Fearful responding to interoceptive exposure in social anxiety disorder

There is accumulating evidence suggesting that anxiety sensitivity (AS) may play a role in social anxiety disorder (SAD; e.g., Ball, Otto, Pollack, Uccello, & Rosenbaum, 1995). Precedent research has demonstrated the role of AS in panic disorder and posttraumatic stress disorder, and subsequently, treatment techniques aimed at reducing AS (i.e., interoceptive exposure (IE)) have been studied in these populations (Schmidt and Trakowski, 2004, Wald and Taylor, 2008). The purpose of this study was to examine the types of responses elicited during IE exercises among individuals with SAD. This study describes the responses of individuals with SAD (n = 37) and nonclinical control participants (n = 28) to six IE exercises. Significant differences in responses to the IE exercises were found between participants with SAD and nonclinical controls. However, there were no significant differences in responses to the exercises among persons with SAD, depending on whether the exercises were completed in private versus group settings. Similarity to symptoms during naturally occurring anxiety significantly predicted fearful responding across all exercises in persons with SAD. Implications and directions for future research are discussed.     

Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: A randomized controlled trial

In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3-month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale – self-rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohen's d = 0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.     

Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial

Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.     

Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial

We compared the effects of a 16-week Cognitive-Behavioral Therapy (CBT) program and a Social Recreational (SR) program on anxiety in children with Autism Spectrum Disorders (ASD). Seventy children (9–16 years old) were randomly assigned to either of the programs (n _CBT = 36; n _SR = 34). Measures on child’s anxiety using the Spence Child Anxiety Scale—Child (SCAS-C) and the Clinical Global Impression—Severity scale (CGI-S) were administered at pre-, post-treatment, and follow-ups (3- and 6-month). Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “Normal” and “Borderline” for both programs. Findings from the present study suggest factors such as regular sessions in a structured setting, consistent therapists, social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD.     

Anxiety trajectories in response to a speech task in social anxiety disorder: Evidence from a randomized controlled trial of CBT

The subjective experience of anxiety plays a central role in cognitive behavioral models of social anxiety disorder (SAD). However, much remains to be learned about the temporal dynamics of anxiety elicited by feared social situations. The aims of the current study were: (1) to compare anxiety trajectories during a speech task in individuals with SAD (n = 135) versus healthy controls (HCs; n = 47), and (2) to compare the effects of CBT on anxiety trajectories with a waitlist control condition. SAD was associated with higher levels of anxiety and greater increases in anticipatory anxiety compared to HCs, but not differential change in anxiety from pre- to post-speech. CBT was associated with decreases in anxiety from pre- to post-speech but not with changes in absolute levels of anticipatory anxiety or rates of change in anxiety during anticipation. The findings suggest that anticipatory experiences should be further incorporated into exposures.     

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

BackgroundGroup social skills interventions (SSI) are partially effective for addressing the communication and social interaction impairments experienced by individuals with autism spectrum disorders (ASD). Social anxiety has been found to be a moderating mechanism for SSI in young people with ASD. Comparatively few studies have investigated the effectiveness of SSI in the adult ASD population, and none so far have investigated group approaches incorporating SSI and anxiety management techniques.MethodThe present study describes the design and evaluation of a non-randomised single-arm, 11 week group interaction anxiety and social skills intervention, piloted on three occasions during routine clinical practice at an adult ASD service. The intervention was informed by a cognitive behaviour therapy (CBT) framework. Eighteen cognitively-able adult males with ASD attended. Outcome measures were completed pre- and post-intervention.ResultsSelf-reported social anxiety improved (p = 0.01, d = 0.65). Low mood, general anxiety and functioning did not change significantly (p > 0.05, d < 0.20). Qualitative feedback indicated that participants found the intervention to be acceptable and useful for improving social knowledge and coping strategies, and reducing avoidance behaviours. Attrition was low (n = 2).ConclusionsThese results suggest that integrating SSI and anxiety management techniques in a group format is acceptable to adults with ASD, and can reduce symptoms of social anxiety. Whether SSI enhance social skills in adults requires further investigation. In clinical practice, consideration should be given to augmenting SSI with CBT techniques designed to target concurrent symptoms of social anxiety.     

