Social anxiety disorder, avoidance and safety behavior: a systematic review

O Transtorno de Ansiedade Social (TAS) caracteriza-se por um medo persistente de situações sociais. Objetiva-se identificar na literatura indexada, estudos relativos à qualidade técnica de instrumentos psicométricos e experimentais sobre a avaliação dos pensamentos negativos e comportamentos de segurança associados ao TAS. Foram identificados 22 artigos, agrupados em dois conjuntos, considerando os procedimentos utilizados. No primeiro conjunto os estudos investigaram as qualidades psicométricas de instrumentos que avaliam cognições e TAS, sendo que destes, quatro abordaram versões já aferidas previamente e dois avaliaram instrumentos propostos especificamente para mensurar comportamento de segurança e pensamentos negativos. Os estudos do segundo conjunto investigaram, por meio de simulações de situações de desempenho verbal, aspectos cognitivos associados à ansiedade, destacando as variáveis auto-imagem negativa, pensamentos negativos e comportamentos de segurança associados ao aumento da ansiedade social. A análise dos estudos aponta que a identificação de comportamentos evitativos pode ser útil para a implementação de intervenções.Social anxiety disorder (SAD) is characterized by and intense and constant fear of social situations. The goal of this work is to identify, in indexed publications, psychometric and empirical studies on the evaluation of negative thoughts and safety behaviors associated with SAD. Twenty-two articles were located and grouped into two sets considering the type of procedure used. In the first set, studies investigated the psychometric properties of instruments that evaluate cognition and SAD, out of which four studies addressed instruments that had been previously evaluated, and two others evaluated instruments specifically proposed for measuring safety behavior and negative thoughts. The studies in the second set used simulations of verbal performance situations to investigate the cognitive aspects associated with anxiety. These studies confirmed the association of negative self-image, negative thoughts, and safety behaviors with social anxiety. The analysis of the studies reveals that identifying avoidance behaviors can be useful for implementing intervention procedures

Instrumentos de avaliação do transtorno de ansiedade social

Social anxiety disorder (SAD) is difficult to diagnose by clinicians, a fact that stimulates the study and development of instruments that will favor its early and systematic recognition. The objective of the present study was to identify in the literature indexed from 1999 to July 2004 articles related to psychometric studies on instruments for the assessment of SAD. A systematic search was performed in the PsychoInfo, Lilacs and Medline indexing services using the following key words: social phobia scale, social phobia validity, social phobia reliability and social anxiety scale, with 26 papers being identified. For analysis, the studies were divided into two groups: a) Eleven regarding the Liebowitz Social Anxiety Scale (LSAS) and b) Fifteen regarding other scales already validated or in the process of validation. Among the studies with the LSAS, six worked with the hetero-applied version and four with the self-applied version, identifying satisfactory psychometric qualities regarding validity in the original language (English) and in other languages such as French, Hebrew, Turkish and Spanish. In addition, good reliability indices were found, and regarding factorial analysis, the four-factor model was considered to be the most adequate. Among the studies using other scales, eight worked with instruments already validated and seven with new scales, identifying satisfactory values regarding validity and reliability. The main limitations pointed out in the studies surveyed were related to the diversity of the gold standard adopted; sample composition with the absence of clear inclusion and exclusion criteria, and the small number of studies on non-clinical samples, impairing the use of the instruments for general population screening. Future studies are clearly needed to improve the validation of the criterion based on factorial and cluster analysis.O transtorno de ansiedade social (TAS) é um distúrbio de difícil diagnóstico pelos clínicos, o que estimula o estudo e desenvolvimento de instrumentos que favoreçam seu reconhecimento precoce e sistemático. Objetiva-se identificar na literatura indexada entre janeiro de 1999 e julho de 2004, artigos relativos a estudos psicométricos sobre instrumentos para avaliação do TAS. Procedeu-se à busca sistemática nos indexadores PsycoInfo, Lilacs e Medline, utilizando-se as palavras-chaves: social phobia scale, social phobia validity, social phobia reliability e social anxiety, identificando-se 26 artigos. Para a análise, os estudos foram agrupados em dois conjuntos: a) onze relativos à Liebowitz Social Anxiety Scale (LSAS), e b) quinze relativos a outras escalas já validadas ou em validação. Dos estudos com a LSAS, seis trabalharam com a versão hetero-aplicada e quatro com a auto-aplicada, tendo identificado qualidades psicométricas satisfatórias quanto à validade no idioma original (inglês), e outros idiomas: francês, hebraico, turco e espanhol. Do mesmo modo, bons índices de fidedignidade foram encontrados e quanto à análise fatorial, o modelo de quatro fatores foi considerado o mais adequado. Dos estudos com outras escalas, sete trabalharam com instrumentos já validados e oito com novas escalas, identificando valores satisfatórios quanto à validade e fidedignidade. As principais limitações verificadas nos estudos relacionaram-se à diversidade de padrão-ouro adotada, composição amostral com ausência de claros critérios de inclusão e exclusão, e pequeno número de estudos com amostras não-clínicas, dificultando o uso dos instrumentos para rastreamento na população geral Estudos futuros que visem aprimorar a validação de critério com base na análise fatorial e de cluster, parecem necessários e oportunos

