The structure of feared social situations among race-ethnic minorities and Whites with social anxiety disorder in the United States

We investigated feared social situations in individuals with social anxiety disorder from different racial and ethnic groups in the United States. The sample included 247 African Americans, 158 Latinos, and 533 non-Latino Whites diagnosed with social anxiety disorder within the past 12 months from the integrated Collaborative Psychiatric Epidemiology Studies data set. After randomly splitting the full sample, we conducted an exploratory factor analysis with half of the sample to determine the structure of feared social situations in a more diverse sample than has been used in previous studies. We found evidence for a model consisting of three feared social domains: performance/public speaking, social interaction, and observational. We then conducted a confirmatory factor analysis on the remaining half of the sample to examine whether this factor structure varied significantly between the race-ethnic groups. Analyses revealed an adequate fit of this model across all three race-ethnic groups, suggesting invariance of the factor structure between the study groups. Broader cultural contexts within which these findings are relevant are discussed, along with important implications for comprehensive, culturally sensitive assessment of social anxiety.R01 MH078308 - NIMH NIH HHS; R01 MH081116 - NIMH NIH HHS; MH-081116 - NIMH NIH HHS; K23 MH096029 - NIMH NIH HHS; MH-078308 - NIMH NIH HH

The effects of approach-avoidance modification on social anxiety disorder

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Recent empirical studies using approach-avoidance modification have found a reduction in symptoms and relapse in individuals with substance use, achieved by modifying unhealthy approach tendencies. This raises the question as to whether the benefits of such an intervention can generalize to reduction of unhealthy avoidance tendencies as observed in social anxiety. In the current double-blind study, 43 adults (aged 18 to 53) with social anxiety disorder were randomly assigned to an active condition (implicit training to approach smiling faces) or control condition (equal approach and avoidance of smiling faces) of the Approach and Avoidance Task (a computerized joystick task) in three sessions over the span of a week. Pre- to post-assessment changes were assessed on the following outcome measures: social anxiety (Liebowitz Social Anxiety Scale and Social Phobia Inventory), depression (Beck Depression Inventory-II), other self-report (State-Trait Anxiety Inventory - State version and Social Interaction Self-Statement Test), implicit measures of attention (dot probe) and rejection (implicit association task), and behavioral approach tasks (a conversation with a stranger and an impromptu speech). There were no differences between the groups on the basis of baseline approach tendency or experimental condition, except for a strong interaction effect between baseline approach tendency and condition on latency to engage in the conversation task. Specifically, individuals with a baseline avoidance tendency in the active training condition took longer to engage in this interaction at post-test. In addition, analyses revealed that the whole sample significantly improved on both social anxiety measures, and indicated reduced subjective distress on the speech task and reduced number of negative self-statements made after both behavioral tasks. There were no changes in level of depression or in performance on the other implicit measures (i.e., dot probe and implicit association task). Finally, participants' own beliefs that they were in the active condition of the study significantly predicted lower objectively-rated anxiety during the speech at post-test, regardless of baseline social anxiety severity or actual condition. In sum, a multi-session approach-avoidance modification that trains approach towards smiling faces appears to be limited in its effectiveness for treatment of social anxiety disorder

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women’s rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings

Adapting the National Diabetes Prevention Program: Learning from Lifestyle Coach strategies and adjustments during the COVID-19 pandemic in the United States

Background: The National Diabetes Prevention Program (National DPP) is an evidence-based lifestyle intervention successfully disseminated across the United States. Some adaptations have been made to address real-world needs, including during the COVID-19 pandemic. This study aims to qualitatively describe adaptations Lifestyle Coaches made in response to the pandemic. Methods: Between May and June 2021, Lifestyle Coaches (n = 300) from organizations across the United States answered open-ended survey questions about adjustments implemented during the pandemic. Survey responses were descriptively coded and codes were grouped into categories. Results: Nearly all coaches transitioned the format of their class from in-person to remote delivery (93.0 %; n = 279). Other commonly-reported strategies included adjusting contact with participants (48.0 %; n = 144), increasing support for participants (36.7 %; n = 110), and tailoring materials (28.3 %; n = 85). Conclusions: Maintaining these adaptations may address barriers to engagement in the National DPP and improve access to the program. Increased support for emotional symptoms and ensuring a patient-centered approach to care are particularly promising strategies