The From Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD

This study evaluated the efficacy of the From Survivor to Thriver program, an interactive, online therapist-facilitated cognitive-behavioral program for rape-related PTSD. Eighty-seven college women with rape-related PTSD were randomized to complete the interactive program (n = 46) or a psycho-educational self-help website (n = 41). Both programs led to large reductions in interview-assessed PTSD at post-treatment (interactive d = 2.22, psycho-educational d = 1.10), which were maintained at three month follow-up. Both also led to medium- to large-sized reductions in self-reported depressive and general anxiety symptoms. Follow-up analyses supported that the therapist-facilitated interactive program led to superior outcomes among those with higher pre-treatment PTSD whereas the psycho-educational self-help website led to superior outcomes for individuals with lower pre-treatment PTSD. Future research should examine the efficacy and effectiveness of online interventions for rape-related PTSD including whether treatment intensity matching could be utilized to maximize outcomes and therapist resource efficiency.     

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder

Background and ObjectivesNegative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect.MethodsWe used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively.ResultsResults showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women.ConclusionsThese findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.     

A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community,delivered via the Internet

ObjectiveThis study evaluated the efficacy of a spiritually integrated treatment (SIT) for subclinical anxiety in the Jewish community.MethodOne hundred and twenty-five self-reported religious Jewish individuals with elevated levels of stress and worry received SIT (n = 36), progressive muscle relaxation (PMR, n = 42), or a waitlist control condition (WLC, n = 47). SIT and PMR participants accessed Internet-based treatment on a daily basis for a period of 2 weeks. All participants completed self-report assessments at pre-treatment (T1), post-treatment (T2), and 6–8-week follow-up (T3).ResultsSIT participants reported large improvements in primary (stress and worry) and secondary (depression and intolerance of uncertainty) outcomes, and moderate improvements in spiritual outcomes (positive/negative religious coping; trust/mistrust in God). SIT participants reported greater belief in treatment credibility, greater expectancies from treatment and greater treatment satisfaction than PMR participants. SIT participants also reported better improvements in both primary outcomes (stress and worry), one of two secondary outcomes (intolerance of uncertainty), and two of four spiritual outcomes (positive religious coping and mistrust in God) compared to the WLC group, whereas PMR and WLC participants did not differ on most outcomes.ConclusionsResults of this investigation offer initial support for the efficacy of SIT for the treatment of subclinical anxiety symptoms among religious Jews. Results further suggest that it is important to incorporate spiritual content into treatment to help facilitate the delivery of psychotherapy to religious individuals.     

Reduction of depersonalization during social stress through cognitive therapy for social anxiety disorder: A randomized controlled trial

Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome.In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n = 20) or a waitlist period (n = 20) and were compared to healthy controls (n = 21). Self-reported depersonalization was measured immediately after each stress test.Depersonalization significantly decreased following CT, especially in treatment responders (η_p² = 0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety.Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.     

Reductions in social anxiety during treatment predict lower levels of loneliness during follow-up among individuals with social anxiety disorder

IntroductionIndividuals with social anxiety disorder (SAD) are at elevated risk of loneliness, yet little research has examined loneliness in this population. Cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) have demonstrated efficacy in treating SAD, yet research has not examined whether they lead to reductions in loneliness.MethodsThis sample comprised 108 individuals with SAD who were randomized to CBGT, MBSR, or a waitlist control (WL); WL participants were re-randomized to CBGT or MBSR following WL. Assessments were completed pre- and post-treatment, and 3-, 6-, 9-, and 12-month follow-up assessments.ResultsCompared to WL, individuals in CBGT and MBSR were less lonely at post-treatment; there was no difference between treatments after treatment or during follow-up. Greater reductions in social anxiety from pre- to post-treatment predicted lower levels of loneliness during follow-up. Greater reductions in loneliness from pre- to post-treatment also predicted lower levels of social anxiety during follow-up.DiscussionIndividuals who experience reductions in their social anxiety during treatment may also feel less lonely following treatment. Reductions in loneliness also lead to improvements in social anxiety. Future research should continue to examine the relationship between social anxiety and loneliness and how interventions for SAD may help reduce loneliness.     

