Liebowitz Social Anxiety Scale (LSAS): Optimal cut points for remission and response in a German sample.

The Liebowitz Social Anxiety Scale (LSAS) is the most frequently used instrument to assess social anxiety disorder (SAD) in clinical research and practice. Both a self-reported (LSAS-SR) and a clinician-administered (LSAS-CA) version are available. The aim of the present study was to define optimal cut-off (OC) scores for remission and response to treatment for the LSAS in a German sample. Data of N = 311 patients with SAD were used who had completed psychotherapeutic treatment within a multicentre randomized controlled trial. Diagnosis of SAD and reduction in symptom severity according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, served as gold standard. OCs yielding the best balance between sensitivity and specificity were determined using receiver operating characteristics. The variability of the resulting OCs was estimated by nonparametric bootstrapping. Using diagnosis of SAD (present vs. absent) as a criterion, results for remission indicated cut-off values of 35 for the LSAS-SR and 30 for the LSAS-CA, with acceptable sensitivity (LSAS-SR: .83, LSAS-CA: .88) and specificity (LSAS-SR: .82, LSAS-CA: .87). For detection of response to treatment, assessed by a 1-point reduction in the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, rating, a reduction of 28% for the LSAS-SR and 29% for the LSAS-CA yielded the best balance between sensitivity (LSAS-SR: .75, LSAS-CA: .83) and specificity (LSAS-SR: .76, LSAS-CA: .80). To our knowledge, we are the first to define cut points for the LSAS in a German sample. Overall, the cut points for remission and response corroborate previously reported cut points, now building on a broader data basis.

The social phobia psychotherapy research network. The first multicenter randomized controlled trial of psychotherapy for social phobia: rationale, methods and patient characteristics.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP.

Screening for social phobia in medical in- and outpatients with the German version of the Social Phobia Inventory (SPIN).

OBJECTIVE: To evaluate the German version of the Social Phobia Inventory (SPIN) as a screening device and to report corresponding cut-off scores for different populations. METHOD: In Study 1, 2043 subjects from a representative sample completed the SPIN. Cut-off values were established on the basis of means and standard deviations. In Study 2, different aspects of validity were examined in a clinical sample comprising 164 subjects, including social phobic individuals, individuals with other anxiety disorders and depression, and non-clinical control subjects. Internal consistency was evaluated. Convergent and divergent validity were explored using several established measures. Finally, the sensitivity and specificity of the German SPIN with regard to social anxiety classification were investigated by means of receiver operating characteristics (ROC) analyses. RESULTS: In Study 1, mean scores and standard deviations were used to determine cut-off scores for the German SPIN. In Study 2, excellent internal consistency and good convergent and divergent validity were obtained. ROC analyses revealed that the German SPIN performed well in discriminating between social phobic individuals on the one hand and psychiatric and non-psychiatric controls on the other. A cut-off score of 25 represented the best balance between sensitivity and specificity. CONCLUSION: Comparable to the original version, the German SPIN demonstrates solid psychometric properties and shows promise as an economic, reliable, and valid screening device.

Cognitive therapy for social phobia: individual versus group treatment.

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.

[Diagnosis of body dysmorphic disorder. A pilot study]. / Diagnostische Erfassung der Körperdysmorphen Störung. Eine Pilotstudie.

The assessment of body dysmorphic disorder (BDD) is complicated by poorly defined diagnostic criteria and a lack of valid instruments. The present pilot study examines the possible benefit of specific instruments in the discrimination of other body image disorders. Thirteen patients with BDD, 13 with disfiguring defects, and 21 with no significant impairment of appearance participated in the study. The participants were recruited from dermatological outpatients on the basis of semistructured diagnostic interviews and clinical ratings of disfigurement. Furthermore, structured interviews were conducted to determine comorbidity with depressive disorders and social phobia and to obtain a clinical rating of obsessive-compulsive symptoms using the modified version of the YBOCS for body dysmorphic disorders. In addition, the Beck depression inventory, the Social Phobia Scale, and the Social Interaction Anxiety Scale were completed. Patients with BDD differed significantly from disfigured and unimpaired patients in obsessive-compulsive symptoms, in particular obsessions, and the discrepancy between personal and clinical rating of disfigurement. However, depression and social phobia scores were only higher in comparison with unimpaired patients. Comorbidity with depressive disorders was significantly increased. Our results support the utility of the specific diagnostic instruments and indicate the particular importance of obsessive-compulsive symptoms in BDD.