Aspectos cognitivos do falar em público: validação de uma escala de autoavaliação para universitários brasileiros

BACKGROUND: Fear of public speaking is the most prevalent fear in the general population and among persons with a social anxiety disorder (SAD). Nevertheless, studies about the assessment of this specific phenomenon are still needed. OBJECTIVES: To examine the validity of the Self Statements during Public Speaking (SSPS) scale in a general population of Brazilian university students (GP, n = 2314), in an SAD sample (n = 88), and in a non-SAD sample (n = 90). METHODS: The study was conducted in two phases: a) completing a self-administered questionnaire in the classroom, b) participating in a telephone and face-to-face interview. RESULTS: The SSPS showed low/median correlations with the Social Phobia Inventory (GP = 0.22-0.65; SAD = 0.28-0.32; non-SAD = 0.21-0.30), the Beck Anxiety Inventory (GP = 0.18-0.53; SAD = 0.25-0.33; non-SAD = 0.22-0.25), and the Brief Social Phobia Scale (SAD = not significant, non-SAD = 0.23-0.31) in all the samples, especially in the GP sample. Factorial analysis indicated the presence of two factors associated with positive and negative self-assessment. The study of discriminative validity demonstrated that the SSPS has the ability to differentiate between cases and non-cases of SAD. DISCUSSION: The SSPS is an adequate instrument to be used within the Brazilian context. The positive self-assessment subscale seems to be more effective for the evaluation of SAD samples. The negative self-assessment subscale appears to have a better screening characteristic in the general population of university students.CONTEXTO: O falar em público é o medo mais prevalente na população geral e no Transtorno de Ansiedade Social (TAS). Assim sendo, estudos que dimensionem essa situação específica são necessários. OBJETIVOS: Validar a Self Statements during Public Speaking (SSPS) em amostra da população geral de estudantes universitários (PG - n = 2.314), casos (C - n = 88) e não casos de TAS (NC - n = 90) do Brasil. MÉTODOS: Conduziu-se o estudo em duas fases: a) preenchimento dos questionários autoaplicados em sala de aula; b) participação em entrevista telefônica e ao vivo. RESULTADOS: Evidenciaram-se correlações baixas/moderadas entre SSPS e Inventário de Fobia Social (PG = 0,22-0,65; C = 0,28-0,32; NC = 0,21-0,30), Inventário de Ansiedade de Beck (PG = 0,18-0,53; C = 0,25-0,33; NC = 0,22-0,25) e Escala Breve de Fobia Social (C = não significativa, NC = 0,23-0,31) nas diferentes amostras, especialmente para a PG. A análise fatorial apontou a presença de dois fatores, associados à autoavaliação positiva e negativa. O estudo da validade discriminativa evidenciou a capacidade da SSPS de discriminar os casos dos não casos de TAS. CONCLUSÃO: A SSPS é adequada para uso no contexto brasileiro, sendo que a subescala autoavaliação positiva parece ser mais efetiva para a avaliação de amostras identificadas ou suspeitas de TAS e a subescala autoavaliação negativa ter uma característica mais rastreadora quando aplicada em amostras da população geral

