Anger in social anxiety disorder.

The present study focused on the emotional experience of anger among individuals with and without social anxiety disorder (SAD). Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling measurement (ESM) in which they reported on daily social interactions and emotions. Using multilevel linear modeling we found that individuals with SAD experienced more anger compared to individuals without SAD. We also found a Diagnosis × Social Context interaction such that interactions with distant others were associated with elevated anger compared to interactions with close others for individuals with SAD but not for individuals without SAD. Finally, we found that for individuals with SAD (but not those without SAD) anger on a given day (day t) was associated with elevated anxiety on the following day (day t + 1), above and beyond previous anxiety, sadness and guilt (i.e. anxiety, sadness and guilt reported on day t). This suggests that anger may play a unique role in maintaining or exacerbating anxiety among individuals with SAD. Additional implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder.

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety-depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Pre-reproductive stress in adolescent female rats alters maternal care and DNA methylation patterns across generations.

Stress during development affects maternal behavior and offspring phenotypes. Stress in adolescence is particularly consequential on brain development and maturation, and is implicated in several psychiatric disorders. We previously showed that pre-reproductive stress (PRS) in female adolescent rats affects behavior and corticotropin releasing hormone receptor 1 (CRHR1) expression in first- (F1) and second- (F2) generation offspring. We further showed that offspring phenotypes are partially reversed by post-stress treatment with fluoxetine (FLX) or the CRHR1 antagonist NBI27914 (NBI). Epigenetic processes, such as DNA methylation, are implicated in the stress response and interact with maternal care quality across generations. Here, we asked whether PRS and FLX or NBI exposure would affect maternal care and global DNA methylation in the brains of exposed dams and their adult F1 and paternally-derived F2 offspring. We found that PRS decreased self-care while increasing pup-care behaviors. PRS also increased DNA methylation in the amygdala of dams and their F1 male offspring, but decreased it in F2 females. Drug treatment had no effect on maternal care, but affected DNA methylation patterns in F0 and F1 generations. Furthermore, PRS altered the expression of DNA methylating enzymes in brain, blood and oocytes. Finally, maternal care variables differentially predicted methylation levels in PRS and control offspring. Thus, the effects of adolescent stress are long-lasting and impact methylation levels across three generations. Combined with our findings of epigenetic changes in PRS-exposed oocytes, the present data imply that biological changes and social mechanisms act in concert to influence adult offspring phenotypes.

Blend in or stand out: social anxiety levels shape information-sharing strategies.

Although living in social groups provides many benefits for group members, such groups also serve as a setting for social competition over rank and influence. Evolutionary accounts suggest that social anxiety plays a role in regulating in-group conflict, as individuals who are concerned about social threat may choose to defer to others to maintain the hierarchical status quo. Here, we examine how social anxiety levels are related to the advice-giving style an individual adopts: a competitive influence-seeking strategy or a defensive blend-in strategy. We begin by demonstrating that similarity to others drives activity in the brain's valuation system, even during a competitive advice-taking task. Then, in three behavioural experiments, we show that social anxiety levels are related to the tendency to give advice resembling the advice given by rival advisers and to refrain from status-seeking behaviour. Social anxiety was also associated with negative social comparisons with rival advisers. Our findings highlight the role of competing social goals in shaping information sharing.

The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis.

Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.

Are some therapists better at facilitating and consolidating sudden gains than others?

BACKGROUND: Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs. METHODS: The analyses are based on a sample of patients (N = 1937) who were seen by 155 therapists and received individual psychotherapy at a university outpatient clinic. First, the therapist effect (TE) on SG was investigated using multilevel modeling (MLM). Second, MLM was used to explore the relative importance of patient and therapist variability in SGs as they relate to outcome. RESULTS: The TE on SGs accounted for 1.8% of variance, meaning that therapists are accountable for inter-individual differences in their patients' likelihood to experience SGs. Furthermore, results revealed a significant effect of SGs on outcome for both levels, while therapist differences regarding the consolidation of SGs were not significant. CONCLUSIONS: The analyses indicated that some therapists are better in facilitating and initiating SGs. The process of triggering SGs seems to be a therapist skill or competence, which opens up an additional pathway to positive outcomes that could be used to improve clinical training.

