The Effectiveness of School-Based Skills-Training Programs Reducing Performance or Social Anxiety: Two Randomized Controlled Trials.

Background: Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking. Objective: The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills. Methods: Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (M age = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed. Results: The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health. Conclusions: A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety. Trial registration: International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019). Supplementary Information: The online version contains supplementary material available at 10.1007/s10566-023-09736-x.

Interpretation Biases in Social Scenarios and Social Anxiety: The Role of Safety Behaviors.

BACKGROUND: Interpretation bias (IB) and safety behaviors (SB) are maintenance mechanisms of social anxiety (SA). However, few studies have examined the role of IB and SB together in explaining SA. The objective of this study was to determine whether SB explains the association between IB and SA. To evaluate these variables, the Adolescents' Interpretation and Beliefs Questionnaire (AIBQ 2.0) and the Social Phobia Safety Behaviors Scale (SPSBS) needed to be adapted for Spanish adolescents and young people. METHOD: 826 Spanish vocational training students (60% males, 14-28 years old) completed a measure of SA and the AIBQ 2.0 and SPSBS. RESULTS: Path analysis showed that IB in offline scenarios was associated with SA through SB. IB in offline situations, but not in online situations, was directly associated with SA. As expected, the AIBQ 2.0 showed a two-dimensional structure and good internal consistency. The SPSBS demonstrated a unidimensional structure and good internal consistency. CONCLUSIONS: In the absence of longitudinal studies, the data are compatible with the possible mediating role of SB in the association between IB and SA. Both instruments (AIBQ 2.0 and SPSBS) exhibited good psychometric properties for Spanish students.

Trajectories of adolescent perceived stress and symptoms of depression and anxiety during the COVID-19 pandemic.

Adolescents might be particularly affected by the drastic social changes as a consequence of the COVID-19 pandemic, given the increased stress-sensitivity and importance of the social environment in this developmental phase. In order to examine heterogeneity during the pandemic, the current study aimed to identify whether subgroups of adolescents could be distinguished based on their levels of perceived stress and symptoms of depression and anxiety. In addition, we examined which prepandemic factors predicted these trajectories. Adolescents were assessed before the pandemic (N = 188, Mage = 13.49, SD = 0.81) and at three timepoints during the pandemic (i.e., eight, ten, and 15 months after the start of the pandemic in the Netherlands). Results showed no support for distinct trajectories of perceived stress, adolescents experienced stable moderate levels during the pandemic. In contrast, results showed three trajectories for depression and anxiety. The majority of adolescents reported stable low or moderate levels and one small subgroup reported high levels of depression and anxiety that decreased during the pandemic. Certain prepandemic factors predicted higher initial levels of stress and symptoms of depression and anxiety during the pandemic. To support adolescents with prepandemic vulnerabilities, strategies could be developed, for instance enhancing adolescents' social support.

Interpretation Biases in Social Scenarios and Social Anxiety: The Role of Safety Behaviors / Sesgos de Interpretación en Escenarios Sociales y Ansiedad Social: el Rol de las Conductas de Seguridad

Background: Interpretation bias (IB) and safety behaviors (SB) are maintenance mechanisms of social anxiety (SA). However, few studies have examined the role of IB and SB together in explaining SA. The objective of this study was to determine whether SB explains the association between IB and SA. To evaluate these variables, the Adolescents’ Interpretation and Beliefs Questionnaire (AIBQ 2.0) and the Social Phobia Safety Behaviors Scale (SPSBS) needed to be adapted for Spanish adolescents and young people. Method: 826 Spanish vocational training students (60% males, 14–28 years old) completed a measure of SA and the AIBQ 2.0 and SPSBS. Results: Path analysis showed that IB in offline scenarios was associated with SA through SB. IB in offline situations, but not in online situations, was directly associated with SA. As expected, the AIBQ 2.0 showed a two-dimensional structure and good internal consistency. The SPSBS demonstrated a unidimensional structure and good internal consistency. Conclusions: In the absence of longitudinal studies, the data are compatible with the possible mediating role of SB in the association between IB and SA. Both instruments (AIBQ 2.0 and SPSBS) exhibited good psychometric properties for Spanish students.(AU)

