Reward positivity moderates the association between pubertal status and social anxiety symptoms in nine-to-12-year-old youths.

The transition to adolescence is characterized by rapid development of puberty, reward processing, and internalizing psychopathology (i.e., depression and anxiety). More advanced pubertal status and altered reward processing are both known to be associated with elevated internalizing symptoms. However, it was unclear to what extent pubertal status and reward processing interacted with each other in predicting internalizing psychopathology. We examined how the puberty-psychopathology association was moderated by the reward processing indexed by ERPs, including the reward positivity (RewP) and the late positive potential (LPP). A-hundred-and-fifteen nine-to-12-year-old typically developing youths (66 girls; Mean age/SD =10.98/1.18 years) reported their pubertal status and symptoms of depression and social anxiety and completed an EEG Doors task that assessed monetary reward feedback processing. A principal component analysis of the ERP data identified a RewP, an anterior LPP, and a posterior LPP, elicited by the win and loss feedback of the task. The puberty-social anxiety relationship was moderated by the RewP, an identified neural marker of reward sensitivity. Specifically, more advanced puberty was associated with heightened social anxiety symptoms in the presence of a larger, but not smaller, RewP. We did not observe any moderating effect of the LPPs. Our study provided novel evidence that a hypersensitivity toward the reward stimuli (indexed by an enlarged RewP) further exacerbated the risks associated with more advanced pubertal status for social anxiety.

Psychometric evaluation of the Social Touch Questionnaire in Chinese adolescents.

Social touch promotes psychological well-being through inducing positive effects on social affiliation and stress alleviation, especially in adolescence. However, there is a scarcity of instruments available for evaluating adolescents' attitude toward social touch in China. The present study aimed to investigate the validity and reliability of the Social Touch Questionnaire (STQ) in Chinese adolescents. A total of 2839 high school students were enrolled, ranging in age from 11 to 19 years. The dimensions of the scale were conducted by exploratory factor analysis, and validated by confirmatory factor analysis. A three-factor model showed the best fit and consisted of the following subgroups: liking of informal social touch, liking of general social touch, and dislike of social touch. Furthermore, positive associations were found between social touch and interaction anxiety, fear of negative evaluation, depressive and anxiety symptoms, and sleep quality. Short-term prediction of dislike of social touch in anxiety symptoms was determined, while no significant predictor of depressive symptoms was found. The STQ demonstrates reliability and validity as a self-report questionnaire designed to assess behaviors and attitudes toward social touch. It effectively adapts to the nuances of the Chinese context among adolescents.

Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions.

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

The impact of physical activity on social anxiety among college students: the chain mediating effect of social support and psychological capital.

Objective: As a topic of widespread concern in the fields of mental health and public health, social anxiety has many negative impacts on the physical and mental health of contemporary college students. Therefore, this study aims to provide new ideas for solving the problem of social anxiety among college students by exploring the potential mediating role of social support and psychological capital in the relationship between physical activity and social anxiety. Methods: A cross-sectional survey was conducted on 874 college students from five universities in Shandong Province. Various self-report tools such as physical activity rating scale, social support scale, positive psychological capital scale, and social anxiety scale were used to collect information needed for this study. Related data. Use this to conduct descriptive statistical analysis, correlation analysis, and mediation effect analysis. Results: The results showed that physical activity was significantly positively correlated with college students' social support (r = 0.354, p < 0.01) and psychological capital (r = 0.448, p < 0.01), and social support was significantly positively correlated with psychological capital (r = 0.556, p < 0.01), the above three are significantly negatively correlated with social anxiety (r = -0.326, -0.381, -0.432, p < 0.01); the mediation effect analysis shows that physical activity has a significant direct effect on college students' social anxiety The effect value is -0.136, accounting for 43.31% of the total effect; social support and psychological capital both play a separate mediating role between physical activity and social anxiety among college students, with effect values of -0.064 and -0.073 respectively, accounting for the total effect. 20.38, 23.25%, and also played a chain intermediary role, with an effect value of -0.041, accounting for 13.05% of the total effect. Conclusion: Current research shows that physical activity can not only directly reduce social anxiety among college students, but also indirectly alleviate social anxiety among college students by increasing the level of social support and psychological capital. This has important reference significance for helping college students in China and even around the world overcome social anxiety.

Indicated Prevention for Children Screened in Routine Health Care: Effectiveness of a Social Skills Program on Social Anxiety and Depressive Symptoms.