Impact of a brief behavioral treatment for insomnia (BBTi) on metacognition in older adults

IntroductionBrief (≤4 sessions) behavioral treatment for insomnia (BBTi) improves insomnia symptoms in older adults. Findings for BBTi-related improvements in objective cognition are mixed, with our recent trial reporting no effects. Metacognition (appraisal of one's own performance) has not been examined. This study examined the effects of BBTi on metacognition in older adults with insomnia.MethodsOlder adults with insomnia [N = 62, Mage = 69.45 (SD = 7.71)] were randomized to 4-weeks of BBTi (n = 32; psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, review/maintenance) or self-monitoring control (SMC; n = 30; social conversations). Throughout the study (2 week baseline, 4 week treatment, 2 week post-treament, 2 week 3-month followup), participants completed daily paper/pencil cognitive tasks (measuring verbal memory, attention, processing speed and reasoning) and provided daily metacognition ratings of their performance in four areas: quality, satisfaction, compared to same age peers, compared to own ability. Two-week averages of metacognitive ratings were calculated for baseline, treatment-first half, treatment-second half, post-treatment, and 3-month follow-up. Multilevel Modeling examined treatment effects (BBTi/SMC) over time on metacognition, controlling for age and sex.ResultsA significant group by time interaction (p = 0.05) revealed consistent improvements over time in better metacognitive ratings relative to same age peers for BBTi. Specifically, baseline ratings [mean (M) = 51.21, standard error (SE) = 3.15] improved at first half of treatment (M = 56.65, SE = 3.15, p < 0.001), maintained improvement at second-half of treatment (p = 0.18), showed additional improvement at post-treatment (M = 60.79, SE = 3.15, p = 0.02), and maintained improvement at follow-up (M = 62.30, SE = 3.15; p = 0.02). SMC prompted inconsistent and smaller improvements between baseline (M = 53.24, SE = 3.29) and first-half of treatment (M = 56.62, SE = 3.28; p = 0.004), with additional improvement at second-half of treatment (M = 59.39, SE = 3.28; p = 0.02) that was maintained at post-treatment (p = 0.73) and returned to levels observed at first-half of treatment (M = 57.78, SE = 3.21; p = 0.55). Significant main effects of time (all ps < 0.001) for other metacognition variables (Quality, Satisfaction, Compared to own ability) indicated general improvements over time for both groups.DiscussionMetacognition generally improved over time regardless of treatment. BBTi selectively improved ratings of performance relative to same age peers. Repeated objective testing alone may improve metacognition in older adults with insomnia. Better understanding of metacognition and how to improve it has important implications for older adults as metacognitive complaints have been associated with mild cognitive impairment.     

The effects of cognitive-behavioral therapy for youth anxiety on sleep problems

The present study examined (a) whether sleep related problems (SRPs) improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders, (b) whether variables that may link anxiety and SRPs (e.g., pre-sleep arousal, family accommodation, sleep hygiene) changed during treatment, and (c) whether such changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N = 69 completers, Mage = 10.86). Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders with regard to anxiety yielded greater SRP improvements than nonresponders. Parent report of bedtime resistance and sleep anxiety showed significant improvements. Youth reported lower rates of SRPs compared to their parents and did not demonstrate pre- to post-treatment changes in SRPs. Pre-sleep arousal and family accommodation decreased over treatment but did not predict lower SRPs at posttreatment. Higher accommodation was correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate links between accommodation and posttreatment SRPs.     

Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes

This study examined social anxiety symptoms and/or diagnosis as a predictor of differential short- and long-term cognitive-behavioral treatment (CBT) outcomes. Ninety-one anxiety-disordered youth participated in a randomized clinical trial of CBT. Semi-structured interviews provided dimensional clinical severity ratings (CSRs) for children's principal anxiety disorder at pretreatment, posttreatment, 1-year and 7.4-year follow-up assessments for youth with versus without pretreatment social anxiety. Thirty-nine youth presented with either principal (n = 17), secondary (n = 11), or tertiary social phobia diagnoses (n = 7) or subclinical social anxiety symptoms (n = 4). Hierarchal linear modeling (HLM) indicated that youth made similar gains from pretreatment to posttreatment and 1-year follow-up regardless of their social anxiety symptoms or diagnosis; however, youth with social anxiety symptoms or diagnosis were significantly less improved at 7.4-year follow-up. This pattern was distinct from that of youth with the most severe (CSR = 4) principal anxiety disorders at pretreatment. Though initially responsive to CBT, children who present with social anxiety diagnoses or symptoms may require an enhanced or extended treatment to maintain their gains into young adulthood whether or not social anxiety is considered their principal childhood difficulty.     

