Anger in social anxiety disorder.

The present study focused on the emotional experience of anger among individuals with and without social anxiety disorder (SAD). Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling measurement (ESM) in which they reported on daily social interactions and emotions. Using multilevel linear modeling we found that individuals with SAD experienced more anger compared to individuals without SAD. We also found a Diagnosis × Social Context interaction such that interactions with distant others were associated with elevated anger compared to interactions with close others for individuals with SAD but not for individuals without SAD. Finally, we found that for individuals with SAD (but not those without SAD) anger on a given day (day t) was associated with elevated anxiety on the following day (day t + 1), above and beyond previous anxiety, sadness and guilt (i.e. anxiety, sadness and guilt reported on day t). This suggests that anger may play a unique role in maintaining or exacerbating anxiety among individuals with SAD. Additional implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder.

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety-depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Pre-reproductive stress in adolescent female rats alters maternal care and DNA methylation patterns across generations.

Stress during development affects maternal behavior and offspring phenotypes. Stress in adolescence is particularly consequential on brain development and maturation, and is implicated in several psychiatric disorders. We previously showed that pre-reproductive stress (PRS) in female adolescent rats affects behavior and corticotropin releasing hormone receptor 1 (CRHR1) expression in first- (F1) and second- (F2) generation offspring. We further showed that offspring phenotypes are partially reversed by post-stress treatment with fluoxetine (FLX) or the CRHR1 antagonist NBI27914 (NBI). Epigenetic processes, such as DNA methylation, are implicated in the stress response and interact with maternal care quality across generations. Here, we asked whether PRS and FLX or NBI exposure would affect maternal care and global DNA methylation in the brains of exposed dams and their adult F1 and paternally-derived F2 offspring. We found that PRS decreased self-care while increasing pup-care behaviors. PRS also increased DNA methylation in the amygdala of dams and their F1 male offspring, but decreased it in F2 females. Drug treatment had no effect on maternal care, but affected DNA methylation patterns in F0 and F1 generations. Furthermore, PRS altered the expression of DNA methylating enzymes in brain, blood and oocytes. Finally, maternal care variables differentially predicted methylation levels in PRS and control offspring. Thus, the effects of adolescent stress are long-lasting and impact methylation levels across three generations. Combined with our findings of epigenetic changes in PRS-exposed oocytes, the present data imply that biological changes and social mechanisms act in concert to influence adult offspring phenotypes.

Blend in or stand out: social anxiety levels shape information-sharing strategies.

Although living in social groups provides many benefits for group members, such groups also serve as a setting for social competition over rank and influence. Evolutionary accounts suggest that social anxiety plays a role in regulating in-group conflict, as individuals who are concerned about social threat may choose to defer to others to maintain the hierarchical status quo. Here, we examine how social anxiety levels are related to the advice-giving style an individual adopts: a competitive influence-seeking strategy or a defensive blend-in strategy. We begin by demonstrating that similarity to others drives activity in the brain's valuation system, even during a competitive advice-taking task. Then, in three behavioural experiments, we show that social anxiety levels are related to the tendency to give advice resembling the advice given by rival advisers and to refrain from status-seeking behaviour. Social anxiety was also associated with negative social comparisons with rival advisers. Our findings highlight the role of competing social goals in shaping information sharing.

The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis.

Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.

Are some therapists better at facilitating and consolidating sudden gains than others?

BACKGROUND: Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs. METHODS: The analyses are based on a sample of patients (N = 1937) who were seen by 155 therapists and received individual psychotherapy at a university outpatient clinic. First, the therapist effect (TE) on SG was investigated using multilevel modeling (MLM). Second, MLM was used to explore the relative importance of patient and therapist variability in SGs as they relate to outcome. RESULTS: The TE on SGs accounted for 1.8% of variance, meaning that therapists are accountable for inter-individual differences in their patients' likelihood to experience SGs. Furthermore, results revealed a significant effect of SGs on outcome for both levels, while therapist differences regarding the consolidation of SGs were not significant. CONCLUSIONS: The analyses indicated that some therapists are better in facilitating and initiating SGs. The process of triggering SGs seems to be a therapist skill or competence, which opens up an additional pathway to positive outcomes that could be used to improve clinical training.

Biased distance estimation in social anxiety disorder: A new avenue for understanding avoidance behavior.