Social anxiety is common in childhood and potentially transitions into clinical disorders including depression. The present study aimed to examine the effectiveness of an indicated prevention program for children screened in routine care. Data came from the PROMPt project, a prospective implementation study (10/2018-09/2022) that explored a novel care chain, starting with screening with the Strengths and Difficulties Questionnaire (SDQ) as part of regular health check-ups, followed by indicated assignment and participation in a prevention program. Questionnaires assessing anxiety and depression symptoms were administered shortly after screening or before program participation (T0), six months after screening or after program participation (T1) and at a follow-up, six months after T1 (T2). Children who participated in a group cognitive-behavioral social skills program (TT; n = 145) were compared using mixed model analyses with non-participating children who were either screened as normal (NOR; n = 894) or refused program participation despite indication (NoTT; n = 67). TT scores improved from T0 to T1 compared to NOR and NoTT (anxiety ß = -0.71 and ß = -0.71, social anxiety ß = -0.46 and ß = -0.52, depression ß = -0.52 and ß = -0.73). Improvement was maintained at T2. Moderation analyses showed a trend toward greater benefit for participants with higher baseline scores. Indicated prevention can improve anxiety and depression symptoms in children identified by screening in routine care. Systematic screening and targeted prevention may positively affect mental health of children on a population level.

New insights into recalled parental behavior in social anxiety disorder: A cluster analytic approach.

BACKGROUND: Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables. METHODS: This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables. RESULTS: The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness. LIMITATIONS: The present study is cross-sectional, therefore unable to confirm causal interpretations. CONCLUSION: Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality.

Event-related potentials of social comparisons in depression and social anxiety.

Social comparison is central in human life and can be especially challenging in depression and social anxiety. We assessed event-related potentials and emotions using a social comparison task in which participants received feedback on both their own and a co-player's performance, in participants with depression and/or social anxiety (n = 63) and healthy controls (n = 72). Participants reported more negative emotions for downward (being better than the co-player [participant correct, co-player wrong]) and upward (being worse than the co-player [participant wrong, co-player correct]) comparisons versus even outcomes, with these effects being stronger in depression and social anxiety. At the Medial Frontal Negativity, both controls and depressed participants showed a more negative amplitude for upward comparison versus both the participant and co-player performing wrong. Socially anxious subjects showed the opposite effect, possibly due to greater expectations about being worse than others. The P300 decreased for downward and upward comparisons compared to even outcomes, which may relate to the higher levels of conflict of social inequality. Depressed and socially anxious subjects showed a blunted P300 increase over time in response to the task outcomes, suggesting deficits in allocating resources for the attention of incoming social information. The LPP showed increased amplitude for downward and upward comparison versus the even outcomes and no group effect. Emotional findings suggest that social comparisons are more difficult for depressed and socially anxious individuals. Event-related potentials findings may shed light on the neural substrates of these difficulties.

Social anxiety modulating early processing for social threat words: an ERP study.

Even though some recent research revealed individuals with HSA typically display enhanced processing in the early stages of emotional information processing due to hypervigilance and vulnerability to negative stimuli, it is still unclear whether social anxiety affects the time course underlying processing bias for emotional stimuli. Therefore, the present study aimed to explore the early stage of processing social threat stimuli in high social anxiety (HSA) individuals by recording RTs and EEG data in the emotional Stroop task. Behavioral data showed that the HSA group responded to the threat words faster than neutral words (i.e. negative bias), but no emotional effects in the low social anxiety (LSA) group. Although the P1 component did not show any early effects, ERP data exhibited an enhanced N170 for HSA than for LSA groups. Threat words elicited larger N170 than neutral words in the LSA group only; this emotion effect was not evident in the HSA group. These findings indicated that social anxiety modulates early processing for social threat words. This study revealed the neural mechanisms underlying early emotional processing in individuals with social anxiety, providing insights for the evaluation and intervention of social anxiety.

The Association Between Proneness to Smartphone Addiction and Social Anxiety Among School Students and the Mediating Role of Social Support: A Call to Advance Jordanian Adolescents' Mental Health.

BACKGROUND: Social anxiety is an emerging public health issue associated with significant impairment of social functioning during adolescence. Among many determinants of social anxiety, proneness to smartphone addiction may significantly contribute to the development of social anxiety. To cope with the consequential development of social anxiety, adolescent school students may rely on various forms of social support. Particularly in the Middle East, including Jordan, the relationship between proneness to smartphone addiction and adolescent social anxiety is understudied. AIM: To examine the mediating role of social support in the relationship between proneness to smartphone addiction and social anxiety in a sample of adolescent school students. METHODS: In this cross-sectional study, 432 adolescents were recruited via a random cluster sample from public schools across three provinces in Jordan. The data were collected face-to-face using the Social Anxiety Scale for Adolescents, the Smartphone Addiction Proneness Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS: Significantly higher levels of social anxiety were associated with females of lower economic status who reported more gaming hours and higher levels of proneness to smartphone addiction. Familial social support significantly mediated the relationship between proneness to smartphone addiction and social anxiety, controlling for the other covariates in the social anxiety model. CONCLUSIONS: Familial social support reduced the impact of proneness to smartphone addiction on social anxiety. Nurses may supplement treatment for reducing social anxiety in adolescents suffering from proneness to smartphone addiction by fostering sources of familial social support.

