Social anxiety and psychological distress among polycystic ovarian syndrome patient's in Pakistan.

OBJECTIVE: To examine the fear of negative evaluation as a predictor, and to explore the association of social anxiety with psychological correlates among women with polycystic ovaries. Methods: The cross-sectional study was conducted from August 2020 to November 2021 after approval form the University of Central Punjab, Lahore, Pakistan, and comprised unmarried women aged 18-26 diagnosed with polycystic ovary syndrome. The sample was raised from different clinics and hospitals based in Lahore and Gujranwala cities. The sample was divided into obese, hirsutism and acne vulgaris groups. Data was collected using a demographic proforma along with standardised Derriford Appearance Scale, Brief Fear of Negative Evaluation Scale, University of California, Los Angeles, Loneliness Scale and the Social Interaction Anxiety Scale. Data was analysed using SPSS 24. RESULTS: Of the 180 patients, 60(33.3%) were in each of the 3 groups. The overall mean age was 21.4+/-2.27 years. A significant association of fear of negative evaluation was found with appearance distress, social anxiety and loneliness (p<0.05). The fear of negative evaluation and appearance distress also significantly predicted loneliness in the subjects (p<0.01). The obese group scored significantly higher in terms of fear of negative evaluation and social anxiety compared to the other groups (p<0.05). Conclusion: Women with polycystic ovaries were found to be suffering from adverse psychological outcomes and social anxiety.

Ansiedade social: adaptação e evidências de validade da forma curta da Social Interaction Anxiety Scale e da Social Phobia Scale para o Brasil / Social anxiety: adaptation and evidence of validity of the short form of the Social Interaction Anxiety Scale and Social Phobia Scale for Brazil

OBJETIVO: A ansiedade social é um transtorno psicológico pouco publicizado, mas com importante distribuição epidemiológica. O presente estudo teve como objetivo adaptar para o contexto brasileiro as versões reduzidas da Social Interaction Anxiety Scale (SIAS) e da Social Phobia Scale (SPS) (SIAS-6 e SPS-6) e produzir evidências de validade. Essas escalas avaliam ansiedade em interações sociais e ansiedade social diante da possibilidade de escrutínio por outras pessoas, sendo complementares. MÉTODOS: Como são escalas com reconhecido uso internacional, a adaptação para o Brasil pode trazer contribuições para as investigações clínicas e científicas acerca do transtorno de ansiedade social. Foram realizados processos criteriosos para a adaptação (tradução, avaliação por juízes, retrotradução, avaliação pelo público-alvo) e conduzido um levantamento on-line com 1.049 pessoas, maiores de 18 anos, com média de idade de 25,98 anos (DP = 7,55). RESULTADOS: Utilizaram-se Análises Fatoriais Confirmatórias e, desse modo, constatou-se que os índices de ajuste produzidos são, em geral, adequados (SRMR < 0,04, CFI > 0,96, TLI > 0,94 e RMSEA < 0,05) e que os itens possuem cargas fatoriais adequadas (entre 0,441 e 0,837). As evidências de validade discriminante também se mostraram satisfatórias, conseguindo diferenciar grupos por renda e orientação sexual, como esperado pela literatura. CONCLUSÕES: Os resultados sugerem que as escalas são adequadas para uso no Brasil, tanto para uso em separado como para uso combinado, como fatores correlacionados.

OBJECTIVE: Social anxiety is a poorly publicized psychological disorder, but with an important epidemiological distribution. The present study aimed to adapt the reduced versions of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) (SIAS-6 and SPS-6) to the Brazilian context and produce evidence of validity. These scales assess anxiety in social interactions and social anxiety in face of the possibility of scrutiny by other people, being complementary. METHODS: As they are scales with recognized international use, adaptation to Brazil can bring contributions to clinical and scientific investigations about Social Anxiety Disorder. Judicious processes for adaptation were carried out (translation, evaluation by judges, back-translation, evaluation by the target audience) and an online survey was conducted with 1,049 people, over 18 years of age with an average age of 25.98 years (SD = 7.55). RESULTS: Confirmatory Factor Analysis was used and, thus, it was found that the adjustment indexes produced are, generally, adequate (SRMR < 0.04, CFI > 0.96, TLI > 0.94 and RMSEA < 0.05) and that the items have adequate factor loads. Evidence of discriminant validity was also satisfactory, managing to differentiate groups by income and sexual orientation as expected by the literature. CONCLUSIONS: The results suggest that the scales are suitable for use in Brazil, both for separate use and for combined use, as correlated factors.