Aun considerándose los sesgos de interpretación (IB) y las conductas de seguridad (SB) mecanismos mantenedores de la ansiedad social (SA), son escasos los estudios que examinan estas variables en conjunto. El objetivo del estudio fue evaluar si las SB explican la asociación entre IB y la SA. Para evaluar estas variables se requirió adaptar el Adolescents’ Interpretation and the Beliefs Questionnaire (AIBQ 2.0) y el Social Phobia Safety Behaviors Scale (SPSBS) en adolescentes y jóvenes españoles. Método: 826 estudiantes españoles de formación profesional (60% hombres, 14-28 años) completaron una medida de SA y el AIBQ 2.0 y SPSBS. Resultados: El path analysis mostró que las IB en escenarios offline se asociaron con SA a través de SB. Las IB en situaciones offline, pero no online, se asociaron directamente con SA. El AIBQ 2.0 mostró una estructura de dos dimensiones y consistencia interna aceptable. El SPSBS mostró una estructura unidimensional y buena consistencia interna. Conclusiones: A falta de estudios longitudinales, los datos son compatibles con el posible rol mediador de las SB respecto a la relación entre IB y SA. Ambos instrumentos (AIBQ 2.0 y SPSBS) disponen de buenas propiedades psicométricas en estudiantes españoles.(AU)

The effects of school-based interventions on physiological stress in adolescents: A meta-analysis.

Chronic stress is associated with dysregulations in the physiological stress system, resulting in diverse negative developmental outcomes. Since adolescence is a period characterized by increased stress-sensitivity, and schools are an important environment for the developing adolescent, school-based interventions promoting psychosocial functioning are of particular interest to prevent adverse outcomes. The present study therefore aimed to investigate the effectiveness of such interventions on hypothalamic pituitary adrenal-axis (i.e., cortisol) and cardiovascular (i.e., blood pressure [BP] and heart rate [HR]/heart rate variability [HRV]) parameters of stress in adolescents, and examined moderators of effectiveness. The search resulted in the inclusion of k = 9 studies for cortisol, k = 16 studies for BP, and k = 20 studies for HR/HRV. The results indicated a significant small overall effect on reducing BP, but no significant effect for HR/HRV. For cortisol, large methodological variation in the few primary studies did not allow for quantitative analyses, but a qualitative review demonstrated inconsistent results. For BP and HR/HRV, larger effects were observed for intervention programs with a mindfulness and/or meditation component, for interventions without a cognitive-behavioural component and for interventions with a higher intensity. Providing adolescents with techniques to improve indicators of physiological stress may prevent emerging mental health problems.

Concurrent and Prospective Associations Between Social Anxiety and Responses to Stress in Adolescence.

Several studies have investigated the relationship between adolescents' responses to stress and general anxiety and depression, but only few studies addressed the relationship between responses to stress and social anxiety. The current three-wave longitudinal study, that covered a period of 5 years with a time interval of on average two years between waves, examined concurrent as well as prospective relations between adolescents' self-reported stress responses, including coping responses, and self-perceived social anxiety. Both the predictive power of social anxiety for different stress responses and, reversely, of stress responses for social anxiety were evaluated. Participants were 331 youth (170 boys) aged 9 to 17 years old at Wave 1. Self-report questionnaires were used to measure social anxiety, responses to social stress, and depressive symptoms. Results showed significant concurrent relations between social anxiety and maladaptive stress responses. Moreover, the study yielded evidence for social anxiety predicting stress responses across time as well as stress responses predicting social anxiety, although evidence for the former link is stronger. The findings suggest that a relative lack of adaptive stress responses may heighten social anxiety and social anxiety in turn may trigger maladaptive as well as adaptive responses to social problems. The relevance of these findings for social anxiety prevention and intervention purposes are discussed.

Prepandemic Risk Factors of COVID-19-Related Concerns in Adolescents During the COVID-19 Pandemic.