Mutual eye gaze and vocal pitch in relation to social anxiety and depression: A virtual interaction task.

BACKGROUND: Individuals with high social interaction anxiety (SIA) and depression often behave submissively in social settings. Few studies have simultaneously examined the associations between objectively assessed submissive behaviors and SIA or depression, despite their high comorbidity and unknown mechanisms regarding submissiveness. METHODS: A sample of 45 young adults self-reported trait SIA and depression, state positive/negative affect (PA/NA) before and after a virtual social interaction. Participants engaged in a four-minute conversation with a confederate who was trained to behave neutrally. Mutual eye gaze, via eye-tracking, and vocal pitch were assessed throughout the interaction. RESULTS: Depression and SIA were positively correlated with NA, poorer self-rated performance, and vocal pitch. Highly socially anxious women engaged in less mutual eye gaze than highly socially anxious men. Also, vocal pitch was inversely associated with mutual eye gaze and positively related to NA and (nonsignificantly) to self-ratings of poor performance. Finally, our data partially replicated past research on the use of vocal pitch during social stress to detect social anxiety disorder. LIMITATIONS: The current sample is relatively homogenous in educational attainment, age, and race. All research confederates were women. Future research should examine whether these archival data replicate with the latest telecommunication technologies. CONCLUSION: Our findings highlight nuanced relationships among SIA, depression, emotions, self-perceptions, and biobehavioral indicators of submissive behavior-in response to an ambiguously negative/positive social interaction. Sex/gender may interact with these effects, emphasizing considerations for research method designs.

Bullying victimization and bullying perpetration, social anxiety, and social withdrawal in Portuguese adolescents: A reciprocal association model.

Further research is needed to clarify the association of the different forms of bullying with social anxiety and social withdrawal over time in adolescents. This two-wave panel study with a 1-year time lag (October 2021-October 2022) examined the cross-lagged relationships between bullying victimization and bullying perpetration, social anxiety (i.e., fear or distress in social situations), and social withdrawal (i.e., consistent, and deliberate social solitude). Participants were 485 middle school students (234 girls) attending the seventh or eighth grade at Time 1 (T1) (Mage = 12.67 years, SD = 1.14 years). Social anxiety and social withdrawal were assessed using subscales of the Social and Emotional Competencies Evaluation Questionnaire. Bullying perpetration and bullying victimization were assessed using the Bullying and Cyberbullying Behavior Questionnaire-Short Form. The within-wave associations between the study variables were similar at T1 and Time 2 (T2), with the exception that the association between bullying perpetration and social anxiety was much weaker at T1 than at T2. The results of the path analysis showed that T1 bullying perpetration predicted T2 social anxiety, and that T1 bullying victimization predicted T2 social withdrawal. We also found a reciprocal relationship between social anxiety and social withdrawal. These findings highlight the importance of preventive and remediation interventions to reduce social anxiety in adolescents who engage in and experience bullying behavior.

Temporal associations of emotional and social loneliness and psychosocial functioning in emerging adulthood.

Emerging adulthood is an important developmental phase often accompanied by peaks in loneliness, social anxiety, and depression. However, knowledge is lacking on how the relationships between emotional loneliness, social loneliness, social isolation, social anxiety and depression evolve over time. Gaining insight in these temporal relations is crucial for our understanding of how these problems arise and maintain each other across time. Young adults from a university sample (N = 1,357; M = 23.60 years, SD = 6.30) filled out questionnaires on emotional and social loneliness, social isolation, depressive and social anxiety symptoms at three time points within a 3-year period. Random intercept cross-lagged panel models were used to disentangle reciprocal and prospective associations of loneliness subtypes, social isolation, depressive and social anxiety symptoms across time. Results showed that on the within-person level, increases in emotional and social loneliness as well as social isolation predicted higher depression levels on later timepoints. Increases in depressive symptoms also predicted increases in subsequent social loneliness, but not in emotional loneliness. Finally, increases in depressive symptoms predicted increases in social isolation. There were no significant temporal relations between loneliness and social isolation on the one hand and social anxiety symptoms on the other hand. Social distancing imposed by COVID-19 related government restrictions may have impacted the current results. The findings suggest that emotional and social loneliness precede development of depressive symptoms, which in turn precedes development of social loneliness and social isolation, indicating a potential vicious cycle of social loneliness, social isolation and depressive symptoms in emerging adulthood. Social anxiety did not precede nor follow loneliness, depressive symptoms, or social isolation. The current study sheds more light on the temporal order of loneliness and psychopathological symptoms and hereby assists in identifying times where prevention and intervention efforts may be especially helpful to counter development of depression and loneliness.