OBJECTIVES: People regulate their interpersonal space appropriately to obtain a comfortable distance for interacting with others. Socially anxious individuals are especially prone to discomfort from and fear of physical closeness, leading them to prefer a greater interpersonal distance from others. Previous studies also indicate that fear can enhance the threat-related elements of a threatening stimulus. For example, spider phobia is associated with estimating spiders as bigger and faster than they actually are. Nonetheless, it is still unclear whether the preference of those with social anxiety disorder (SAD) to maintain greater distance from others is associated with biased estimations of interpersonal distance. MATERIALS AND METHODS: A total of 87 participants (44 clinically diagnosed with SAD and 43 control) performed validated computerized and ecological tasks in a real-life setting while social space estimations and preferences were measured. RESULTS: Participants with SAD felt comfortable when maintaining a greater distance from unfamiliar others compared to the control group and estimated unfamiliar others to be closer to them than they actually were. Moreover, the estimation bias predicted their preferred distance from strangers, indicating a strong association between estimation bias severity and actual approach-avoidance behavior. CONCLUSION: Our findings indicate that distance estimation bias underlies avoidance behavior in SAD, suggesting the involvement of a new cognitive mechanism in personal space regulation.

Admixture analysis of age at onset in older patients with schizophrenia spectrum disorders.

The nature of schizophrenia spectrum disorders with an onset in middle or late adulthood remains controversial. The aim of our study was to determine in patients aged 60 and older if clinically relevant subtypes based on age at onset can be distinguished, using admixture analysis, a data-driven technique. We conducted a cross-sectional study in 94 patients aged 60 and older with a diagnosis of schizophrenia or schizoaffective disorder. Admixture analysis was used to determine if the distribution of age at onset in this cohort was consistent with one or more populations of origin and to determine cut-offs for age at onset groups, if more than one population could be identified. Results showed that admixture analysis based on age at onset demonstrated only one normally distributed population. Our results suggest that in older schizophrenia patients, early- and late-onset ages form a continuum.

Reducing avoidance in adults with high spider fear using perceptual discrimination training.

BACKGROUND: Fear overgeneralization is a central feature of anxiety disorders and can lead to excessive avoidance. As perceptual discrimination is a key component of fear overgeneralization, a perceptual discrimination training task was created aimed at improving perceptual discrimination and reducing fear overgeneralization. METHODS: Participants with high spider fear were randomized into training or placebo conditions. After completing their assigned task, perceptual discrimination was tested. Thereafter, participants completed a behavioral avoidance test, consisting of five stimuli ranging from a paper spider to a live tarantula. Last, participants completed a threat/safety discrimination task using schematic morphs ranging from a flower to a spider, while self-report and skin conductance responses were collected. RESULTS: The training group showed better perceptual discrimination during the test than did the placebo group. Furthermore, as stimuli became increasingly similar to a live spider, participants in the training group exhibited decreased avoidance behavior. Finally, participants in the training group indicated that schematic morphs were less similar to a spider and showed less physiological arousal than did the placebo group. CONCLUSIONS: Together, these results attest to the possible clinical relevance of the perceptual discrimination training.

Gender differences in social anxiety disorder.

OBJECTIVE: Despite the ample literature on gender differences in anxiety and mood disorders, gender differences in social anxiety disorder (SAD) have received little empirical attention. The aim of the present study is to examine gender differences in 12-months prevalence, patterns of comorbidity, clinical presentation, subjective distress and functional impairment, age of onset, and treatment seeking, and discuss their clinical implications. METHOD: We used data from the National Comorbidity Survey-Replication (NCS-R; n = 652, 63.3% women) to examine gender differences. RESULTS: Main findings highlighted that compared with men, women are more likely to have SAD, to have a more severe clinical presentation of the disorder and to have greater subjective distress. Women are more likely than men to have comorbid specific phobia, generalized anxiety disorder and posttraumatic stress disorder, whereas men are more likely to have comorbid substance abuse disorders and conduct disorder. CONCLUSIONS: Greater SAD prevalence and severity among women can have implications for assessment (e.g., potentially setting gender-specific cutoffs) and treatment (e.g., guiding exposures) of SAD.

The relationship between positive affect and negative affect during treatment for major depressive disorder.

OBJECTIVE: The present study examined the relationship between positive affect (PA) and negative affect (NA) along the course of combined cognitive behavior therapy and pharmacological treatment for major depressive disorder (MDD). METHOD: Participants were 165 individuals who sought treatment for MDD in a partial hospital setting. Participants' PA, NA, and depressive symptoms were measured at pre- and post-treatment and PA and NA were measured at up to 10 additional measurements along the course of treatment. RESULTS: Results indicated that PA at pre-treatment predicted depressive symptoms at post-treatment above and beyond NA and the PA*NA interaction. However, an analysis of patterns of change during treatment using lower level mediational modeling in a multilevel framework indicated that NA predicted subsequent PA to a greater extent than vice versa. CONCLUSION: Though many treatments for MDD predominantly focus on reducing NA, our findings suggest that PA may be an important predictor of outcome in treatment for MDD, and that the inclusion of interventions to increase the experience of PA may help improve the efficacy of treatment.