Caution When Screening for Autism among Socially Anxious Youth.

Social anxiety disorder (SAD) is commonly comorbid with autism spectrum disorder (ASD). Here, in a sample of 86 children and adolescents (MAGE = 12.62 years; 68.6% male), 28 of whom were diagnosed with ASD, 34 with SAD, and 24 with comorbid ASD and SAD, we compared parent-reported scores from the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber in Social Responsiveness Scale (SRS; Constantino and Gruber 2012) to determine the sensitivity and specificity of the measure in cases of differential diagnosis between SAD and ASD. Results suggest that neither the subscales, nor the SRS-2 total score, consistently differed between ASD and SAD. Sensitivity and specificity analyses suggested that the SRS-2 total poorly discriminated ASD from SAD. When screening socially anxious youth for possible ASD, caution should be taken.

Look at me: The relation between empathy and fixation on the emotional eye-region in low vs. high social anxiety.

BACKGROUND AND OBJECTIVES: Fixation on another person's eye-region may be an effective measure of one's level of empathy. In the present study, we tested the hypothesis that this type of empathy measure may not be appropriate for individuals with high levels of social anxiety, since avoidance or hypervigilance attentional biases towards emotional faces are frequent in this condition. METHODS: Using eye-tracking, we measured fixation time on the eye-region of another person in participants with low vs. high social anxiety, and we correlated this measure with empathy levels. In a second eye-tracking task, the two groups of participants were presented with pairs of emotional-neutral faces to determine the presence of attentional biases. RESULTS: While participants with low social anxiety showed an association between empathy and fixation time on the other person's eyes, the association was null for participants with high social anxiety. Attentional biases towards emotional faces were absent in high social anxiety, but social anxiety correlated negatively with fixation on the eye region. LIMITATIONS: Our sample was made up of Psychology undergraduates, and this may have had an influence on gaze behavior towards the eye region. CONCLUSION: Fixation on the eye region is not a valid measure of empathy in high social anxiety, possibly due to systematic eye-region avoidance.

Feasibility Study of Three-Phase Implementation of International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set in an Outpatient Consultation-Liaison Psychiatry Practice.

OBJECTIVE: We describe a three-phase implementation of the International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set in a Consultation-Liaison Psychiatry practice. METHODS: During the preintervention phase, we reviewed patient-reported outcome tools and engaged stakeholders and leadership. During phase 1, the standard set was converted into an electronic previsit intake assessment that was implemented in a physician champion's practice. Patients completed the intake on a tablet, and computer adaptive testing was used to reduce response burden. Physician-facing data display facilitated use during subsequent in-person visits. An electronic version of the follow-up standard set was used during follow-up visits. During phase 2, a second physician tested scalability and the intervention was disseminated department wide in phase 3. RESULTS: During phase 1, 186 intakes and 67 follow-up electronic patient-reported outcome sets were completed. Average patient age was 54 years, and 44% were male. On average, patients ranked the tool 4.4 out of 5 and spent 22 minutes completing the intake. Time-driven activity-based costing found the new process to be cost-effective. During phase 2, 386 patients completed electronic patient-reported outcome sets, with 315 follow-up visits. Patients ranked the tool as 4.0 out of 5 and spent 26 minutes completing the questions. During phase 3, 2166 patients completed intake electronic patient-reported outcome sets and 1249 follow-up visits. Patients ranked the tool 4.3 out of 5 and spent 26 minutes on it. Scores and completion time did not differ greatly between phases. CONCLUSIONS: Integration of the International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set is feasible. Future research comparing International Consortium for Health Outcomes Measurement set with other approaches and in different settings is needed.

Disgust and fear: common emotions between eating and phobic disorders.

Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Psychiatric disorders in women with polycystic ovary syndrome. / Wystepowanie zaburzen psychicznych u kobiet z zespolem policystycznych jajników.