Treating specific phobia in youth: A randomized controlled microtrial comparing gradual exposure in large steps to exposure in small steps

IntroductionExposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE).MethodsChildren and young people with a specific phobia (SP) (N = 50, age 8–17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up.ResultsWithin exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one’s individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises.DiscussionSmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.     

The impact of social skills training for social anxiety disorder: A randomized controlled trial

ObjectiveSocial anxiety disorder (SAD) impacts social, occupational and academic functioning. Although many interventions report change in social distress, improvement in social behavior remains under-addressed. This investigation examined the additive impact of social skills training (SST) for the treatment of SAD.MethodUsing a sample of 106 adults who endorsed SAD across numerous social settings, participants were randomized to exposure therapy (imaginal and in vivo) alone, a combination of SST and exposure therapy known as Social Effectiveness Therapy (SET), or a wait list control. The assessment strategy included self-report measures, blinded clinical ratings and blinded assessment of social behavior.ResultsBoth interventions significantly reduced distress in comparison to the wait list control and at post-treatment, 67% of patients treated with SET and 54% of patients treated with exposure therapy alone no longer met diagnostic criteria for SAD, a difference that was not statistically significant. When compared to exposure therapy alone, SET produced superior outcomes (p < .05) on measures of social skill and general clinical status. In addition to statistical significance, participants treated with SET or exposure reported clinically significant decreases on two measures of self-reported social anxiety and several measures of observed social behavior (all ps < .05).ConclusionsBoth interventions produced efficacious treatment outcome, although SET may provide additional benefit on measures of social distress and social behavior.     

Visual search attentional bias modification reduced social phobia in adolescents

Background and objectivesAn attentional bias for negative information plays an important role in the development and maintenance of (social) anxiety and depression, which are highly prevalent in adolescence. Attention Bias Modification (ABM) might be an interesting tool in the prevention of emotional disorders. The current study investigated whether visual search ABM might affect attentional bias and emotional functioning in adolescents.MethodsA visual search task was used as a training paradigm; participants (n = 16 adolescents, aged 13–16) had to repeatedly identify the only smiling face in a 4 × 4 matrix of negative emotional faces, while participants in the control condition (n = 16) were randomly allocated to one of three placebo training versions. An assessment version of the task was developed to directly test whether attentional bias changed due to the training. Self-reported anxiety and depressive symptoms and self-esteem were measured pre- and post-training.ResultsAfter two sessions of training, the ABM group showed a significant decrease in attentional bias for negative information and self-reported social phobia, while the control group did not. There were no effects of training on depressive mood or self-esteem.LimitationsNo correlation between attentional bias and social phobia was found, which raises questions about the validity of the attentional bias assessment task. Also, the small sample size precludes strong conclusions.ConclusionsVisual search ABM might be beneficial in changing attentional bias and social phobia in adolescents, but further research with larger sample sizes and longer follow-up is needed.     

L’addiction aux smartphones : validation française de l’échelle Internet Addiction Test-version smartphone (IAT-smartphone) et caractéristiques psychopathologiques associées