The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement.

BACKGROUND: High levels of prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTS) are relatively common following bereavement. The two types of bereavement complications share some but not all of the same features. Little research has studied which of the two precedes the other following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in PGS and PTS during the first 4 years following old age spousal loss. METHODS: Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who during the year of 2006 lost their spouse. Participants completed self-report questionnaires at 6 months (n = 237), 13 months (n = 198), 18 months (n = 192), and 48 months (n = 213) post loss. Main outcome measures were Inventory of Complicated Grief-Revised and the Harvard Trauma Questionnaire. RESULTS: Lower level mediation analyses were performed. Results indicated that PGS mediated 83% of the relationship between time and PTS, whereas PTS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTS following spousal bereavement to a greater extent than vice versa. CONCLUSIONS: The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological interventions at an early point in the long-term perspective following old age spousal bereavement.

Posttraumatic symptom structure across age groups.

The applicability of diagnostic criteria of Posttraumatic Stress Disorder to the pediatric population has been a focus of much debate (e.g., Carrion, Weems, Ray, & Reiss, 2002 ), informing changes in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). The current study examined the factor structure of posttraumatic distress among adult versus pediatric samples using confirmatory factor analysis. The analysis was performed on the DSM-IV-adherent Posttraumatic Diagnostic Scale (Foa, Cashman, Jaycox, & Perry, 1997 ) and Child Posttraumatic Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001 ). The sample included 378 adult and 204 child and adolescent victims of diverse single-event traumas. A series of models based on previous findings and DSM-IV specification were evaluated. A 4-factor model (Intrusions, Avoidance, Dysphoria, and Hyperarousal), similar to the DSM-5 model, best fit the data among adults, and a different 4-factor model (Intrusion, Avodiance, Numbing, and Hyperarousal) best fit the data among children and adolescents. Despite some similarity, the posttraumatic symptom profiles of pediatric and adult samples may differ. These differences are not fully incorporated into the DSM-5, and warrant further examination.

Effectiveness of cognitive behavior therapy for severe mood disorders in an acute psychiatric naturalistic setting: a benchmarking study.

The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, "real world" settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.

The factor structure of the Liebowitz Social Anxiety Scale for Children and Adolescents: development of a brief version.

The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA-SR) is a validated instrument for the assessment of social anxiety in youth. The three main objectives of the present study were to (a) examine the factor structure of the LSAS-CA-SR; (b) to validate the factors against relevant personality measures, and (c) to create a brief and reliable version of the questionnaire. A total of 1,362 adolescents completed self-report measures of social anxiety, temperament, character and personality traits. The factor structure was examined using a combination of confirmatory and exploratory factor analysis. The analysis was conducted on both the anxiety and avoidance sub-scales, and identical items for both sub-scales were maintained. Two factors emerged: social interaction and school performance. These factors demonstrated high internal consistency and a significant correlation with relevant self-report measures. A brief version comprised of 14 items was highly correlated (0.96) with the full version. The new factor structure represents advancement over the previous efforts, and holds promise for efficient utilization of the LSAS-CA.

Dating in social anxiety disorder: A daily diary study.

Romantic relationships are vital for health, well-being and quality of life, and an increasing percentage of romantic relations begin via use of dating apps and subsequently progress to dates. In the present study we examined dating application use and dates among individuals with SAD (n = 54) and without SAD (n = 54). Our sample included young adults (age range 18 to 33) who were not in a romantic relationship at the time of the study. For both individuals with SAD and without SAD, half of the participants were men, and half were women. We used a daily diary measurement in which participants reported on their dating application use and dates, as well as on concomitant emotions and perceptions for 21 consecutive days. We found that individuals with and without SAD did not differ in the frequency/duration of application use nor in the number of dates attended. However, individuals with SAD experienced dates as more negative compared to individuals without SAD (Cohen's d = 0.65). Interestingly, individuals with SAD did not significantly differ in their experience of dates as positive compared to individuals without SAD. Moreover, use of dating applications/going on dates were associated with increases in shame (Cohen's d = 0.59) and embarrassment (Cohen's d = 0.45) and this was found to a greater extent among individuals with SAD compared to individuals without SAD (Cohen's d = 0.50, 0.39 for shame and embarrassment respectively). Findings are discussed in the context of cognitive behavioral models of SAD and implications for treatment are considered.

Safety behaviors and positive emotions in social anxiety disorder.

