The Influence of Intolerance of Uncertainty on Anxiety and Depression Symptoms in Chinese-speaking Samples: Structure and Validity of The Chinese Translation of The Intolerance of Uncertainty Scale.

Few studies evaluated the structure of the short versions of the Chinese translation of the Intolerance of Uncertainty Scale (IUS) among Chinese-speaking individuals. Meanwhile, contemporary theory of IU has emphasized the role of IU as the basic transdiagnostic mechanism underlying emotional disorders, and further empirical support is awaited. Thus, the current research aimed to examine the structure of the IUS (Chinese translation) and the hierarchical model of IU. Confirmatory factor analysis was used to compare fit of the two-factor and bifactor models of the original and short versions (IUS-18 and IUS-12) of the IUS (Chinese translation) among Chinese-speaking samples of adults. The direct effects of IU and indirect effects of IU via neuroticism on anxiety and depression symptoms were examined using structural equation modeling. All IUS models demonstrated acceptable fit. Using the bifactor model of the IUS-12 (Chinese translation), the hierarchical model of IU affecting anxiety and depression via neuroticism was supported. The prospective and inhibitory IU factors performed differently in relating to emotional vulnerabilities and symptoms. We provide suggestions for measuring and modeling IU, and the role of IU as the basic transdiagnostic vulnerability was suggested in Chinese-speaking samples.

Predictors of treatment outcomes and adherence in internet-based cognitive behavioral therapy for social anxiety in China.

BACKGROUND: Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes. AIMS: The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes. METHOD: Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined. RESULTS: No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = -0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms. CONCLUSIONS: Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.

Telesupervision-of-supervision across national boundaries: United States and China.

This article describes technology-assisted telesupervision-of-supervision, which is a component of a 2-year U.S.-China collaborative program designed to systematically train clinical supervisors in China. Using Zoom conferencing platform, several U.S.-based supervisors facilitated telesupervision-of-supervision groups, with six to ten participants in each group, from different geographic locations in China. This article employs the perspectives of both U.S.-based supervisors and group participants who are themselves supervision scholars in China, describing their experiences and insights about the rewards and challenges of this telesupervision-of-supervision project.

Attention allocation in social anxiety during a speech.

Cognitive models assume that social anxiety is associated with and maintained by biased information processing, leading to change in attention allocation, which can be measured by examining eye movement. However, little is known about the distribution of attention among positive, neutral and negative stimuli during a social task and the relative importance of positive versus negative biases in social anxiety. In this study, eye movement, subjective state anxiety and psychophysiology of individuals with high trait social anxiety (HSA) and low trait social anxiety (LSA) were measured during a speech task with a pre-recorded audience. The HSA group showed longer total fixation on negative stimuli and shorter total fixation on positive stimuli compared to the LSA group. We observed that the LSA group shifted attention away from negative stimuli, whereas the HSA group showed no differential attention allocation. The total duration of fixation on negative stimuli predicted subjective anxiety ratings. These results point to a negative bias as well as a lack of a positive bias in HSA individuals during social threat.

SPECIFIC EFFECTS OF ANGER RUMINATION ON PARTICULAR EXECUTIVE FUNCTIONS (.).

The effects of two types of rumination on different kinds of executive functions were investigated. Fifty-nine participants (M age = 22.8 yr., SD = 2.5) were assigned to one of three conditions and instructed either to: (1) ruminate in a self-distanced way, (2) ruminate in a self-immersed way, or (3) think about the layout of their campus following anger induction. Afterward, the participants were directed to finish tasks designed to assess three kinds of executive functions: shifting, inhibition, and updating. Results showed that self-immersed rumination impaired shifting ability the most, while participants engaged in self-distanced rumination showed the worst performance on the inhibition task. No significant difference was found in the updating task. These results suggest that rumination influenced particular executive functions in different ways.

Time-course of attentional bias for positive social words in individuals with high and low social anxiety.

