Inhibited and impulsive subgroups of socially anxious young adults: Their depressive symptoms and life satisfaction

Socially anxious people are typically thought of as being behaviorally inhibited; however, an atypical subgroup, which is impulsive rather than inhibited, has recently been identified [1]. Theoretically, inhibition and impulsivity could be viewed as different strategies for coping with anxiety that have the same goal—escape from negative emotions—but they seem to have different implications. Previous studies have found that the socially anxious-impulsive subgroup was higher on risk-prone behavior, as for example drug use, compared with a socially anxious inhibited subgroup. In this study, we aimed to identify these subgroups in a general population, and asked whether they also experience various levels of depressive symptoms and life satisfaction, as well as moderating effects of gender. Methods: Cluster analysis was used to identify subgroups of young adults (20 - 24 years old; N = 772) characterized by different profiles of social anxiety and impulsivity. These subgroups were compared on levels of internal adjustment, and the moderating effects of gender were also tested. Results: We identified five clusters, including an Anxious-Inhibited and an Anxious-Impulsive cluster. In the interaction between gender and cluster membership, gender showed evidence of moderation regarding both depressive symptoms and life satisfaction, with the young women in the Anxious-Inhibited and the Anxious-Impulsive clusters faring worst. Conclusions: We replicated previous findings demonstrating the existence of a socially anxious-impulsive subgroup, thus solidifying current knowledge that may be important when it comes to diagnostics and treatment. This may prove particularly important for young women regarding internalizing symptoms

Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial

Background and Aims: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting. Methods: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n = 64) or CBGT (n = 62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points. Results: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%-76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%-58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68-17.66 (Cohens d between group = 0.41) and -22.51-15.69 (Cohens d between group = 0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F = 1.58; df = 2, 219; p = .21). Conclusions: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT.Original Publication:Erik Hedman, Gerhard Andersson, Brjann Ljotsson, Erik Andersson, Christian Ruck, Ewa Mortberg and Nils Lindefors, Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial, 2011, PLOS ONE, (6), 3, .http://dx.doi.org/10.1371/journal.pone.0018001Licensee: Public Library of Science (PLoS)http://www.plos.org

Treatment of social phobia : Development of a method and comparison of treatments

Social phobia is a common (13 %) and disabling anxiety disorder associated with considerable social and occupational handicap. It is not likely to remit without treatment. Although the efficacy of cognitive behavioural and pharmacological interventions are relatively well established there is a need for further development, as many patients remain disabled at the end of treatment. There is still a lack of understanding of the factors involved in incomplete treatment responses. In addition, it is important to examine how treatments actually work in clinical practice. The aims of the present thesis were to examine the effectiveness of an intensive (3 weeks) cognitive behavioural group treatment (CBGT) in a pilot study and in a waiting list controlled study. Taking into account some recent developments in psychological treatment the intensive CBGT was modified (and renamed intensive group cognitive treatment /IGCT/) and compared to individual cognitive therapy (ICT) and treatment as usual (TAU), involving medication, in a randomized controlled study of 100 patients. Finally, a trait-based study of personality patterns before and after treatment was conducted aiming to outline personality characteristics in patients with social phobia, and patterns of change following treatment. The result of the pilot study as well of the waiting list controlled study showed that patients improved significantly after three weeks of treatment, with reduced levels of social phobia related symptoms. The treatment effects were maintained at one year post-treatment. The efficacy of the intensive treatment was further confirmed in the randomized, controlled trial of IGCT, ICT and TAU. ICT was, however, more effective than IGCT and TAU, which showed equal efficacy. The personality patterns of patients were characterised by pronounced levels of harm avoidance and character traits associated with personality disorders. Dysfunctional traits were changed following treatments: however, nonresponders still exhibited high levels of harm avoidance. To conclude, brief intensive group treatment is a feasible and effective option in the treatment of social phobia in routine psychiatric practice. It works fast and shows maintained or improved effects at one year post-treatment. IGCT, ICT and TAU are all effective and enduring treatments for social phobia. However, ICT is superior to IGCT and TAU. The 3-week IGCT seems to be more accepted and is as effective as the 12-month medication focused TAU. Pronounced harm avoidance is a general vulnerability trait in patients with social phobia and may be a general predictor of poor treatment response. Further studies are needed for additional understanding of factors contributing to incomplete treatments responses

Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms.

Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt, depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD

A longitudinal study of prevalence and predictors of incidence and persistence of sub-diagnostic social anxiety among Swedish adolescents

This longitudinal study aimed to examine the 1-year prevalence, incidence and persistence of sub-diagnostic social anxiety (SSA) as well as general risk factors for the incidence and persistence of SSA during early and mid-adolescence. A Swedish sample of adolescents (N = 2,523) aged 13-14 years at Time 1 and 14-15 years at Time 2 completed measures of anxiety, depressive symptoms, stressors and emotion regulation strategies across the two timepoints. SSA was defined and assessed by the Social Phobia Screening Questionnaire for Children. The prevalence of SSA was 16%, the incidence 12%, and the persistence 53% over time. Symptoms of depression and general anxiety, various stressors and emotion regulation strategies were overall significantly related to SSA. Predictors for the incidence of SSA were lower age, female gender and elevated general anxiety and behavioral avoidance (i.e. being afraid of new activities when there is uncertainty about the outcome). Predictors for persistent SSA were female gender and increased behavioral avoidance. In conclusion, SSA is very common among young individuals, and behavioral avoidance appears particularly important for understanding the development and persistence of SSA in adolescence

Demographic description of the participants.

<p><i>Abbreviations:</i> SAD, social anxiety disorder; HC-M, Healthy controls-main sample; HC-R, Healthy controls, replication sample;</p>*<p> = significant at alpha-level .05.</p

Means, SDs and effect sizes on measures of shame, guilt, social anxiety and depressive symptom.

<p>Abbreviations: TOSCA, Test of Self-Conscious Affect; LSAS-SR, Liebowitz Social Anxiety Scale-Self report; SIAS, Social Interaction Anxiety Scale; BDI, Beck Depression Inventory, Post, Post-treatment; SAD, Social anxiety disorder; HC-M, Healthy controls-main sample; HC-R, Healthy controls-replication sample. Note: all between group analyses conducted on baseline scores; follow-up scores collected at one-year follow-up;</p>*<p> = significant at <.05;</p>**<p> = significant at <.01.</p

Intercorrelations on measures of shame, guilt, social anxiety and depressive symptoms for participants with SAD.

<p>Abbreviations: TOSCA, Test of Self-Conscious Affect; LSAS-SR, Liebowitz Social Anxiety Scale-Self report; SIAS, Social Interaction Anxiety Scale; BDI, Beck Depression Inventory. Note:</p>a<p>partial correlations represent associations between TOSCA and social anxiety scales controlling for BDI scores and vice versa;</p>*<p> = significant at <.05;</p>**<p> = significant at <.01. All correlations are based on data collected before treatment.</p