Coping with acne vulgaris. Evaluation of the chronic skin disorder questionnaire in patients with acne.

The present study investigated how patients with acne vulgaris cope with their disease. By means of questionnaires, relations and interactions between acne and psyche were evaluated. In addition to the evaluation of a specific questionnaire for patients with chronic skin disorders (CSD), assessing psychosocial impairment by the disease, depression and social anxiety were investigated in patients with acne. The study included 50 patients with acne. The CSD showed significant correlations with Beck's depression inventory, the interaction-anxiety questionnaire and the health locus of control scale. The CSD revealed significant differences compared to a control group of 33 patients with healthy skin. Furthermore the patients' attitudes towards triggering factors and disease-related limitations in everyday life are presented. The results of the study demonstrate that patients with acne suffer from emotional distress and psychosocial problems caused by their disease; however, impairment is not correlated with the objective severity of acne.

Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention.

A randomized controlled trial compared the effectiveness of 4 group treatments for atopic dermatitis, a chronic skin disorder characterized by severe itching and eczema: dermatological educational program (DE), autogenic training as a form of relaxation therapy (AT), cognitive-behavioral treatment (BT), and the combined DE and BT treatments (DEBT). BT comprised relaxation, self-control of scratching, and stress management. Group treatments were also compared with standard medical care (SMC). Assessments at 1-year follow-up showed that the psychological treatments (AT, BT, and DEBT) led to significantly larger improvement in skin condition than intensive (DE) or standard (SMC) dermatological treatment, accompanied by significant reductions in topical steroids used. The results corroborate preliminary reports that psychological interventions are useful adjuncts to dermatological treatment in atopic dermatitis.

[Counseling of parents with children with atopic dermatitis]. / Eltern-Beratung bei Kindern mit atopischer Dermatitis.

Parents who have a child suffering from atopic dermatitis usually have to deal with a lot of problems. They seldom find support in coping with this problem. If families are left alone with these difficulties for a long period of time, chronical problems have to be expected, that might disturb the relationship between the parents and their child. A counseling program for parents of children suffering from atopic dermatitis is presented which was developed to prevent distress and helplessness of the parents. The program involved the following topics: 1. Medical information 2. Coping with scratching and itching 3. Care of the skin 4. Relaxation training. 5. Educational problems. Preliminary experiences with 23 parents indicate the usefulness of the counseling program as an important adjunct to the dermatological therapy of atopic eczema in childhood.

[Cutaneous artefacts--possibilities for treatment and their limits]. / Kutane Artefakte--Behandlungsmöglichkeiten und ihre Grenzen.

Factitious disorders (FD) of the skin are emergency calls of the patient, whose psychological problems are mostly unconscious. The therapeutic approach is difficult, because the patient does not accept the necessary psychiatric or psychotherapeutic therapy. Therefore, they remain under the medical care of their dermatologists. We report on the experiences of our psychological team gathered during a clinical study on 16 patients with FD. We distinguish between three types of FD, each implicating a different therapeutic approach: unconscious FD (type A), conscious FD (type B), and so-called neurotic excoriations (type C). On the basis of 3 corresponding cases, we discuss the possible psychosomatic therapeutic approaches, the indications and limits of the treatment, as well as prognostic aspects.

[The concept of disease in patients with atopic dermatitis]. / Das Krankheitskonzept von Patienten mit endogenem Ekzem.

34 former patients of a dermatological department with atopic dermatitis were compared with 29 patients of an Ear-Nose-Throat-department having similar age, sex and occupation and showing hardly any psychosomatic disturbances. Contrary to our expectations, the empiric-psychological examination did not reveal any impairment of the social behavior or the emotional competence of patients suffering from atopic dermatitis. In comparison to the control group, the patients of the dermatological department attached significantly greater importance to psychological influences on development as well as treatment of the disease. There was a correlation between symptoms "coming from outside" and the social competence; however, this correlation was not significantly greater than the control group. Our investigations suggest that atopic dermatitis may be differentiated into somatical-organizing types and rather psychological-organizing types. The second group shows uncertainties with regard to the social competence.