Mentalizing impairments and hypermentalizing bias in individuals with first-episode schizophrenia-spectrum disorder and at-risk mental state: the differential roles of neurocognition and social anxiety.

Mentalizing, or theory of mind (ToM), impairments and self-referential hypermentalizing bias are well-evident in schizophrenia. However, findings compared to individuals with at-risk mental states (ARMS) are inconsistent, and investigations into the relationship between social cognitive impairments and social anxiety in the two populations are scarce. This study aimed to examine and compare these deficits in first-episode schizophrenia-spectrum disorder (FES) and ARMS, and to explore potential specific associations with neurocognition and symptomatology. Forty patients with FES, 40 individuals with ARMS, and 40 healthy controls (HC) completed clinical assessments, a battery of neurocognitive tasks, and three social cognitive tasks. The comic strip and hinting tasks were used to measure non-verbal and verbal mentalizing abilities, and the gaze perception task was employed to assess self-referential hypermentalizing bias. FES and ARMS showed comparable mentalizing impairments and self-referential hypermentalizing bias compared to HC. However, only ambiguous self-referential gaze perception (SRGP) bias remained significantly different between three groups after controlling for covariates. Findings suggested that self-referential hypermentalizing bias could be a specific deficit and may be considered a potential behavioral indicator in early-stage and prodromal psychosis. Moreover, working memory and social anxiety were related to the social cognitive impairments in ARMS, whereas higher-order executive functions and positive symptoms were associated with the impairments in FES. The current study indicates the presence of stage-specific mechanisms of mentalizing impairments and self-referential hypermentalizing bias, providing insights into the importance of personalized interventions to improve specific neurocognitive domains, social cognition, and clinical outcomes for FES and ARMS.

Computational modeling of social evaluative decision-making elucidates individual differences in adolescent anxiety.

Adolescents experience significant developmental changes during a time of heightened sensitivity to social cues, particularly rejection by peers, which can be especially overwhelming for those with elevated levels of social anxiety. Social evaluative decision-making tasks have been useful in uncovering the neural correlates of information processing biases; however, linking youths' task-based performance to individual differences in psychopathology (e.g., anxiety symptoms) has proven more elusive. Here, we address this weakness with drift diffusion modeling to decompose youths' performance on the social judgment paradigm (SJP) to determine if this approach is useful in discovering individual differences in anxiety symptoms, as well as puberty, age, and sex. A sample of 103 adolescents (55 males, Mage = 14.49, SD = 1.69) completed the SJP and self-report measures of anxiety, as well as self- and parent-reported measures of puberty. The decision threshold parameter, reflecting the amount of evidence needed to make a social evaluative decision, predicted youth self-reported anxiety, above and beyond typical metrics of SJP performance. Our results highlight the potential advantage of parsing task performance according to the underlying cognitive processes. Future research would likely benefit from applying computational modeling approaches to social judgment tasks when attempting to uncover performance-based individual differences in psychopathology.

Diurnal cortisol profiles in autistic adolescents and young adults: Associations with social difficulties and internalizing mental health symptoms.

Several autism-related characteristics, such as social difficulties, may contribute to high perceived stress and increased exposure to stressful life events in some autistic individuals. Repeated exposure to stress might lead to the dysfunction of the hypothalamic-pituitary-adrenocortical-axis and be a vulnerability factor for developing mental health difficulties. Previous studies show contradictory findings on salivary cortisol in autism. In the current study, we investigated diurnal cortisol profiles in autistic adolescents and young adults, as well as their associations with social difficulties, stress exposure, and mental health symptoms. Autistic (n = 48, Mage = 17.6) and nonautistic (n = 51, Mage = 18.4) participants collected salivary cortisol at home six times a day for 2 days. Social difficulties, exposure to stressful life events/bullying, and mental health symptoms were assessed with questionnaires and clinical interviews. Similar diurnal cortisol slopes (DCS) and cortisol awakening responses were observed between the groups, but autistic participants showed higher total cortisol output (AUCG, area under the curve with respect to ground) during the day (b = 19.09, p = 0.009). In the autistic group, more severe social difficulties were associated with flatter DCS (b = 0.01, p = 0.007). Finally, cortisol alterations were associated with self-reported mental health symptoms, especially in autistic females in analyses uncorrected for multiple comparisons. In conclusion, our results do not indicate autism-related group-level alterations in most diurnal cortisol measures, but autistic youth showed higher total cortisol (AUCG) compared with nonautistic peers. More detailed investigation of interindividual variability in cortisol profiles within autistic people might give us important insights into vulnerability to developing stress-related mental health difficulties.