BACKGROUND: Although accumulating research demonstrates the association between attentional bias and social anxiety, the bias for positive stimuli has so far not been adequately studied. AIMS: The aim is to investigate the time-course of attentional bias for positive social words in participants with high and low social anxiety. METHOD: In a modified dot-probe task, word-pairs of neutral and positive social words were randomly presented for 100, 500, and 1250 milliseconds in a nonclinical sample of students to test their attentional bias. RESULTS: Non-significant interaction of Group × Exposure Duration was found. However, there was a significant main effect of group, with significantly different response latencies between the high social anxiety (HSA) and low social anxiety (LSA) groups in the 100 ms condition, without for 500 or 1250 ms. With respect to attentional bias, the LSA group showed enhanced preferential attention for positive social words to which the HSA group showed avoidance in the 100 ms condition. In the 500 ms condition, preferential attention to positive social words was at trend in the LSA group, relative to the HSA group. Neither group showed attentional bias in the 1250 ms condition. CONCLUSIONS: These findings extend recent research about the attention training program and add to the empirical literature suggesting that the initial avoidance of positive stimuli may contribute to maintaining social anxiety.

The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial.

Background: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.

Pathological network changes in patients with social anxiety disorder before and after an Internet-based CBT.

A network perspective may shed light on the understanding of Internet-based CBT efficacy for social anxiety disorder. Previous cross-sectional evidence revealed a densely interconnected network for individuals with social anxiety. Yet, longitudinal network changes before and after ICBT are lacking. This study aimed to investigate pathological network changes with Graphical Gaussian Model among patients with social anxiety disorder (n = 249). Social phobia scale (SPS) and Social interaction anxiety scale (SIAS) were measured before and after 8 weeks Internet-based CBT. Results revealed the connection between symptom tension when speaking and symptom awkward when being watched was the most robust edges during ICBT interventions. The pathological network benefited from ICBT and exhibited modification in several prominent interconnections. The overall network connectivity continues to exhibit comparable strength after ICBT. This study represents the first examination of social anxiety network changes after patients with SAD completed a systematic ICBT. Changes in critical edges and nodes provide valuable insights for the design and efficacy assessment of ICBT interventions.

A novel one-dimensional Co(II) coordination polymer: catena-poly[[hexaaquacobalt(II)] [[diaquabis(sulfato-κO)cobalt(II)]-µ-4,4'-bipyridine-κ2N:N'] [[triaqua(sulfato-κO)cobalt(II)]-µ-4,4'-bipyridine-κ2N:N']].

The title compound, {[Co(H(2)O)(6)][Co(SO(4))(C(10)H(8)N(2))(H(2)O)(3)][Co(SO(4))(2)(C(10)H(8)N(2))(H(2)O)(2)]}(n), contains three crystallographically unique Co(II) centres, all of which are in six-coordinated environments. One Co(II) centre is coordinated by two bridging 4,4'-bipyridine (4,4'-bipy) ligands, one sulfate ion and three aqua ligands. The second Co(II) centre is surrounded by two N atoms of two 4,4'-bipy ligands and four O atoms, i.e. two O atoms from two monodentate sulfate ions and two from water molecules. The third Co(II) centre forms part of a hexaaquacobalt(II) ion. In the crystal structure, there are two different one-dimensional chains, one being anionic and the other neutral, and adjacent chains are arranged in a cross-like fashion around the mid-point of the 4,4'-bipy ligands. The structure features O-H···O hydrogen-bonding interactions between sulfate anions and water molecules, resulting in a three-dimensional supramolecular network.

Social anxiety does not impair attention inhibition: An emotion anti-saccade task.

BACKGROUND AND OBJECTIVES: Attention avoidance and attention vigilance are two typical attentional biases in individuals with social anxiety disorder (SAD). Attention inhibition is a type of attention control, which may be the key factor affecting attention vigilance and attention avoidance. However, previous studies have not examined the difference between the attention inhibition in individuals with SAD and healthy controls. METHODS: To further explore this question, the current study used the single anti-saccade task with emotional facial stimuli to assess attention inhibition in 27 individuals with SAD and 22 healthy controls. RESULTS: Regardless of the emotional valence of the facial stimuli, error rates in the social anxiety group were lower than that of the healthy control group, but there was no significant group difference in the saccade latency. LIMITATIONS: This research only examined the attentional inhibition process highly related to attention avoidance and attention vigilance. Future research may benefit from adopting different research paradigms for more robust and generalizable conclusions. CONCLUSIONS: Results suggest that individuals with SAD have better attention inhibition abilities than healthy control. Such enhanced attention inhibition may underlie their avoidance of threatening social cues.