Polycystic ovary syndrome (PCOS) is the most commonly diagnosed endocrine disorder in women of reproductive age, affecting approximately 5-8% of females in this group. It is characterized by hyperandrogenism, abnormal periods (rare periods or amenorrhea) and polycystic ovaries visualized through ultrasonography. The etiopathogenesis of polycystic ovary syndrome has not been elucidated in detail. There are numerous hypotheses on this subject which tend to complement one another. The most widely recognized hypothesis is that the development of PCOS is due to insulin resistance and hyperinsulinemia, which subsequently lead to hyperandrogenism. On the basis of an as of yet relatively small number of studies, an increased prevalence of various psychiatric disorders can be observed in women with PCOS. These include: depression, generalized anxiety disorder, personality disorders, social phobia, obsessive-compulsive disorder, attention deficit hyperactivity disorder (ADHD), and eating disorders. Bipolar affective disorder, schizophrenia and other psychotic disorders have also been reported in women with PCOS more often than in the general population. The higher prevalence of psychiatric disorders in patients with PCOS, especially depression and anxiety disorders, may be due to both hyperandrogenism and the resulting somatic symptoms. These symptoms can undoubtedly be stigmatizing for women and lower their quality of life. This article is intended to provide an overview of the literature regarding mental disorders associated with polycystic ovary syndrome and to present own research on depression and sexual dysfunction in this group.

Reconsidering the associations between self-reported alcohol use disorder and mental health problems in the light of co-occurring addictions in young Swiss men.

BACKGROUND: Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems. METHOD: Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction. RESULTS: Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR's ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder. CONCLUSIONS: AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.

The long-term effects of microvascular decompression on social phobia and health-related quality of life in patients with hemifacial spasm: a 3-year prospective study.

BACKGROUND: Although not a life-threatening condition, hemifacial spasm (HFS) frequently leads to social phobia because it causes significant facial disfigurement and consequently reduces health-related quality of life (HRQoL). The purpose of the current study was to examine the long-term effects of MVD on psychological aspects and HRQoL in HFS patients with social anxiety over a 36-month follow-up. METHODS: Thirty patients with HFS who underwent MVD from January 2015 to May 2015 were included in this prospective study. Clinical data, including standardized measures of general anxiety and depression (Hospital Anxiety Depression Scale (HADS)), social anxiety (Liebowitz Social Anxiety Scale (LSAS)), and the severity of HFS, were collected postoperatively, and 6 months and 36 months after MVD. Likewise, data on HRQoL were collected at baseline, and 6 months and 36 months after MVD using the Korean version of the Short Form 36 (SF-36). RESULTS: Twenty-two patients who completed the 36-month follow-up were classified into social phobia group and non-social phobia group based on the LSAS total scores of 60. Repeated measures analysis of variance demonstrated significant differences between the two groups over time for the total LSAS score (p < 0.001), anxiety subscale score of the HADS (p = 0.002), and the Mental Component Summary (MCS) (p = 0.046) of the SF-36. A comparison of these two groups in terms of differences observed in their scales at 6 months after MVD has shown that the improvements of the social phobia group in HADS anxiety subscale (p = 0.010), LSAS total score (p = 0.008), and MCS (p = 0.040) were significantly more improved than the those of non-social phobia group. And at 36 months after surgery, the improvement of the scales mentioned above was maintained, and additionally Vitality (p = 0.040) and Mental Health (p = 0.040) dimensions showed a statistically significant improvement. CONCLUSIONS: The improvements previously observed in psychological aspects and HRQoL over a short-term follow-up after MVD in HFS patients with social phobia were maintained for at least 36 months after MVD.

Clarifying the Relation between Social Interaction Anxiety and Cannabis Use: Personality as a Distinguishing Factor.

Background: Individuals with social interaction anxiety, a facet of social anxiety disorder, are heterogeneous with respect to approaching or avoiding risky behaviors, including substance use. Additionally, the relation between social anxiety and cannabis use frequency has been inconsistent in the literature. Objective: The present study aimed to clarify the relation between social interaction anxiety and cannabis use by examining the effects of personality traits known to differentially predict substance use, including sensation seeking, emotion dysregulation, urgency, behavioral approach, and behavioral inhibition. Methods: We explored heterogeneity in social interaction anxiety using finite mixture modeling to discern profiles differing in mean scores on measures of social interaction anxiety and personality. We then examined how profiles differed in their likelihood of cannabis use. Results: The profile with low social interaction anxiety and high scores on personality measures was the most likely to use cannabis at all time periods. Two profiles with high social interaction anxiety scores were discerned. Between these two profiles, the profile with the highest levels of social interaction anxiety and most measured personality traits was more likely to use cannabis across all measured time periods. The profile with the high social interaction anxiety and low scores on personality measures was the least likely to use cannabis. Conclusions: Results of the present study identified personality traits most associated with increased risk of cannabis use for people high and low in social interaction anxiety, including facets of emotion regulation, urgency, and sensation seeking.

