Assessing Peer-Related Impairments Linked to Adolescent Social Anxiety: Strategic Selection of Informants Optimizes Prediction of Clinically Relevant Domains.

Socially anxious adolescents commonly experience impaired interpersonal functioning with unfamiliar, same-age peers. Yet, we lack short screening tools for assessing peer-related impairments. Recent work revealed that a parent-reported, three-item screening tool produced scores that uniquely related to social anxiety concerns. However, this tool ought to go beyond linking impairments to service needs (i.e., social anxiety symptoms). This tool should also inform the goals of services, in particular by linking impairments to key domains relevant to therapeutically addressing adolescents' anxiety-related needs, such as social skills when interacting with unfamiliar peers. This requires an assessment approach that involves strategic selection of informants who vary in their expertise for observing anxiety-related needs, as well as the therapeutic goals for addressing anxiety-related impairments (e.g., social skills within peer interactions). We leveraged parents' reports to link impairments to social anxiety-related needs. To link impairments to social skills, we leveraged informants (i.e., unfamiliar untrained observers [UUOs]) who observed adolescents within tasks designed to simulate interactions with same-age, unfamiliar peers. We tested this approach using a mixed-clinical/community sample of 134 adolescents, ages 14- to 15 years old. We leveraged multi-informant survey reports to assess adolescent social anxiety, and trained independent observers rated adolescents' social skills within unfamiliar peer interactions. Parents' reports performed best when distinguishing adolescents on referral status and predicting survey-reported social anxiety, whereas only UUOs' reports predicted independent observers' social skills ratings. These findings inform the strategic selection of informants for assessing impairments that commonly prompt the need for adolescents to access mental health services for social anxiety.

Adolescent Safety Behaviors and Social Anxiety: Links to Psychosocial Impairments and Functioning with Unfamiliar Peer Confederates.

Socially anxious adolescents often endure anxiety-provoking situations using safety behaviors: strategies for minimizing in-the-moment distress (e.g., avoiding eye contact, rehearsing statements before entering a conversation). Studies linking safety behaviors to impaired functioning have largely focused on adults. In a sample of one hundred thirty-four 14 to 15 year-old adolescents, we tested whether levels of safety behaviors among socially anxious adolescents relate to multiple domains of impaired functioning. Adolescents, parents, and research personnel completed survey measures of safety behaviors and social anxiety, adolescents and parents reported about adolescents' evaluative fears and psychosocial impairments, and adolescents participated in a set of tasks designed to simulate social interactions with same-age, unfamiliar peers. Relative to other adolescents in the sample, adolescents high on both safety behaviors and social anxiety displayed greater psychosocial impairments, evaluative fears, and observed social skills deficits within social interactions. These findings have important implications for assessing and treating adolescent social anxiety.

Unfamiliar Untrained Observers' Ratings of Adolescent Safety Behaviors Within Social Interactions with Unfamiliar Peer Confederates.

Adolescents experiencing social anxiety often engage in safety behaviors-covert avoidance strategies for managing distress (e.g., avoiding eye contact)-that factor into the development and maintenance of their concerns. Prior work supports the psychometric properties of the Subtle Avoidance Frequency Examination (SAFE), a self-report survey of safety behaviors. Yet, we need complementary methods for assessing these behaviors within contexts where adolescents often experience concerns, namely, interactions with unfamiliar peers. Recent work indicates that, based on short, direct social interactions with adolescents, individuals posing as unfamiliar peers (i.e., peer confederates) and without assessment training can capably report about adolescent social anxiety. We built on prior work by testing whether we could gather valid SAFE reports from unfamiliar untrained observers (UUOs), who observed adolescents within archived recordings of these short social interactions. A mixed clinical/community sample of 105 adolescents self-reported on their functioning and participated in a series of social interaction tasks with peer confederates, who also provided social anxiety reports about the adolescent. Based on video recordings of these tasks, trained independent observers rated adolescents' observed social skills, and an additional set of UUOs completed SAFE reports of these same adolescents. Unfamiliar untrained observers' SAFE reports (a) related to adolescents' SAFE self-reports, (b) distinguished adolescents on clinically elevated social anxiety concerns, (c) related to trained independent observers' ratings of adolescent social skills within interactions with peer confederates, and (d) related to adolescents' self-reported arousal within these same interactions. Our findings support use of unfamiliar observers' perspectives to understand socially anxious adolescents' interpersonal functioning.

A Paradigm for Understanding Adolescent Social Anxiety with Unfamiliar Peers: Conceptual Foundations and Directions for Future Research.

Adolescents who experience social anxiety concerns often display symptoms and impairments when interacting with unfamiliar peers. For adolescent clients, reducing symptoms and impairments within these interactions comprises a key treatment target within exposure-based therapies for social anxiety. Recent work on mechanisms of change in exposure-based therapies highlights the need for therapeutic exposures to simulate real-world manifestations of anxiety-provoking social situations. Yet, researchers encounter difficulty with gathering ecologically valid data about social interactions with unfamiliar peers. The lack of these data inhibits building an evidence base for understanding, assessing, and treating adolescent clients whose concerns manifest within these social interactions. Consequently, we developed a paradigm for understanding adolescent social anxiety within social interactions with unfamiliar peers. In this paradigm, we train peer confederates to interact with adolescents as if they were a same-age peer, within a battery of social interaction tasks that mimic key characteristics of therapeutic exposures. Leveraging experimental psychopathology and multi-modal assessment approaches, this paradigm allows for understanding core components of social interactions with unfamiliar peers relevant to exposure-based therapy, including stimuli variability, habituation, expectancy violations, peers' impressions about socially anxious adolescents, and maladaptive coping strategies that inhibit learning from exposures (e.g., safety behaviors). We detail the conceptual and empirical foundations of this paradigm, highlight important directions for future research, and report "proof of concept" data supporting these research directions. The Unfamiliar Peer Paradigm opens new doors for building a basic science that informs evidence-based services for social anxiety, within clinically relevant contexts in adolescents' social worlds.

Ruptures in psychotherapy: Experiences of therapist trainees.

Method: We used consensual qualitative research (CQR) to investigate the experiences of therapist trainees who had a rupture with a client. Results: Of 21 trainees who were tracked weekly, 14 experienced a rupture and were interviewed 1 week after the rupture and again 2 weeks later about antecedents, repair attempts, and consequences. Trainees typically reported experiencing tension at the beginning of the rupture session and difficult emotions during the rupture (e.g., anger, depleted self-efficacy). Conclusion: Trainees typically tried to repair the rupture by using immediacy or facilitating exploration about the conflict. Trainees typically reported both negative (e.g., strained therapeutic relationship) and positive consequences (e.g., therapeutic work became more productive). Trainees seemed to be less aware of withdrawal than confrontational ruptures. Implications are that trainees could benefit from learning more about ruptures including how to regulate negative emotions toward clients and acquiring more rupture-repair tools, as well as realizing that ruptures can have some positive as well as negative aspects.