Tris(1,10-phenanthroline-κN,N')nickel(II) bis-(2,4,5-tricarb-oxy-benzo-ate) monohydrate.

In the title compound, [Ni(C(12)H(8)N(2))(3)](C(10)H(5)O(8))(2)·H(2)O, the Ni(II) cation is coordinated by six N atoms of the three bidentate chelating 1,10-phenanthroline ligands in a slightly distorted octa-hedral coordination geometry. The Ni-N bond lengths range from 2.074 (2) to 2.094 (2) Å. The dihedral angles between the three chelating NCCN groups to each other are 85.71 (3), 73.75 (2) and 85.71 (3)°, respectively. The Ni cation, the phenyl ring of the 1,10-phenanthroline ligand and the lattice water molecule are located on special positions (site symmetry 2). In the crystal, the uncoordinated 2,4,5-tricarb-oxy-benzeno-ate anions join with each other through O-H⋯O hydrogen bonds, forming a two-dimensional hydrogen-bonded layer structure along the bc plane. The layers are further linked via additional O-H⋯O inter-actions between water and carboxyl groups, resulting in a three-dimensional supra-molecular network.

Self-focused attention vs. negative attentional bias during public speech task in socially anxious individuals.

Enhanced self-focused attention (SFA) and negative attentional bias (NAB) towards social cues are characteristic hallmarks of social anxiety. It is essential to investigate these two attentional phenomena under socially relevant situations using comparable stimuli. In the present study, individuals with high social anxiety (HSA, n = 32) and low social anxiety (LSA, n = 29) were compared according to their attention toward self-related stimuli and toward positive, neutral, and negative feedback related stimuli. Video stimuli of moving indicators of self-anxiety-status and positive, neutral, and negative feedback from an audience were presented during an impromptu speech task (high anxiety condition) and a re-watching phase (low anxiety condition). Eye movements in response to the different stimuli served as readouts for attentional preference. An interaction effect suggested that the HSA group directed more attention to self-related stimuli relative to other stimuli and the LSA group only during the high anxiety condition. The LSA group exhibited a general attentional preference toward positive feedback, especially during the low anxiety condition. Meanwhile, only the total duration of fixation on positive feedback negatively correlated with subjective anxiety rating. Our results point to increased SFA rather than NAB in HSA individuals under social threats.

Vigilance-Avoidance Toward Negative Faces in Social Anxiety With and Without Comorbid Depression.

Despite the growing evidence for the attentional bias toward emotional related stimuli in patients with social anxiety disorder (SAD), it remains unclear how the attentional bias manifests in normal individuals with SAD and/or depressive traits. To address this question, we recruited three groups of normal participants with different psychiatric traits-individuals with comorbid SAD and depression (SADd, N = 19), individuals with only SAD (SAD, N = 15), and healthy control individuals (HC, N = 19). In a dot-probe paradigm, participants view angry, disgusted, and sad face stimuli with durations ranging from very brief (i.e., 14ms) that renders stimuli completely intangible, to relatively long (i.e., 2000ms) that guarantees image visibility. We find significant early vigilance (i.e., on brief stimuli) and later avoidance (i.e., on long stimuli) toward angry faces in the SADd group. We also find vigilance toward angry and disgusted faces in the SAD group. To our best knowledge, this is the first study to unify both vigilance and avoidance within the same experimental paradigm, providing direct evidence for the "vigilance-avoidance" theory of comorbid SAD and depression. In sum, these results provide evidence for the potential behavioral differences induced by anxiety-depression comorbidity and a single trait in non-clinical populations, but the lack of a depression-only group cannot reveal the effects of high levels of depression on the results. The limitations are discussed.

Avoidance of all feedback? Attention allocation during and after public speech in social anxiety.