To identify adolescents who may be at risk for adverse outcomes, we examined the extent of COVID-19-related concerns reported by adolescents and investigated which prepandemic risk and protective factors predicted these concerns during the COVID-19 pandemic. Dutch adolescents (N = 188; Mage  = 13.49, SD = .81) were assessed before the pandemic and at eight and ten months into the pandemic. Results demonstrated that adolescents' most frequently reported COVID-19-related concerns were about social activities and getting delayed in school. Adolescents that have specific vulnerabilities before the pandemic (i.e., higher stress, maladaptive coping, or internalizing problems) experience more concerns during the pandemic, stressing the importance of guiding and supporting these adolescents in order to prevent adverse developmental outcomes.

Can Schools Reduce Adolescent Psychological Stress? A Multilevel Meta-Analysis of the Effectiveness of School-Based Intervention Programs.

Increased levels of psychological stress during adolescence have been associated with a decline in academic performance, school dropout and increased risk of mental health problems. Intervening during this developmental period may prevent these problems. The school environment seems particularly suitable for interventions and over the past decade, various school-based stress reduction programs have been developed. The present study aims to evaluate the results of (quasi-)experimental studies on the effectiveness of school-based intervention programs targeting adolescent psychological stress and to investigate moderators of effectiveness. A three-level random effects meta-analytic model was conducted. The search resulted in the inclusion of k = 54 studies, reporting on analyses in 61 independent samples, yielding 123 effect sizes (N = 16,475 individuals). The results indicated a moderate overall effect on psychological stress. Yet, significant effects were only found in selected student samples. School-based intervention programs targeting selected adolescents have the potential to reduce psychological stress. Recommendations for practice, policy and future research are discussed.

A cross-sectional and longitudinal network analysis approach to understanding connections among social anxiety components in youth.

As proposed in a prominent developmental model, social anxiety has different manifestations: social fear, shy temperament, anxious cognitions, and avoidance of social situations. Drawing from this model, we used the network approach to psychopathology to gain a detailed understanding of specific social anxiety components and their associations. The current article investigated (a) how social anxiety components are interconnected within a network, and (b) the consistency of the network over time, in a community sample of children and adolescents. Data from 3 waves of a longitudinal study were used. At Time 1 (T1) the total sample comprised 331 participants (Mage = 13.34 years); at Time 3 (T3) there were 236 participants (Mage = 17.48 years). Social anxiety components were assessed with self-report questionnaires. Networks of 15 nodes (i.e., components) were estimated. Network analysis of T1 components revealed 4 communities: cognitive, social-emotional, avoidance of performance, and avoidance of interaction situations. There were no direct connections between the cognitive and behavioral communities; social-emotional nodes appeared to act as bridge components between the 2 communities. A similar pattern of component associations and communities was found in the T2 and T3 networks, and the longitudinal network incorporating node change trajectories. Networks were estimated on group-level observational data and conclusions about cause-effect relationships are tentative. Although the sample size decreased across the 3 waves, the reliability of parameter estimates were minimally affected. Findings attest to the potential value of applying the network approach to investigate the pattern of associations among social anxiety components in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effectiveness of school-based skills-training programs promoting mental health in adolescents: a study protocol for a randomized controlled study.

BACKGROUND: Adolescence is a period of elevated stress sensitivity, which places adolescents at increased risk of developing mental health problems such as burnout, depression, anxiety, and externalizing problems. Early intervention of psychological needs and low-threshold care addressing such needs may prevent this dysfunctional development. Schools may provide an important environment to identify and address psychological needs. The aim of this protocol is to describe the design of a study aiming to evaluate the effectiveness of low-threshold school-based skills-training programs promoting the mental health of adolescents and to examine moderators of the effectiveness. METHODS: A Randomized Controlled Trial will be conducted to examine the effectiveness of two school-based skills-training programs aiming to promote mental health by improving either skills to deal with performance anxiety or social skills. A multi-informant (i.e., students, parents, and trainers) and multi-method (i.e., questionnaires and physiological measurements) approach will be used to assess program targets (skills to deal with performance anxiety or social skills), direct program outcomes (performance or social anxiety) and mental health outcomes (i.e., stress, internalizing and externalizing problems, self-esteem and well-being), as well as specific moderators (i.e., student, parent and program characteristics, social support, perfectionism, stressful life events, perceived parental pressure, positive parenting behavior, treatment alliance and program integrity). DISCUSSION: The current study will provide information on the effectiveness of school-based skills-training programs. It is of crucial importance that the school environment can provide students with effective, low-threshold intervention programs to promote adolescents' daily functioning and well-being and prevent the emergence of mental health problems that negatively affect school performance. TRIAL REGISTRATION: Dutch Trial Register number NL7438 . Registered 12 December 2018.