Cognitive aspects of public speaking: validation of a self-assessment scale for Brazilian university students

CONTEXTO: O falar em público é o medo mais prevalente na população geral e no Transtorno de Ansiedade Social (TAS). Assim sendo, estudos que dimensionem essa situação específica são necessários. OBJETIVOS: Validar a Self Statements during Public Speaking (SSPS) em amostra da população geral de estudantes universitários (PG - n = 2.314), casos (C - n = 88) e não casos de TAS (NC - n = 90) do Brasil. MÉTODOS: Conduziu-se o estudo em duas fases: a) preenchimento dos questionários autoaplicados em sala de aula; b) participação em entrevista telefônica e ao vivo. RESULTADOS: Evidenciaram-se correlações baixas/moderadas entre SSPS e Inventário de Fobia Social (PG = 0,22-0,65; C = 0,28-0,32; NC = 0,21-0,30), Inventário de Ansiedade de Beck (PG = 0,18-0,53; C = 0,25-0,33; NC = 0,22-0,25) e Escala Breve de Fobia Social (C = não significativa, NC = 0,23-0,31) nas diferentes amostras, especialmente para a PG. A análise fatorial apontou a presença de dois fatores, associados à autoavaliação positiva e negativa. O estudo da validade discriminativa evidenciou a capacidade da SSPS de discriminar os casos dos não casos de TAS. CONCLUSÃO: A SSPS é adequada para uso no contexto brasileiro, sendo que a subescala autoavaliação positiva parece ser mais efetiva para a avaliação de amostras identificadas ou suspeitas de TAS e a subescala autoavaliação negativa ter uma característica mais rastreadora quando aplicada em amostras da população geral

Fobia social e habilidades sociais: uma revisão da literatura

  This study aimed to identify in the indexers Medline, PsycINFO, Lilacs and Scielo, in the period between 2000 and 2005, empirical studies that investigated social phobia in relation to social skills, followed by a critical analysis of the methodologies used by the studies listed. Sixteen papers were identified and grouped in two categories: Therapeutic Modalities - Application and Comparison of Clinical Interventions (N=6) and Characterization of the Social Skills Repertoire (N = 10). The studies that compared therapeutic approaches evidenced the higher efficiency of the Social Skills Training (SST), for the development of more competent social repertoire, compared to cognitive-behavioral therapy. The studies of profile characterization (10) reported that the patients with social phobia presented a social skills deficit, suggesting the potential benefit of participation in social skills training programs. The critical analysis of the researches design pointed to the need of new studies with clinical and non-clinical samples, with random allocation of participants, precise diagnosis, and proposition of contextualized interaction tasks, in order to support the generalization of findings related to the association between the social skills and social phobia, and to demonstrate the functionality and process by which anxiety interferes with social performance.   Keywords: social phobia; social anxiety; social skills.Objetivou-se identificar nos indexadores Medline, PsycINFO, Lilacs e Scielo, no período de 2000 a 2005, estudos empíricos que abordem a fobia social e suas associações às habilidades sociais, visando a análise crítica das metodologias empregadas nesses estudos. Identificou-se 16 artigos, agrupados para análise em duas categorias: Modalidades Terapêuticas - Aplicação e Comparação de Intervenções Clínicas (N = 6), e Caracterização do Repertório de Habilidades Sociais (N = 10). Os estudos que compararam abordagens terapêuticas constataram a maior eficiência do treinamento em habilidades sociais (THS) para o desenvolvimento de repertório social mais competente, em comparação com a terapia cognitivo-comportamental. Os estudos de caracterização de perfis (10), relataram que os pacientes com fobia social apresentaram habilidades sociais mais deficitárias, apontando para o benefício potencial da participação em programas de THS. A análise crítica dos delineamentos apontou para a necessidade de novos estudos com amostras clínicas e não-clínicas, com alocação randômica dos participantes, com diagnóstico preciso e proposição de tarefas de interação contextualizadas, de modo a respaldar a generalização quanto à associação das habilidades sociais e fobia social, e evidenciar a funcionalidade e o processo pelo qual a ansiedade interfere no desempenho social. Palavras-chave: fobia social; ansiedade social; habilidades sociais