BACKGROUND AND OBJECTIVES: Attention avoidance of feedback-related stimuli is proposed to be associated with and maintain social anxiety. However, previous research has mainly focused on comparing the attention bias between two types of stimuli, while little is known about attention distribution patterns among positive, neutral, and negative feedback and non-feedback stimuli in individuals with high trait social anxiety (HSA) or low trait social anxiety (LSA). METHODS: The current study assessed eye movement pattern of participants with HSA or LSA during a speech task (high anxiety condition) or while solely watching audience feedback of the speech (low anxiety condition). A pre-recorded audience who displayed approving, neutral, or disapproving gestures was presented as feedback stimuli, while neutral facial photos were used as non-feedback stimuli. RESULTS: Only in the high anxiety condition, participants with HSA exhibited longer total fixation on non-feedback stimuli compared to those with LSA; whereas in the low anxiety condition, both groups paid more attention to emotional feedback stimuli. LIMITATIONS: The final sample size was modest due to a high suspicion rate of the reality of the audience. CONCLUSIONS: These findings suggest that only in highly anxious social situations, socially anxious individuals lack the attentional preference toward positive feedback that individuals with low anxious have.

The Effect of Shame on Patients With Social Anxiety Disorder in Internet-Based Cognitive Behavioral Therapy: Randomized Controlled Trial.

BACKGROUND: Prior research has demonstrated the efficacy of internet-based cognitive behavioral therapy (ICBT) for social anxiety disorder (SAD). However, it is unclear how shame influences the efficacy of this treatment. OBJECTIVE: This study aimed to investigate the role shame played in the ICBT treatment process for participants with SAD. METHODS: A total of 104 Chinese participants (73 females; age: mean 24.92, SD 4.59 years) were randomly assigned to self-help ICBT, guided ICBT, or wait list control groups. For the guided ICBT group, half of the participants were assigned to the group at a time due to resource constraints. This led to a time difference among the three groups. Participants were assessed before and immediately after the intervention using the Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS). RESULTS: Participants' social anxiety symptoms (self-help: differences between pre- and posttreatment SIAS=-12.71; Cohen d=1.01; 95% CI 9.08 to 16.32; P<.001 and differences between pre- and posttreatment SPS=11.13; Cohen d=0.89; 95% CI 6.98 to 15.28; P<.001; guided: SIAS=19.45; Cohen d=1.20; 95% CI 14.67 to 24.24; P<.001 and SPS=13.45; Cohen d=0.96; 95% CI 8.26 to 18.64; P<.001) and shame proneness (self-help: differences between pre- and posttreatment ESS=7.34; Cohen d=0.75; 95% CI 3.99 to 10.69; P<.001 and guided: differences between pre- and posttreatment ESS=9.97; Cohen d=0.88; 95% CI 5.36 to 14.57; P<.001) in both the self-help and guided ICBT groups reduced significantly after treatment, with no significant differences between the two intervention groups. Across all the ICBT sessions, the only significant predictors of reductions in shame proneness were the average number of words participants wrote in the exposure module (ß=.222; SE 0.175; t96=2.317; P=.02) and gender (ß=-.33; SE 0.002; t77=-3.13; P=.002). We also found a mediation effect, wherein reductions in shame fully mediated the relationship between the average number of words participants wrote in the exposure module and reductions in social anxiety symptoms (SIAS: ß=-.0049; SE 0.0016; 95% CI -0.0085 to -0.0019 and SPS: ß=-.0039; SE 0.0015; 95% CI -0.0075 to -0.0012). CONCLUSIONS: The findings of this study suggest that participants' engagement in the exposure module in ICBT alleviates social anxiety symptoms by reducing the levels of shame proneness. Our study provides a new perspective for understanding the role of shame in the treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900021952; http://www.chictr.org.cn/showproj.aspx?proj=36977.

Shame, personality, and social anxiety symptoms in Chinese and American nonclinical samples: a cross-cultural study.