Prospective associations of androgens and sex hormone-binding globulin with 12-month, lifetime and incident anxiety and depressive disorders in men and women from the general population.

BACKGROUND: Findings on associations of androgens and sex hormone-binding globulin (SHBG) with anxiety and depressive disorders in the general population remain inconclusive. METHODS: We used data of n = 993 men and n = 980 women from the Study of Health in Pomerania (SHIP, a prospective-longitudinal general population study from northeastern Germany). Immunoassay-measured serum concentrations of total testosterone, androstenedione and SHBG were assessed when participants were aged 20-80. 12-month, lifetime and incident DSM-IV anxiety and depressive disorders were assessed with the DIA-X/M-CIDI at 10-year follow-up, when participants were aged 29-89. Logistic regressions were adjusted for age, smoking, alcohol consumption, physical activity, waist circumference, hypertension and oral contraceptive use (women only) at baseline and follow-up interval. RESULTS: In men and women, androgens and SHBG were not associated significantly with incident anxiety and depressive disorders. In men, higher total testosterone predicted any 12-month (OR = 1.46) and lifetime (OR = 1.34) anxiety disorder, lifetime social phobia (OR = 2.15), and 12-month (OR = 1.48) and lifetime (OR = 1.39) specific phobia, but neither 12-month nor lifetime depression. Moreover, androstenedione in men interacted with age in predicting lifetime anxiety disorders (OR = 0.98): Higher androstenedione more strongly predicted lifetime anxiety in younger vs. older men. These findings, however, did not survive correction for multiple testing. In women, androgens and SHBG were not associated significantly with 12-month and lifetime anxiety and depressive disorders. LIMITATIONS: The follow-up period was relatively long and other factors might have affected the examined associations. CONCLUSIONS: Higher serum total testosterone in men and androstenedione in younger men may relate to an increased risk of anxiety disorders.

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder.

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions.

A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder.

BACKGROUND: Attention bias modification (ABM) therapy aims to modify threat-related attention patterns via computerized tasks. Despite showing medium clinical effect sizes for anxiety disorders, underlying neural-cognitive mechanisms of change remain unclear. We used visual mismatch negativity (vMMN), an event-related potential sensitive to violations of learned statistical contingencies, to assess therapy-related contingency extraction processes in healthy participants and in patients with social anxiety disorder (SAD). We then assessed whether vMMN amplitude predicts ABM treatment outcome. METHODS: A modified version of the dot-probe task was used to elicit vMMN, in which 80% of trials were standard and 20% were deviant. In study 1, 30 healthy adults were randomly assigned to one of two ABM conditions: one in which threat-congruent targets were deviant trials and threat-incongruent targets were standard trials, and another in which the contingency was reversed. Electroencephalography (EEG) was continuously measured and vMMN analyzed. In study 2, 38 patients with SAD underwent six sessions of ABM therapy. We tested whether rule extraction in the ABM task, indicated by vMMN amplitude, predicts treatment outcome. RESULTS: vMMN clearly emerged over prespecified scalp locations indicating contingency extraction during ABM (study 1). vMMN amplitude predicted clinical improvement after ABM therapy, uniquely accounting for 7% and 14.4% of the variance in clinician-rated and self-reported posttreatment SAD symptoms, respectively. CONCLUSIONS: vMMN emerges as a neural marker for contingency learning in ABM, suggesting a significant role for contingency extraction processes in the clinical efficacy of this therapy.

