A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder.

To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions-an individual and a group intervention-in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms.

Comparar la efectividad de dos intervenciones de Terapia Cognitivo-Conductual (TCC)-intervención individual y grupal- en tratamiento del Trastorno de ansiedad social. Comparamos los dos grupos de tratamiento con una condición de lista de espera en un ensayo clínico aleatorizado con 86 adultos jóvenes. La intervención individual de TCC fue la Terapia Cognitiva Basada en Ensayos (TCBE) desarrollada por De-Oliveira, una técnica novedosa en la cual el terapeuta involucra al paciente en un juicio judicial simulado con el objetivo de identificar y cambiar las creencias disfuncionales centrales. La intervención grupal consistió en terapia de exposición basada en el protocolo Hofmann y Otto (TCC grupal) para reestructurar cogniciones negativas y disfuncionales con respecto a situaciones sociales. Ambas intervenciones redujeron los síntomas psiquiátricos antes y después de la prueba y los síntomas de ansiedad y depresión social primarios en relación con los controles de la lista de espera. Las intervenciones se introdujeron recientemente en Brasil, y este es el primer ensayo de control aleatorizado para comparar TCBE y TCC grupal, que fueron efectivos para los cambios en los síntomas de ansiedad social y los síntomas psiquiátricos concurrentes.

Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample

Objective: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal. Methods: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR. Results: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as inter-factor correlations, invariance, reliability, and validity of the scale were also found. Conclusion: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample.

OBJECTIVE: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal. METHODS: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR. RESULTS: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as inter-factor correlations, invariance, reliability, and validity of the scale were also found. CONCLUSION: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

Social anxiety and social norms in individualistic and collectivistic countries.

BACKGROUND: Social anxiety is assumed to be related to cultural norms across countries. Heinrichs et al. [2006: Behav Res Ther 44:1187-1197] compared individualistic and collectivistic countries and found higher social anxiety and more positive attitudes toward socially avoidant behaviors in collectivistic rather than in individualistic countries. However, the authors failed to include Latin American countries in the collectivistic group. METHODS: To provide support for these earlier results within an extended sample of collectivistic countries, 478 undergraduate students from individualistic countries were compared with 388 undergraduate students from collectivistic countries (including East Asian and Latin American) via self-report of social anxiety and social vignettes assessing social norms. RESULTS: As expected, the results of Heinrichs et al. [2006: Behav Res Ther 44:1187-1197] were replicated for the individualistic and Asian countries, but not for Latin American countries. Latin American countries displayed the lowest social anxiety levels, whereas the collectivistic East Asian group displayed the highest. CONCLUSIONS: These findings indicate that while culture-mediated social norms affect social anxiety and might help to shed light on the etiology of social anxiety disorder, the dimension of individualism-collectivism may not fully capture the relevant norms.