The present study examined contextual factors that affect safety behavior use as well as positive emotions when using safety behaviors among individuals with SAD. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling methodology (ESM) measurement in which they reported on daily social interactions, safety behavior use, and emotions. Using multilevel linear modeling we found that both individuals with and without SAD used more safety behaviors when interacting with distant others compared to close others, but this effect was greater for individuals with SAD compared to individuals without SAD. We also found that social anxiety significantly moderated the relationship between safety behaviors in social interactions and positive emotions. Specifically, our findings indicated that individuals with higher levels of social anxiety reported lower levels of positive emotions when using safety behaviors. Implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Catching a (sine) wave: Temporal dynamics of nonverbal synchrony in social anxiety disorder.

Individuals with social anxiety disorder (SAD) experience a range of interpersonal problems and studies have found that nonverbal synchrony (the coordination between interaction partners' movements) may be impaired in dyads in which one individual has SAD (Asher et al., 2020). In the present study, we examined the temporal dynamics of nonverbal synchrony during "getting aquatinted" conversations of individuals with and without SAD. Specifically, participants (n = 146) formed either SAD dyads (dyads in which one individual had SAD and the other did not; n = 37 dyads), or control dyads (dyads in which both individuals did not have SAD; n = 36 dyads). Dyads were randomized to either small talk or closeness-generating (i.e., intimate) conversations. We found that during conversations, nonverbal synchrony followed a repeating pattern of increases and decreases that was best modeled by a sinusoidal wave (explained variance = 63.74 %). We found significant Diagnosis × Social Context interactions in the temporal dynamics of nonverbal synchrony (i.e., in the parameters of sine waves). Specifically, we found that for SAD dyads (but not control dyads), the average sine wave amplitude which indicates increases and decreases in nonverbal synchrony was greater during small talk conversations compared to closeness-generating conversations. In addition, we found that among control dyads (but not SAD dyads), the average vertical offset of sine waves (i.e., the average level of nonverbal synchrony) during closeness-generating conversations was greater compared to small talk conversations. The findings are interpreted within the context of the social anxiety literature as capturing two distinct social-anxiety related processes, and suggest that when examined temporally (rather than averaged), nonverbal synchrony may be an important implicit biomarker of SAD.

Nonverbal synchrony in diagnostic interviews of individuals with social anxiety disorder.

The present study examined nonverbal synchrony (i.e., synchrony between individuals' movement) during diagnostic interviews of individuals with and without social anxiety disorder (SAD). Specifically, 42 individuals with SAD and 42 individuals without SAD underwent a structured clinical interview, and videos of clinical interviews were analysed using Motion Energy Analysis (an objective machine-based video analysis) to quantify each individuals' movement as well as dyadic synchrony. Results indicated that interviews of individuals with SAD had significantly lower levels of nonverbal synchrony compared to interviews of individuals without SAD. In addition, interviews of individuals with SAD had lower levels of pacing compared to interviews of individuals without SAD (pacing refers to synchrony in which the interviewer initiates movement to which the participant responds). Analyses with social anxiety represented as a continuum of severity (vs. a diagnostic dichotomy) resulted in similar findings. Thus, individuals with SAD synchronized with interviewers' movement to a lesser extent compared to individuals without SAD, and social anxiety was associated with diminished synchrony. Implications for psychopathology and diagnosis of SAD are discussed.

Perception of interpersonal distance and social distancing before and during COVID-19 pandemic.

Since COVID-19 is easily transmitted among people in close physical proximity, the focus of epidemiological policy during the COVID-19 crisis included major restrictions on interpersonal distance. However, the way in which distance restrictions affected spatial perception is unclear. In the current study, we examined interpersonal distance preferences and perceptions at three time points: pre-pandemic, early post-pandemic, and late post-pandemic. The results indicate that following the pandemic outbreak, people perceived others as farther away than they actually were, suggesting that the distance restrictions were associated with an enlargement of perceived interpersonal distance. Interestingly, however, people maintained the same distance from one another as before the outbreak, indicating no change in actual distance behavior due to the risk of infection. These findings suggest that COVID-19 was associated with a change in the way distance is perceived, while in practice, people maintain the same distance as before. In contrast, COVID-related anxiety predicted both a preference for maintaining a greater distance and a bias toward underestimating perceived distance from others. Thus, individuals who were highly fearful of COVID-19 perceived other people to be closer than they actually were and preferred to maintain a larger distance from them. The results suggest that subjective risk can lead to an increased perception of danger and a subsequent change in behavior. Taken together, even when behaviors should logically change, the decision-making process can be based on distorted perceptions. This insight may be used to predict public compliance.