with the Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test, and depression with the Centre for Epidemiological Studies Depression Scale.RESULTS: Of 112 students who completed the E-SPIN questionnaire, 54.4% (n = 61) met criteria for SAD, with significantly more females than males meeting criteria. Ethnicity had a significant effect on SAD symptomatology, but there was no effect of ethnicity on the rates of drug and alcohol abuse in students with and without SAD. Overall significantly more students with SAD met criteria for depression compared with students without the disorder.CONCLUSION: Among university students, SAD is prevalent regardless of whether interactions are with individuals of the same or different ethnic group. However, ethnicity may be an important determinant of social anxiety for some ethnic groups. SAD was significantly associated with major depression but not significantly associated with drug or alcohol abuse.     

社交焦虑障碍患者人格特征及社会支持研究

目的探讨社交焦虑障碍患者的人格特征及社会支持特征。方法对38例社交焦虑障碍患者（研究组）及30名正常人（对照组）采用艾森克个性问卷和社会支持评定量表进行评定,并进行对比分析。结果研究组艾森克个性问卷的N、L维度分均显著高于对照组,E维度分显著低于对照组（P〈0．01）,社会支持评定量表总分及主观支持和对支持利用度因子分均显著低于对照组（P〈0．05或0．01）。结论社交焦虑障碍患者具有神经质、内向和过度掩饰的个性特征;且主观支持和对支持的利用度较低,需社会给予关注。     

In the Presence of Social Threat: Implicit and Explicit Self-Esteem in Social Anxiety Disorder

The present study investigated implicit and explicit self-esteem and the effects of co-morbid depressive disorders on both in a clinical sample of patients with Social Anxiety Disorder (SAD) (n = 40), and in healthy controls (n = 35) following social-threat induction (giving an impromptu speech). Implicit self-esteem was assessed using an implicit association test. Explicit self-esteem was measured with the Rosenberg Self-Esteem Scale. Results indicated that SAD patients had significantly lower implicit self-esteem, relative to healthy controls, and were also characterized by lower explicit self-esteem. Depressed SAD patients revealed more negative explicit self-esteem than non-depressed SAD patients, but no such group differences were found in implicit self-esteem. There were also strong relationships between patients’ explicit self-esteem and symptoms of social anxiety and depression. The findings support cognitive models of SAD and suggest that biased self-processing works on both implicit and explicit levels. Further, it seems that social anxiety and depression are characterized by differential implicit self-evaluative processes.     

Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial

Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness. This study is a parallel groups (two-arm) single-blind randomized controlled trial. A minimum of 96 patients with SAD will be recruited within a public outpatient community mental health clinic in Perth, Australia. The primary outcomes will be self-reported symptom severity, caseness (SAD present: yes/no) based on a structured diagnostic interview, and clinician-rated severity and life impact. Secondary outcomes and mechanism measures include blind observer-rated use of safety behaviors, physiological activity (heart rate variability and skin conductance level) during a standardized speech task, negative self-beliefs, imagery suppression, fear of negative and positive evaluation, repetitive negative thinking, anxiety, depression, self-consciousness, use of safety behaviors, and the EQ-5D-5L and TiC-P for the health economic analysis. Homework completion, group cohesion, and working alliance will also be monitored. The outcomes of this trial will inform clinicians as to whether integrating imagery-based strategies in cognitive behavior therapy for SAD is likely to improve outcomes. Common and distinct mechanisms of change might be identified, along with relative cost-effectiveness of each intervention.     

Alcohol Expectancies and Drinking Behavior in Adults with Social Anxiety Disorder and Dysthymia

Previous research has found a positive relationship between social anxiety disorder and alcoholism, and that certain alcohol outcome expectancies are related to drinking behaviors. The purpose of this study was to examine the relationship among drinking behaviors and alcohol expectancies in treatment-seeking individuals diagnosed with social anxiety disorder or dysthymia, as well as normal controls. No significant differences were found across the 3 groups in alcohol consumption. As expected, socially anxious participants had higher social assertiveness expectancies than both participants with dysthymia and normal controls. Participants with social anxiety disorder had greater tension reduction and global positive change expectancies than the normal controls, but did not differ from participants with dysthymia. Additionally, the increased social assertiveness, tension reduction, and positive change expectancies were found to predict amount of drinking per month for socially anxious participants. Implications for understanding the relationship between social anxiety disorder and alcoholism are discussed.     

Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia

What is known and Background: Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial‐based thought record (TBTR), which targets the restructuring of patients’ core beliefs. Objective: To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT). Methods: A two‐arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven‐column dysfunctional thought record and the positive data log in SAD patients according to DSM‐IV. Results: Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0·001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression – Improvement. In addition, a one‐way ancova , taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0·01 at mid‐treatment and P = 0·004 at post‐treatment), and SADS (P = 0·03 at post‐treatment). What is new and Conclusion: This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders.     

Trait and Daily Emotion Regulation in Social Anxiety Disorder

Emotion regulation strategies vary widely in use and effectiveness across psychological diagnostic categories. However, little data exists on (1) the use of these strategies in social anxiety disorder (SAD), and (2) how trait measures compare with actual daily use of emotion regulation strategies. We collected trait and daily assessments of emotion suppression, cognitive reappraisal, and positive and negative emotions from 40 adults with SAD and 39 matched healthy controls. Participants with SAD reported greater trait suppression and less cognitive reappraisal than healthy controls, and exhibited this same pattern of emotion regulation in daily life. Participants overall reported worse emotional experiences when suppressing positive (vs. negative) emotions, and better emotional experiences when reappraising to feel more positive (vs. less negative) emotions. However, SAD participants exhibited greater benefits (specifically increased positive emotions) from reappraising to feel less negative than healthy controls. These findings highlight the importance of positive emotion regulation strategies, particularly for individuals with SAD.