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents.

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents. Design: Cross-sectional design was utilized. Methods: IB, measured by the Adolescents' Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n = 25) and a control group (n = 29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation. Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn't have more negative interpretations of non-social situations, after controlling for depression. Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.

The Role of Performance Quality in Adolescents' Self-Evaluation and Rumination after a Speech: Is it Contingent on Social Anxiety Level?

BACKGROUND: Cognitive behavioural therapy (CBT) has relatively poor outcomes for youth with social anxiety, possibly because broad-based CBT is not tailored to their specific needs. Treatment of social anxiety in youth may need to pay more attention to negative social cognitions that are considered a key factor in social anxiety development and maintenance. AIMS: The aim of the present study was to learn more about the role of performance quality in adolescents' cognitions about their social performance and, in particular, the moderating role social anxiety plays in the relationship between performance quality and self-cognitions. METHOD: A community sample of 229 participants, aged 11 to 18 years, gave a speech and filled in questionnaires addressing social anxiety, depression, expected and self-evaluated performance, and post-event rumination. Independent observers rated the quality of the speech. The data were analysed using moderated mediation analysis. RESULTS: Performance quality mediated the link between expected and self-evaluated performance in adolescents with low and medium levels of social anxiety. For adolescents with high levels of social anxiety, only a direct link between expected and self-evaluated performance was found. Their self-evaluation was not related to the quality of their performance. Performance quality also mediated the link between expected performance and rumination, but social anxiety did not moderate this mediation effect. CONCLUSIONS: Results suggest that a good performance does not help socially anxious adolescents to replace their negative self-evaluations with more realistic ones. Specific cognitive intervention strategies should be tailored to the needs of socially anxious adolescents who perform well.

Social anxiety and interpretation bias: examining clinical and subclinical components in adolescents.

BACKGROUND: This study aimed to examine whether different components of interpretation bias are clinical or dimensional features of adolescent social anxiety. The study analyzed the components of this bias at a subclinical level of Social Anxiety Disorder (SAD) and compared these with a clinical sample of adolescents with SAD. METHOD: Adolescents in the age range 13-17 years participated. A group with SAD (n = 30) was compared with a group with subclinical SAD (n = 60), and a non-socially anxious group (n = 95). RESULTS: Negative interpretation bias for social situations was found to be a dimensional aspect of social anxiety. In contrast, belief in negative interpretations of social situations appears to be a clinical feature. Contrary to expectations, endorsement of positive interpretations did not differ between the three groups. CONCLUSIONS: The results suggest that a screening instrument based on negative interpretations of social situations could be useful to detect adolescents at-risk of developing SAD. In a clinical setting, the belief in negative interpretations and the presence of the bias in nonsocial situations should also be considered.

Connecting the Dots between Schizotypal Symptoms and Social Anxiety in Youth with an Extra X Chromosome: A Mediating Role for Catastrophizing.

Youth with an extra X chromosome (47, XXY & 47, XXX) display higher levels of schizotypal symptoms and social anxiety as compared to typically developing youth. It is likely that the extra X chromosome group is at-risk for clinical levels of schizotypy and social anxiety. Hence, this study investigated how schizotypal and social anxiety symptoms are related and mechanisms that may explain their association in a group of 38 children and adolescents with an extra X chromosome and a comparison group of 109 typically developing peers (8-19 years). Three cognitive coping strategies were investigated as potential mediators, rumination, catastrophizing, and other-blame. Moderated mediation analyses revealed that the relationship between schizotypal symptoms and social anxiety was mediated by catastrophizing coping in the extra X chromosome group but not in the comparison group. The results suggest that youth with an extra X chromosome with schizotypal symptoms could benefit from an intervention to weaken the tendency to catastrophize life events as a way of reducing the likelihood of social anxiety symptoms.

