Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review.

BACKGROUND: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. OBJECTIVE: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. RESULTS: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. CONCLUSIONS: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Social phobia of Ethiopian students: meta-analysis and systematic review.

BACKGROUND: Social anxiety disorder is defined as the fear of social situations, incorporating situations that involve contact with strangers. People highly fear embarrassing themselves which includes situations like social gatherings, oral presentations, and meeting new people. People with social phobia have nonspecific fears of practicing vague or, performing specific tasks like eating or speaking in front of others. In people with social anxiety disorder, worry can arise from both the circumstance itself and embarrassment from others, for students, social phobia is an overwhelming fear of speaking in front of others or giving presentations in class. The prevalence of social phobia among different studies in Ethiopia was inconsistent and inconclusive therefore, this study showed the cumulative burden of social phobia among students in Ethiopia. METHOD: Observational studies published on social phobia and associated factors among students in Ethiopia were included in this study based on the criteria after independent selection by two authors. Data were extracted by Microsoft Excel spreadsheet to be exported to Stata version 11 for further analysis. The random-effect model was used to estimate the pooled effect size of social phobia and its effect on the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. Sub-group analysis and sensitivity analysis were done. RESULT: A total of 2878 study participants from seven studies were included in this meta-analysis and systematic review. The pooled prevalence of social phobia among students in Ethiopia was 26.81% with a 95% CI (22.31-31.30). The pooled effect size of social phobia in Oromia, Amhara, and SNNPs regions was 24.76%, 24.76%, and 29.47%, respectively. According to the subgroup analysis, university, and college/high school students were 28.05% and 25.34% respectively. Being female [AOR = 2.11 (95% CI 1.72-2.60)], having poor social support [AOR = 2.38 (95% CI 1.54-3.70)], substance use [AOR = 2.25 (95% CI 1.54-3.30)], single parent [AOR = 5.18 (95% CI 3.30-8.12)], and rural residence [AOR = 2.29 (95% CI 1.91-2.75)] were significantly associated in this meta-analysis in Ethiopia. CONCLUSION: The pooled prevalence of social phobia in this meta-analysis and systematic review was high (26.81%) among students therefore, the educational bureau needs to work on decreasing the burden of social phobia to raise the academic achievement and creativity of the students. In therapeutic advice like exposure to presentations, family members take the responsibility for the students' therapy and expose them to various social interactions.

Stress generation in social anxiety and depression: A two-study community assessment.

BACKGROUND: Stress generation theory suggests that people engage in certain behaviors that causally generate "dependent" stressful life events. Stress generation has primarily been studied in the context of depression with limited consideration of anxiety. People with social anxiety exhibit maladaptive social and regulatory behaviors that may uniquely generate stress. METHOD: Across two studies, we examined if people with elevated social anxiety experienced more dependent stressful life events than those lower in social anxiety. On an exploratory basis, we examined differences in perceived intensity, chronicity, and self-blame of stressful life events. As a conservative test, we examined whether observed relationships held after covarying depression symptoms. Community adults (Ns = 303; 87) completed semi-structured interviews about recent stressful life events. RESULTS: Participants with higher social anxiety symptoms (Study 1) and social anxiety disorder (SAD; Study 2) reported more dependent stressful life events than those with lower social anxiety. In Study 2, healthy controls rated dependent events as less impactful than independent events; those with SAD rated dependent and independent events as equally impactful. Regardless of social anxiety symptoms, participants placed greater blame on themselves for the occurrence of dependent than independent events. LIMITATIONS: Life events interviews are retrospective and preclude conclusions about short-term changes. Mechanisms of stress generation were not assessed. CONCLUSIONS: Results provide initial evidence for the role of stress generation in social anxiety that may be distinct from depression. Implications for assessing and treating unique and shared features of affective disorders are discussed.

Man vs. machine: A comparison of human and computer assessment of nonverbal behavior in social anxiety disorder.

Social anxiety disorder (SAD) is a common psychological disorder associated with broad interpersonal impairment. Most previous studies have examined nonverbal behavior in SAD using human coders. However, one recent study utilized a machine-based analysis of nonverbal behavior and dyadic synchrony in SAD (Asher, Kauffmann, & Aderka, 2020). In the present study, we compared human and computer assessments of nonverbal behavior in social anxiety to enhance our knowledge about their commonalities and unique differences in capturing nonverbal behavior in the context of SAD. Specifically, the present study included 152 individuals: 38 individuals diagnosed with SAD and 114 individuals without SAD. Participants formed 76 opposite-sex interaction dyads comprising either two individuals without SAD (n = 39 control dyads) or one individual with SAD and one individual without SAD (n = 37 SAD dyads). All participants underwent a getting-acquainted task and were videotaped during the conversation. Half of the interactions were small talk interactions and half were closeness-generating interactions that required significant self-disclosure. We found that both types of coding were associated with self-reported social anxiety but that machine-based coding was superior in capturing social anxiety in closeness-generating contexts. Implications for research on nonverbal behavior in SAD are discussed.