Validación del Inventario de Fobia y Ansiedad Social- Forma Breve para universitarios argentinos / Validação do Inventário de Fobia e Ansiedade Social- Forma Breve para universitários argentinos / Validation of the Social Phobia and Anxiety Inventory- Brief Form for Argentinean college

Las problemáticas que afectan la capacidad de las personas para desempeñarse adecuadamente en las interacciones sociales, tales como el trastorno de ansiedad social (Social Anxiety Disorder, SAD), constituyen un ámbito de estudio que ha cobrado gran interés, debido a la importancia que las relaciones sociales tienen en todas las áreas de desempeño de los seres humanos. Sin embargo, se observa una escasez generalizada de estudios sobre ansiedad social en países latinoamericanos, en parte, debido a la ausencia de instrumentos construidos o adaptados a la población general o a conjuntos específicos. En función de ello, el objetivo del presente trabajo fue analizar las propiedades psicométricas del Inventario de Fobia y Ansiedad Social- Forma Breve (SPAI- B) para su utilización en estudiantes universitarios argentinos. Los resultados evidenciaron propiedades psicométricas adecuadas de validez y confiabilidad y se aportó evidencia de validez de grupos contrastados y convergente. Se discuten las limitaciones del estudio y nuevas líneas de investigación. (AU)

As problemáticas que afetam a capacidade das pessoas para terem um desempenho adequado nas interações sociais, como o transtorno de ansiedade social (Social Anxiet Disorder, SAD), constituem um âmbito de estudo que ganhou grande interesse devido à importância que as relações sociais têm em todas as áreas de desempenho dos seres humanos. No entanto, há um déficit generalizado de estudos sobre ansiedade social em países latino-americanos, devido a uma ausência de instrumentos construídos ou adaptados à população geral ou grupos específicos. Com base nisso, o objetivo do presente trabalho foi analisar as propriedades psicométricas do Inventario de Fobia e Ansiedade Social - Forma Breve (SPAI- B) para sua utilização com estudantes universitários argentinos. Os resultados mostraram propriedades psicométricas adequadas de validade e fidedignidade e gerou evidência de validade de grupos contrastados e validade convergente. As limitações do estudo e novas linhas de pesquisa são discutidas. (AU)

The problems that affect people's ability to perform adequately in social interactions, such as Social Anxiety Disorder (SAD), constitute an area of study that has gained great interest, due to the importance that social relations have in all areas of performance of human beings. However, there is a general scarcity of studies on social anxiety in Latin American countries, partly because of the absence of instruments built or adapted to the general population or specific groups. Due to this, the objective of the present investigation was to analyze the psychometric properties of the Spanish version of the Social Phobia and Anxiety Inventory-Short form (SPAI - B) to be used in Argentine college students. The results showed appropriate validity and reliability psychometric properties and it also has been provided evidence of contrasting groups and convergent validity. The limitations of the study and new lines of research are discussed. (AU)

Cigarette craving and stressful social interactions: The roles of state and trait social anxiety and smoking to cope.

BACKGROUND: Previous research indicates that social anxiety (SA) is a risk factor for the maintenance and relapse of smoking behaviors. However, little is known about the mechanisms underlying this relationship. The current study tested the effects of state and trait levels of SA as well as smoking to cope with symptoms of SA on craving during a social stressor task in abstinent conditions. METHODS: Participants (n = 60) were daily smokers, aged 18-30. Participants attended two sessions: a baseline session and a second session, wherein they engaged in a social stressor task while deprived from nicotine for 24 h. Subjective ratings of cigarette craving and state levels of SA were assessed six times throughout the task. Data were analyzed via multilevel modeling. RESULTS: Both trait SA and some forms of smoking to cope with symptoms of SA were more likely to predict increased craving during times of high, relative to low, social stress. Further, individuals with higher state SA, greater smoking to cope behaviors, and those who experience greater relief of social distress by smoking experienced greater craving throughout the task. These effects remained after controlling for nicotine dependence, withdrawal symptoms, depression, and other symptoms of anxiety and stress. Smoking to cope with symptoms of SA did not moderate the relationship between state SA and craving. CONCLUSIONS: Smokers high in SA (state and trait) and smoking to cope with symptoms of SA may be at risk for continued smoking and relapse because of the intensity of cravings they experience during stressful social situations.

Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation.