Shame has been observed to play an important role in social anxiety in China [Xu, 1982]. Shame and personality factors, such as neuroticism and introversion-extraversion, are also related to social anxiety symptoms in Chinese college students [Li et al., 2003]. The aim of this study was to explore cross-cultural differences of the effects of shame and personality on social anxiety using the Experience Scale of Shame, the Eysenck Personality Questionnaire-Revised Short Scale and Social Anxiety Inventory. Data were collected from both a Chinese sample (n=211, 66 males and 145 females, average ages 20.12+/-1.56 years) and an American sample (n=211, 66 males and 145 females, average ages 20.22+/-1.90 years) of college students. The structural equation modeling (SEM) was performed separately for the Chinese and American samples. The SEM results reveal a shame-mediating model, which is adaptive and only in the Chinese sample. This suggests that shame is a mediator between the Chinese personality and social anxiety. The shame factor did not play the same role in the American sample. This empirical study supports the hypothesis that shame has a more important effect on social anxiety in the Chinese culture compared to its effect on Americans.

Continual training of attentional bias in social anxiety.

Using the dot-probe paradigm, it has been shown that high social anxiety is associated with an attentional bias toward negative information. In the present study, individuals with high social anxiety were divided into two groups randomly. One group was the attentional bias training group (Group T), and the other was the control group (Group C). For Group T, 7 days' continuous training of attentional bias was conducted using the dot-probe paradigm to make socially anxious individuals focus more on positive face pictures. The results showed that the training was effective in changing attentional bias in Group T. Scores of the Social Interaction Anxiety Scale (SIAS) in Group T were reduced compared to Group C, while the scores of Social Phobia Scale (SPS) and scores of Negative Evaluation Scale (FNE) showed no difference between the two groups, which suggested a limited reduction of social anxiety.

The influence of uncertainty and intolerance of uncertainty on anxiety.

BACKGROUND AND OBJECTIVES: Although the influence of uncertainty and intolerance of uncertainty (IU) on anxiety pathologies has been well-established, only a few studies examined the interaction between uncertainty and IU in producing anxiety. Meanwhile, there is a lack of research utilizing experimental methods to manipulate the situational uncertainty. Therefore, the current study aimed to more systematically investigate whether and how trait IU interacted with uncertainty in the production of anxiety. METHODS: the current study examined the influence of threat-related uncertainty and IU on anxiety in a lab setting. A variant of the threat-of-shock paradigm was employed to manipulate the uncertainty level. State anxiety and worry were measured immediately before and after this manipulation. Hierarchical linear modeling was used for data analysis. RESULTS: Results showed that trait IU contributed to elevated state anxiety and worry. Meanwhile, when under imminent threat, uncertainty provoked increased worry but exerted limited influence on state anxiety. The interaction effect of uncertainty and IU on anxiety was not evident in this study. LIMITATIONS: Results were based on a non-clinical sample rather than individuals with clinical diagnoses. CONCLUSIONS: Uncertainty could be regarded as a trigger of worrying thoughts, while IU is an important cognitive vulnerability factor of anxiety and related symptoms. The possible reasons for these findings and their implications were discussed in light of theoretical models of anxiety, worry, and IU.

Trait anxiety is associated with a decreased visual working memory capacity for faces.

Recent work has suggested that anxiety restricts working memory capacity, which may underlie a wide range of cognitive symptoms in anxiety. However, previous literature on the anxiety-visual working memory association yielded mixed results, with some studies demonstrating an anxiety-related increase in visual working memory capacity. In an attempt to gain a more thorough understanding of the relationship between anxiety and visual working memory maintenance function, the current study examined the influence of trait anxiety on visual working memory capacity and resolution for negative, positive, and neutral faces in a large unselected sample, by conducting two different experiments. Experiment 1 used a change-detection task to estimate visual working memory capacity, while Experiment 2 used a modified time-delay estimation task to measure memory precision. Hierarchical linear modeling was used to analyze the relationship between trait anxiety, emotional valence, and visual working memory. Results showed that trait anxiety was associated with decreased visual working memory capacity for faces in a valence-independent manner, whereas anxiety-related change in visual working memory resolution was not significant. This pattern of results was discussed in light of the theories of anxiety and visual working memory.