Espectroscopia de próton por ressonância magnética de lobo frontal em esquizofrênicos: revisão crítica da metodologia

Schizophrenic patients undergoing proton magnetic resonance spectroscopy show alterations in N-acetyl aspartate levels in several brain regions, indicating neuronal dysfunction. The present review focuses on the main proton magnetic resonance spectroscopy studies in the frontal lobe of schizophrenics. A MEDLINE search, from 1991 to March 2004, was carried out using the key-words spectroscopy and schizophrenia and proton and frontal. In addition, articles cited in the reference list of the studies obtained through MEDLINE were included. As a result, 27 articles were selected. The results were inconsistent, 19 papers reporting changes in the N-acetyl aspartate levels, while 8 reported no change. Methodological analysis led to the conclusion that the discrepancy may be due the following factors: (i) number of participants; (ii) variation in the clinical and demographic characteristics of the groups; (iii) little standardization of the acquisition parameters of spectroscopy. Overall, studies that fulfill strict methodological criteria show N-acetyl aspartate decrease in the frontal lobe of male schizophrenics.Pacientes esquizofrênicos submetidos à espectroscopia de próton por ressonância magnética demonstram alterações nos níveis de N-acetilaspartato em diversas regiões cerebrais, suportando a hipótese de disfunção neuronal nestas áreas. Objetiva-se apresentar uma revisão da literatura, sobre os principais estudos de espectroscopia de próton por ressonância magnética na região frontal em esquizofrênicos. Utilizou-se o indexador MEDLINE, no período entre 1991 e março de 2004, com o cruzamento dos termos spectroscopy, schizophrenia, proton e frontal. Foram selecionados 27 artigos originais, cujos resultados mostram-se discordantes quanto à alteração nos valores de N-acetilaspartato (19 artigos apresentaram alterações nos níveis de N-acetilaspartato e oito estudos não apresentam alterações). A presente revisão sugere que esta diversidade de resultados pode ser atribuída aos seguintes fatores: 1-número de participantes; 2- variação nas características clínicas e demográficas dos grupos; 3- pouca padronização dos parâmetros de aquisição dos espectros. Os artigos que satisfazem os critérios metodológicos mais rígidos sugerem diminuição de NAA no lobo frontal de esquizofrênicos do sexo masculino

Borderline personality disorder and bias in the recognition of facial expressions of emotion: a pathway to understand the psychopathology

Background The identification of facial emotions is a key skill as it promotes rapid and accurate recognition of emotions and enables better communication and greater social adaptation. More recent studies have suggested that impaired social interactions may be related to deficits in social cognition and therefore in the recognition of facial expressions, contributing to social disturbance among individuals with borderline personality disorder (BPD). Objective To present the results of an empirical study assessing the recognition of facial emotion expressions in women with BPD, having as reference a group of healthy women from the general population. Methods The subjects (40 female with BPD and 40 controls) were assessed with a dynamic task on a computer screen for recognition of facial expressions of emotion. Results The BPD group had a lower accuracy in perceiving emotions of fear and surprise and slowness in recognising happiness. Logistic regression analyses also identified an association between BPD and higher sensitivity in the recognition of anger. Discussion Women with BPD made more mistakes in the recognition of negative emotions, which can bias the behaviour and regulation of affective states, favouring in turn the emergence of some typical symptoms associated with BPD