Digital Biomarkers of Social Anxiety Severity: Digital Phenotyping Using Passive Smartphone Sensors.

BACKGROUND: Social anxiety disorder is a highly prevalent and burdensome condition. Persons with social anxiety frequently avoid seeking physician support and rarely receive treatment. Social anxiety symptoms are frequently underreported and underrecognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more research is needed to identify passive biomarkers of social anxiety symptom severity. Digital phenotyping, the use of passive sensor data to inform health care decisions, offers a possible method of addressing this assessment barrier. OBJECTIVE: This study aims to determine whether passive sensor data acquired from smartphone data can accurately predict social anxiety symptom severity using a publicly available dataset. METHODS: In this study, participants (n=59) completed self-report assessments of their social anxiety symptom severity, depressive symptom severity, positive affect, and negative affect. Next, participants installed an app, which passively collected data about their movement (accelerometers) and social contact (incoming and outgoing calls and texts) over 2 weeks. Afterward, these passive sensor data were used to form digital biomarkers, which were paired with machine learning models to predict participants' social anxiety symptom severity. RESULTS: The results suggested that these passive sensor data could be utilized to accurately predict participants' social anxiety symptom severity (r=0.702 between predicted and observed symptom severity) and demonstrated discriminant validity between depression, negative affect, and positive affect. CONCLUSIONS: These results suggest that smartphone sensor data may be utilized to accurately detect social anxiety symptom severity and discriminate social anxiety symptom severity from depressive symptoms, negative affect, and positive affect.

Evaluating the interplay between subclinical levels of mental health symptoms and coordination dynamics.

Viewed under the broad theoretical umbrella of an embodied-embedded approach to psychological activity, body movements can be seen to play an essential role in shaping social interaction. Of note, research concerning the embodiment of social cognition has documented key differences in non-verbal behaviour during social interaction for individuals diagnosed with a range of disorders, including social anxiety disorder and autism spectrum disorder. The present work sets out to extend these findings by better understanding the interplay between subclinical variation in psychopathology and social-motor coordination, a key component of effective interaction. We asked participants, in pairs, to swing hand-held pendula that varied in their intrinsic movement characteristics. Extending previous clinically oriented work (Varlet et al., 2014, Frontiers in Behavioral Neuroscience, 8, 29), our results indicated that subclinical variation in mental health status was predictive of disruption to the patterns of coordination dynamics that characterize effective social exchange. This work provides further evidence for the utility of theorizing social interaction as a self-organizing dynamical system and strengthens support for the claim that disruption to interpersonal coordination may act as an embodied-embedded marker of variation in mental health.

Efficacy and cost-effectiveness of an unguided, internet-based self-help intervention for social anxiety disorder in university students: protocol of a randomized controlled trial.

BACKGROUND: Social anxiety disorder (SAD) is highly prevalent among university students, but the majority of affected students remain untreated. Internet- and mobile-based self-help interventions (IMIs) may be a promising strategy to address this unmet need. This study aims to investigate the efficacy and cost-effectiveness of an unguided internet-based treatment for SAD among university students. The intervention is optimized for the treatment of university students and includes one module targeting fear of positive evaluations that is a neglected aspect of SAD treatment. METHODS: The study is a two arm randomized controlled trial in which 200 university students with a primary diagnosis of SAD will be assigned randomly to either a wait-list control group (WLC) or the intervention group (IG). The intervention consists of 9 sessions of an internet-based cognitive-behavioral treatment, which also includes a module on fear of positive evaluation (FPE). Guidance is delivered only on the basis of standardized automatic messages, consisting of positive reinforcements for session completion, reminders, and motivational messages in response to non-adherence. All participants will additionally have full access to treatment as usual. Diagnostic status will be assessed through Structured Clinical Interviews for DSM Disorders (SCID). Assessments will be completed at baseline, 10 weeks and 6-month follow-up. The primary outcome will be SAD symptoms at post-treatment, assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Secondary outcomes will include diagnostic status, depression, quality of life and fear of positive evaluation. Cost-effectiveness and cost-utility analyses will be evaluated from a societal and health provider perspective. DISCUSSION: Results of this study will contribute to growing evidence for the efficacy and cost-effectiveness of unguided IMIs for the treatment of SAD in university students. Consequently, this trial may provide valuable information for policy makers and clinicians regarding the allocation of limited treatment resources to such interventions. TRIAL REGISTRATION: DRKS00011424 (German Clinical Trials Register (DRKS)) Registered 14/12/2016.

I Did OK, but Did I Like It? Using Ecological Momentary Assessment to Examine Perceptions of Social Interactions Associated With Severity of Social Anxiety and Depression.