BACKGROUND: Cognitive Behavioral Therapy (CBT) for social anxiety disorder (SAD) and other internalizing conditions attempts to improve emotion regulation. Accumulating data indicate anterior cingulate cortex (ACC), and to a lesser extent amygdala, activation in various tasks predicts treatment outcome. However, little is known about ACC and amygdala activation to emotion regulation in predicting clinical improvement following CBT in SAD. METHODS: Before treatment, 38 SAD patients completed implicit and explicit emotion regulation paradigms during fMRI. Implicit regulation involved attentional control over negative distractors. Explicit regulation comprised cognitive reappraisal to negative images. Pre-CBT brain activity was circumscribed to anatomical-based ACC sub-regions (rostral, dorsal) and amygdala masks, which were submitted to ROC curves to examine predictive validity as well as correlational analysis to evaluate prognostic change in symptom severity. RESULTS: More rostral (rACC) activity in implicit regulation and less rACC activity during explicit regulation distinguished responders (34%) from non-responders. Greater amygdala response in implicit regulation also foretold responder status. Baseline rACC and amygdala activity during attentional control correlated with pre-to-post CBT change in symptom severity such that more activation was related to greater decline in symptoms. No significant correlations were observed for explicit regulation. CONCLUSIONS: Across forms of regulation, rACC activity predicted responder status whereas amygdala as a neuromarker was limited to implicit regulation. While the direction of effects (enhanced vs. reduced) in rACC activity was task-dependent, results suggest SAD patients with deficient regulation benefited more from CBT. Findings support previous studies involving patients with depression and suggest the rACC may be a viable marker of clinical improvement in SAD.

Modification of the medical exclusion criterion in DSM-5 social anxiety disorder: Comorbid obesity as an example.

BACKGROUND: The DSM 5 modified the medical exclusion criterion from DSM-IV, which now allows for a diagnosis of social anxiety disorder (SAD) to be given if the fears are related only to the medical condition (e.g., obesity) yet cause significant impairment or distress. METHODS: To examine this modification, the current study compared bariatric surgery candidates with DSM-IV SAD (n=135), modified SAD (clinically significant social fears related to obesity only; n=40), and no history of Axis I disorders (n=616) on variables related to pre-surgical problematic eating behaviors, body image dissatisfaction, functional impairment, and other characteristics related to bariatric surgery. Participants were referred by their surgeon for a psychiatric evaluation as part of the clearance process, and completed a comprehensive, semi-structured diagnostic interview and self-report measures. RESULTS: There were several differences between those with DSM-IV SAD and modified SAD compared to those with no disorder (e.g., on binge and emotional eating), but the two SAD groups did not differ from each other on any of the comparisons. LIMITATIONS: Results may not generalize to individuals suffering from obesity in the general population or those seeking other types of weight loss treatment. Because they were seeking psychiatric clearance, they also may have underreported symptoms/problems for fear that they would not get cleared. CONCLUSIONS: Overall, the modified SAD group more closely resembled the DSM-IV SAD group rather than the no disorder group, providing further support for diagnosing SAD even when the social fears are related to obesity only.

Relationships Between Social Anxiety and Smoking-Specific Experiential Avoidance.

OBJECTIVES: Although social anxiety is associated with higher prevalence of smoking and lower cessation rates, little is known about the underlying mechanisms of these relationships. Research suggests that socially anxious smokers have higher levels of smoking-specific experiential avoidance and are inclined to smoke to avoid internal smoking cues. However, it is unknown which types of internal smoking cues they avoid. Thus, this study aimed to address this gap in the literature. METHODS: Participants (N = 450) were adult smokers from a group-based trial for smoking cessation. Bivariate correlations and hierarchical linear regression models examined relationships between baseline levels of social anxiety and acceptance of internal smoking cues-physical sensations, emotions, and cognitions. RESULTS: Social anxiety was associated with lower levels of acceptance of thoughts, sensations, and emotions that cue smoking. After controlling for levels of nicotine dependence, depression, generalized anxiety, and posttraumatic stress disorder, social anxiety still explained unique variability in overall acceptance of internal smoking cues and in acceptance of physical sensations and emotions that serve as smoking cues. Social anxiety no longer explained unique variability in acceptance of thoughts that trigger smoking. CONCLUSIONS: Smokers with high levels of social anxiety are less accepting of internal smoking cues. For physical and emotional cues, this effect was independent of level of dependence and mental health comorbidity. Results help explain why smokers with social anxiety are less likely to quit and can inform the development of targeted cessation treatments for smokers with social anxiety.

Facial Blushing: Patient Selection and Long-Term Results.

Facial blushing, associated with social phobia, may have severe negative impact on the quality of daily life. The first line of treatment should be psychological and/or pharmacologic. In severe cases not responding to nonsurgical treatment, surgical sympathetic denervation is an option. A thorough disclosure of effects, complications, and side effects is mandatory and patient selection is crucial to obtain high patient satisfaction from surgical treatment.