IntroductionSince their first appearance in 1992 smartphones have improved constantly, and their use, combined with the rapid spread of the Internet, has increased dramatically. The recent emergence of this technology raises new issues, at both individual and societal levels. Several studies have investigated the physical and psychological harm that may be caused by smartphones. The issue of excessive smartphone use as an addictive disorder is frequently raised and debated, although it is not acknowledged in international classifications. In France, there is no validated assessment tool for smartphone addiction. Therefore, the aims of this research were: to validate a French translation of the Internet Addiction Test-smartphone version (IAT-smartphone); to study the links between smartphone addiction, Internet addiction, depression, anxiety and impulsivity.MethodTwo hundred and sixteen participants from the general population were included in the study (January to February 2016), which was available online using Sphinx software. We assessed smartphone addiction (French version of the Internet Addiction Scale – smartphone version, IAT-smartphone), specificity of smartphone use (time spent, types of activity), Internet addiction (Internet Addiction Test, IAT), impulsivity (UPPS Impulsiveness Behavior Scale), and anxiety and depression (Hospital Anxiety and Depression scale, HAD). We tested the construct validity of the IAT-smartphone (exploratory factor analysis, internal consistency, non-parametric correlation tests for convergent validity). We also carried out multiple linear regressions to determine the factors associated with IAT-smartphone.ResultsMean age was 32.4 ± 12.2 years; 75.5% of the participants were women. The IAT-smartphone had a one-factor structure (explaining 42 % of the variance), excellent internal consistency (α = 0.93) and satisfactory convergent validity. Smartphone addiction was associated with Internet addiction (ρ = 0.85), depression (ρ = 0.31), anxiety (ρ = 0.14), and some impulsivity subscales, including “negative urgency” (ρ = 0.20; P < 0.01), “positive urgency” (ρ = 0.20; P < 0.01), and “lack of perseverance” (ρ = 0.16; P < 0.05). Age was negatively associated with the IAT-S total score (ρ = −0.25; P < 0.001), and there was a non-significant difference between the IAT-S total scores of men and women (29.3 ± 10.2 vs. 32.7 ± 12.4; P = 0.06). Multiple linear regression showed that age, anxiety, depression, average time spent on the smartphone, impulsivity and Internet addiction explained 71.4 % of the variance of IAT-smartphone scores. However, this score dropped to 13.2 % when Internet addiction was removed from the model. This variable alone explained 70.8 % of the IAT-smartphone scores.ConclusionThe French version of the IAT-smartphone is a reliable and valid questionnaire to assess smartphone addiction. This addiction appears to be strongly linked to anxiety, depression and impulsivity. The strong association between smartphone addiction and Internet addiction suggests that smartphone addiction is one of the many forms of Internet addiction. In fact, smartphones may not be the object of the addiction but rather a medium facilitating Internet access as it makes it possible to connect anywhere anytime. This raises the issue of the potential role of smartphones in speeding up and facilitating the development of Internet addiction.     

Reliability,validity and sensitivity of a computerized visual analog scale measuring state anxiety

Background and objectivesAssessment of state anxiety is frequently required in clinical and research settings, but its measurement using standard multi-item inventories entails practical challenges. Such inventories are increasingly complemented by paper-and-pencil, single-item visual analog scales measuring state anxiety (VAS-A), which allow rapid assessment of current anxiety states. Computerized versions of VAS-A offer additional advantages, including facilitated and accurate data collection and analysis, and applicability to computer-based protocols. Here, we establish the psychometric properties of a computerized VAS-A.MethodsExperiment 1 assessed the reliability, convergent validity, and discriminant validity of the computerized VAS-A in a non-selected sample. Experiment 2 assessed its sensitivity to increase in state anxiety following social stress induction, in participants with high levels of social anxiety.ResultsExperiment 1 demonstrated the computerized VAS-A's test-retest reliability (r = .44, p < .001); convergent validity with the State-Trait Anxiety Inventory's state subscale (STAI-State; r = .60, p < .001); and discriminant validity as indicated by significantly lower correlations between VAS-A and different psychological measures relative to the correlation between VAS-A and STAI-State. Experiment 2 demonstrated the VAS-A's sensitivity to changes in state anxiety via a significant pre- to during-stressor rise in VAS-A scores (F(1,48) = 25.13, p < .001).LimitationsSet-order administration of measures, absence of clinically-anxious population, and gender-unbalanced samples.ConclusionsThe adequate psychometric characteristics, combined with simple and rapid administration, make the computerized VAS-A a valuable self-rating tool for state anxiety. It may prove particularly useful for clinical and research settings where multi-item inventories are less applicable, including computer-based treatment and assessment protocols. The VAS-A is freely available: http://people.socsci.tau.ac.il/mu/anxietytrauma/visual-analog-scale/.     

Pre-treatment shyness mindset predicts less reduction of social anxiety during exposure therapy

This study examined the moderating role of shyness mindset on the reduction of social anxiety during exposure-based treatment. Participants (N = 60) in an intensive outpatient program for anxiety disorders were assessed at pre- and post-treatment. Social performance anxiety decreased dramatically during treatment, but the amount of decrease differed as a function of pre-treatment shyness mindset. At one standard deviation above the mean on both the social performance anxiety and shyness mindset measures, an average reduction of 15 points on the social performance anxiety measure was observed. At one standard deviation above the mean on the social performance anxiety measure and one standard deviation below the mean on the shyness mindset measure, an average reduction of 27 points on the social performance anxiety measure was observed. These results suggest that targeting shyness mindset during exposure-based treatments for social anxiety disorder might increase the effectiveness of treatment for individuals with a high shyness mindset.