Biased distance estimation in social anxiety disorder: A new avenue for understanding avoidance behavior.

OBJECTIVES: People regulate their interpersonal space appropriately to obtain a comfortable distance for interacting with others. Socially anxious individuals are especially prone to discomfort from and fear of physical closeness, leading them to prefer a greater interpersonal distance from others. Previous studies also indicate that fear can enhance the threat-related elements of a threatening stimulus. For example, spider phobia is associated with estimating spiders as bigger and faster than they actually are. Nonetheless, it is still unclear whether the preference of those with social anxiety disorder (SAD) to maintain greater distance from others is associated with biased estimations of interpersonal distance. MATERIALS AND METHODS: A total of 87 participants (44 clinically diagnosed with SAD and 43 control) performed validated computerized and ecological tasks in a real-life setting while social space estimations and preferences were measured. RESULTS: Participants with SAD felt comfortable when maintaining a greater distance from unfamiliar others compared to the control group and estimated unfamiliar others to be closer to them than they actually were. Moreover, the estimation bias predicted their preferred distance from strangers, indicating a strong association between estimation bias severity and actual approach-avoidance behavior. CONCLUSION: Our findings indicate that distance estimation bias underlies avoidance behavior in SAD, suggesting the involvement of a new cognitive mechanism in personal space regulation.

Admixture analysis of age at onset in older patients with schizophrenia spectrum disorders.

The nature of schizophrenia spectrum disorders with an onset in middle or late adulthood remains controversial. The aim of our study was to determine in patients aged 60 and older if clinically relevant subtypes based on age at onset can be distinguished, using admixture analysis, a data-driven technique. We conducted a cross-sectional study in 94 patients aged 60 and older with a diagnosis of schizophrenia or schizoaffective disorder. Admixture analysis was used to determine if the distribution of age at onset in this cohort was consistent with one or more populations of origin and to determine cut-offs for age at onset groups, if more than one population could be identified. Results showed that admixture analysis based on age at onset demonstrated only one normally distributed population. Our results suggest that in older schizophrenia patients, early- and late-onset ages form a continuum.

Reducing avoidance in adults with high spider fear using perceptual discrimination training.

BACKGROUND: Fear overgeneralization is a central feature of anxiety disorders and can lead to excessive avoidance. As perceptual discrimination is a key component of fear overgeneralization, a perceptual discrimination training task was created aimed at improving perceptual discrimination and reducing fear overgeneralization. METHODS: Participants with high spider fear were randomized into training or placebo conditions. After completing their assigned task, perceptual discrimination was tested. Thereafter, participants completed a behavioral avoidance test, consisting of five stimuli ranging from a paper spider to a live tarantula. Last, participants completed a threat/safety discrimination task using schematic morphs ranging from a flower to a spider, while self-report and skin conductance responses were collected. RESULTS: The training group showed better perceptual discrimination during the test than did the placebo group. Furthermore, as stimuli became increasingly similar to a live spider, participants in the training group exhibited decreased avoidance behavior. Finally, participants in the training group indicated that schematic morphs were less similar to a spider and showed less physiological arousal than did the placebo group. CONCLUSIONS: Together, these results attest to the possible clinical relevance of the perceptual discrimination training.

Gender differences in social anxiety disorder.

OBJECTIVE: Despite the ample literature on gender differences in anxiety and mood disorders, gender differences in social anxiety disorder (SAD) have received little empirical attention. The aim of the present study is to examine gender differences in 12-months prevalence, patterns of comorbidity, clinical presentation, subjective distress and functional impairment, age of onset, and treatment seeking, and discuss their clinical implications. METHOD: We used data from the National Comorbidity Survey-Replication (NCS-R; n = 652, 63.3% women) to examine gender differences. RESULTS: Main findings highlighted that compared with men, women are more likely to have SAD, to have a more severe clinical presentation of the disorder and to have greater subjective distress. Women are more likely than men to have comorbid specific phobia, generalized anxiety disorder and posttraumatic stress disorder, whereas men are more likely to have comorbid substance abuse disorders and conduct disorder. CONCLUSIONS: Greater SAD prevalence and severity among women can have implications for assessment (e.g., potentially setting gender-specific cutoffs) and treatment (e.g., guiding exposures) of SAD.