Predictors of Postoperative Nausea and Vomiting in Neurosurgical Patients.

In the neurosurgery patient population, one of the most frequent complications is postoperative nausea and vomiting (PONV). The purpose of this predictive correlational study was to examine the incidence and predictors of PONV in a cohort of 519 neurosurgery patients undergoing elective spinal and intracranial procedures. Patients were interviewed, and their medical records were reviewed every 24 hours for up to 72 hours postoperatively to identify risk factors for PONV development. After summarizing univariate associations, a multivariable logistic regression model for each outcome was developed using forward and backward stepwise selection, with the p value for a variable to enter or leave the model set to .05. Women, especially those who were younger and with a history of PONV, were most likely to have PONV. In addition, those undergoing craniotomy, particularly infratentorial craniotomy, were more likely to have PONV compared with patients undergoing spine surgery. This study provides a foundation for nursing and interdisciplinary intervention studies aimed at reducing this postoperative symptom in the most susceptible patients.

Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.

Screening situations for risk of ethical conflicts: a pilot study.

BACKGROUND: Ethical conflicts, often leading to poor teamwork and moral distress, are very challenging to patients, patients' families, and health care providers. A proactive approach to ethical conflicts may improve patient care outcomes. OBJECTIVES: To examine acceptability and feasibility of an ethics screening and early intervention tool for use by nurses caring for critically ill patients. METHODS: Twenty-eight nurses in 2 medical centers applied the ethics screening tool to 55 patient situations. Nurses assessed situations for risk factors and early indicators of ethical conflicts and analyzed level of risk. At study completion, nurses participated in focus group discussions about the tool's benefits and challenges. Frequency counts were performed on risk factors and early indicators of ethical conflicts. Content analysis was used on written explanations regarding high-, medium-, and low-risk situations and on focus group data. RESULTS: Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium- and low-risk situations. Certain risk factors featured prominently in high-risk situations. CONCLUSIONS: A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

Developmental pathways of social avoidance across adolescence: the role of social anxiety and negative cognition.

It is argued that the adolescent onset of social anxiety disorder (SAD) may be partly attributable to an increase in avoidance of social situations across this period. The current cohort-sequential study investigated developmental pathways of social avoidance in adolescence and examined the explanatory role of social anxiety and negative cognitive processes. A community sample of youth (9-21 years, N=331) participated in a four-wave study. Trajectory analyses revealed two pathways: an increased avoidance pathway and a low avoidance pathway. The pathways were hardly distinguishable at age 9 and they steadily diverged across adolescence. Logistic regression analyses showed that social anxiety and post-event rumination were significantly related to the increased avoidance pathway; anticipatory processing and self-focused attention were not. The findings suggest that adolescence is a key developmental period for the progression of social avoidance among youth who show relatively high levels of social anxiety and post-event rumination.

The relation between social anxiety and audience perception: examining Clark and Wells' (1995) model among adolescents.

BACKGROUND: Clark and Wells' cognitive model of social anxiety proposes that socially anxious individuals have negative expectations of performance prior to a social event, focus their attention predominantly on themselves and on their negative self-evaluations during an event, and use this negative self-processing to infer that other people are judging them harshly. AIMS: The present study tested these propositions. METHOD: The study used a community sample of 161 adolescents aged 14-18 years. The participants gave a speech in front of a pre-recorded audience acting neutrally, and participants were aware that the projected audience was pre-recorded. RESULTS: As expected, participants with higher levels of social anxiety had more negative performance expectations, higher self-focused attention, and more negative perceptions of the audience. Negative performance expectations and self-focused attention were found to mediate the relationship between social anxiety and audience perception. CONCLUSIONS: The findings support Clark and Wells' cognitive model of social anxiety, which poses that socially anxious individuals have distorted perceptions of the responses of other people because their perceptions are coloured by their negative thoughts and feelings.