False memories in social anxiety disorder

Background False memories are memories of events that never occurred or that occurred, but not exactly as we recall. Events with emotional content are subject to false memories production similar to neutral events. However, individual differences, such as the level of maladjustment and emotional instability characteristics of Social Anxiety Disorder (SAD), may interfere in the production of false memories. Objectives This study aimed to assess the effect of emotion in memory performance for an event witnessed by participants with and without SAD. Methods Participants were 61 young adults with SAD and 76 without any symptoms of SAD who were randomly assigned to watch a story with or without emotional arousal. Participants answered a subjective scale of emotion about the story and a recognition memory test. Results Participants with SAD recovered more true memories and more false memories for the non-emotional version compared to the emotional version of the story. Overall, participants with SAD produced fewer false memories compared to those without SAD. Discussion This finding suggests that social anxiety may have a significant impact on emotional memory accuracy, which may assist in the development and improvement of techniques for therapeutic intervention

Associations between chronic pelvic pain and psychiatric disorders and symptoms

Background Chronic pelvic pain (CPP) is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using the terms (chronic pelvic pain) AND (psychiatry OR psychiatric OR depression OR anxiety OR posttraumatic stress OR somatoform). The searches returned a total of 529 matches that were filtered according to predefined inclusion and exclusion criteria. A total of 18 articles were selected. Results The investigations focused mainly on the assessment of depression and anxiety disorders/symptoms, with rather high rates (17-38.6%). Depression and anxiety symptoms were more prevalent among women with CPP compared to healthy groups. Comparisons between groups with CPP and with specific pathologies that also have pain as a symptom showed that depression indicators are more frequent in CPP. Depressive symptoms tend to be more common in CPP and have no particular association with pain itself, the core feature of CPP. Discussion Other aspects of CPP seem to play a specific role in this association. Anxiety and other psychiatric disorders require further investigation so that their impact on CPP can be better understood

Higher prevalence of major depressive symptoms in Brazilians aged 14 and older

Objective: Depression is a highly prevalent condition and is considered a major public health issue. The aim of the present study was to estimate the prevalence of depressive symptoms in the Brazilian population and establish their sociodemographic correlates. Method: A cross-sectional study was conducted between November 2005 and April 2006. Data were collected in face-to-face interviews using a standardized questionnaire. The sample consisted of 3,007 interviews with individuals aged 14 years and older and followed a probabilistic design covering the Brazilian national territory. Depressive symptoms were assessed according to the Center for Epidemiologic Studies Depression Scale. Results: The observed prevalence of depressive symptoms was 28.3% (13% mild/moderate; 15.3% major/severe; p < 0.01). Increased depressive symptom rates were associated with being a female, being 45 years of age and older, having lower educational attainment, being single, having family income of up to 2.5 times minimum wage, and living in the northern region of Brazil (p < 0.05). Conclusions: The prevalence of depressive symptoms in Brazil is high, with major depressive symptoms being the most frequent form of this symptomatology. Considering the biopsychosocial model of mental disorders, this survey points to the involvement of psychosocial factors in the prevalence of depressive symptoms in Brazil.Universidade Federal de São Paulo (UNIFESP) Department of PsychiatryUniversidade de São Paulo (USP) Ribeirao Preto Medical School Department of Neuroscience and BehaviorNational Science and Technology Institute for Translational Medicine (INCT-TM)USP Ribeirao Preto Medical School Department of Social MedicineUniversidade Federal de Santa Catarina (UFSC) Department of PsychiatryUniversity of Texas School of Public Health Dallas Regional CampusUNIFESP, Department of PsychiatrySciEL