The Impact of COVID on Adolescent Anxiety: Trends, Clinical Considerations, and Treatment Recommendations.

Rates of clinical anxiety have increased during COVID and post-quarantine in youth, with older adolescent girls and youth with minorized racial, gender, and sexuality identities most vulnerable. Given that increased anxiety to a threatening/uncertain environment is adaptive, it is important to conceptualize anxiety from a balanced perspective, evaluating its functionality. For adolescents continuing to struggle with re-integration into their social environments and school avoidance, an exposure framework is necessary to encourage approach behaviors to recalibrate the social environment as safe. Disproportion between demand for services and available providers increased greatly due to the pandemic. Evidence-based treatments for anxiety can be delivered via telehealth, in school, or in primary care settings.

Quality of life, psychological states, and personality traits in patients with pectus excavatum.

Objective: The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE. Methods: A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients' HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits. Results: In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, P < .001) and mental component summary (53.3 ± 8.8, P < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients' self-efficacy (46.1 ± 11.4, P, .001) and level of extraversion (46.5 ± 11.8, P < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores. Conclusions: Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients' psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.

Social anxiety and attentional bias to negative emotional information: the relationship and intervention.

BACKGROUND: According to the cognitive behavioral model of social anxiety, attentional bias to negative emotional information causes and maintains anxiety. The goal of attentional bias modification (ABM) is to reduce anxiety by reducing attention bias to negative emotional information. METHOD: We used questionnaires and experiments to explore the improvement effect of ABM training on social anxiety in college students. In Study 1, we used dot-probe tasks to investigate the attentional bias to negative emotional information and the relationship with social anxiety severity in college students. In Study 2, college students with high social anxiety were divided into two groups: attentional bias modification training task group (ABM) and attention control condition task group (ACC). The ABM group received a continuous intervention for 10 days to observe changes in social anxiety levels and attentional bias scores in the pretest and posttest stages. RESULTS: The results showed that the correlation of attentional bias to negative emotional information and social anxiety severity was significant. Meanwhile, the high social anxiety participants responded more quickly to negative emotional information. After the intervention, social anxiety levels and attentional bias scores of the training group were significantly reduced. CONCLUSIONS: The results showed that attentional bias modification training can reduce attentional bias to negative emotional information in college students with social anxiety and effectively improve their social anxiety.

Comparisons of the amplitude of low-frequency fluctuation and functional connectivity in major depressive disorder and social anxiety disorder: A resting-state fMRI study.

BACKGROUND: Studies comparing the brain functions of major depressive disorder (MDD) and social anxiety disorder (SAD) at the regional and network levels remain scarce. This study aimed to elucidate their pathogenesis using neuroimaging techniques and explore biomarkers that can differentiate these disorders. METHODS: Resting-state fMRI data were collected from 48 patients with MDD, 41 patients with SAD, and 82 healthy controls. Differences in the amplitude of low-frequency fluctuations (ALFF) among the three groups were examined to identify regions showing abnormal regional spontaneous activity. A seed-based functional connectivity (FC) analysis was conducted using ALFF results as seeds and different connections were identified between regions showing abnormal local spontaneous activity and other regions. The correlation between abnormal brain function and clinical symptoms was analyzed. RESULTS: Patients with MDD and SAD exhibited similar abnormal ALFF and FC in several brain regions; notably, FC between the right superior frontal gyrus (SFG) and the right posterior supramarginal gyrus (pSMG) in patients with SAD was negatively correlated with depressive symptoms. Furthermore, patients with MDD showed higher ALFF in the right SFG than HCs and those with SAD. LIMITATION: Potential effects of medications, comorbidities, and data type could not be ignored. CONCLUSION: MDD and SAD showed common and distinct aberrant brain function patterns at the regional and network levels. At the regional level, we found that the ALFF in the right SFG was different between patients with MDD and those with SAD. At the network level, we did not find any differences between these disorders.

Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial.

BACKGROUND: Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. OBJECTIVE: This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. METHODS: A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. RESULTS: In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. CONCLUSIONS: The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. TRIAL REGISTRATION: UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035.