Socially anxious and depressed individuals tend to evaluate their social interactions negatively, but little is known about the specific real-time contributors to these negative perceptions. The current study examined how affect ratings during social interactions predict later perceptions of those interactions, and whether this differs by social anxiety and depression severity. Undergraduate participants (N = 60) responded to a smartphone application that prompted participants to answer short questions about their current affect and social context up to 6 times a day for 2 weeks. At the end of each day, participants answered questions about their perceptions of their social interactions from that day. Results indicated that the link between negative affective experiences reported during social interactions and the end-of-day report of enjoyment (but not effectiveness) of those experiences was more negative when social anxiety was more severe. The link between negative affective experiences rated during social interactions and the end-of-day report of effectiveness (but not enjoyment) during those social encounters was more negative when depression was more severe. These findings demonstrate the importance of examining self-perceptions of social interactions based both on the extent to which individuals think that they met the objective demands of an interaction (i.e., effectiveness, mastery) and the extent to which they liked or disliked that interaction (i.e., enjoyment, pleasure). These findings also highlight how real-time assessments of daily social interactions may reveal the key experiences that contribute to negative self-evaluations across disorders, potentially identifying critical targets for therapy.

Identifying children with anxiety disorders using brief versions of the Spence Children's Anxiety Scale for children, parents, and teachers.

Anxiety disorders are among the most prevalent mental health disorders experienced by children and are associated with significant negative outcomes. Only a minority of affected children, however, access professional help, and a failure to identify children with anxiety disorders presents a key barrier to treatment access. Existing child anxiety questionnaire measures are long and time consuming to complete, limiting their potential for widespread use as identification tools in community settings. We developed a brief questionnaire for parents, children, and teachers using items from the Spence Children's Anxiety Scale (SCAS) and evaluated the new measure's psychometric properties, capacity to discriminate between a community (n = 361) and clinic-referred sample (n = 338) of children aged 7-11, and identified optimal cut-off scores for accurate identification of preadolescent children experiencing clinically significant levels of anxiety. The findings provided support for the reliability and validity of 8-item versions of the SCAS, with the brief questionnaire scores displaying comparable internal consistency, agreement among reporters, and convergent/divergent validity to the full-length SCAS scores. The brief SCAS scores also discriminated between the community and clinic-referred samples and identified children in the clinic-referred sample with a moderate-to-good level of accuracy and acceptable sensitivity and specificity. Combining reporters improved sensitivity, but at the expense of specificity, and findings suggested parent report should be prioritized. This new brief questionnaire has potential for use in community settings as a tool to improve identification of children who are experiencing clinically significant levels of anxiety and warrant further assessment and potential support. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The behavioral economics of social anxiety disorder reveal a robust effect for interpersonal traits.

Recent evidence suggests that reduced generosity among individuals with social anxiety disorder (SAD) in behavioral economic tasks may result from constraint in changing behavior according to interpersonal contingencies. That is, people with SAD may be slower to be more generous when the situation warrants. Conversely, more global effects on generosity may be related to interpersonal vindictiveness, a dimension only somewhat related to SAD. A total of 133 participants, 73 with the generalized form of SAD, completed self-report instruments and a behavioral economic task with simulated interpersonal (friend, romantic partner, stranger) interactions. In a separate visit, friends (n = 88) also came to the lab and rated participants on vindictiveness. Interpersonal vindictiveness was associated with reduced initial and overall giving to simulated friends. SAD predicted a lack of increased giving to a simulated friend, and attenuated an increase in giving to simulated known versus unknown players compared to participants without SAD. Friend-reported vindictiveness predicted in the same direction as diagnosis. However, the findings for SAD were less robust than those for vindictiveness. SAD is perhaps weakly related to behavioral constraint in economic tasks that simulate interpersonal interactions, whereas vindictiveness is strongly related to lower overall generosity as well as (via friend report) behavioral constraint. Further study is needed to better characterize the construct of vindictiveness. Our findings dovetail with the suggestion that SAD is related to impairment in the proposed affiliation and attachment system, but further suggest that direct study of that system may be more fruitful than focusing on disorders.

Social Dysfunction and Diet Outcomes in People with Psychosis.

This analysis aimed to examine the association of social dysfunction with food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption in people with psychosis from the Hunter New England (HNE) catchment site of the Survey of High Impact Psychosis (SHIP). Social dysfunction and dietary information were collected using standardised tools. Independent binary logistic regressions were used to examine the association between social dysfunction and food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption. Although social dysfunction did not have a statistically significant association with most diet variables, participants with obvious to severe social dysfunction were 0.872 (95% CI (0.778, 0.976)) less likely to eat breakfast than those with no social dysfunction p < 0.05. Participants with social dysfunction were therefore, 13% less likely to have breakfast. This paper highlights high rates of social dysfunction, significant food insecurity, and intakes of fruits and vegetables below recommendations in people with psychosis. In light of this, a greater focus needs to be given to dietary behaviours and social dysfunction in lifestyle interventions delivered to people with psychosis. Well-designed observational research is also needed to further examine the relationship between social dysfunction and dietary behaviour in people with psychosis.

Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study.

Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.