Disorders - Social phobia
Crippa, Jose Alexandre S., Derenusson, Guilherme Nogueira, Ferrari, Thiago Borduqui, Wichert-Ana, Lauro, Duran, Fabio L. S., Martin-Santos, Rocio, Simoes, Marcus Vinicius, Bhattacharyya, Sagnik, Fusar-Poli, Paolo, Atakan, Zerrin, Filho, Alaor Santos, Freitas-Ferrari, Maria Cecilia, McGuire, Philip K., Zuardi, Antonio Waldo, Busatto, Geraldo F., Hallak, Jaime Eduardo Cecilio
Animal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naïve patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety (p < 0.001), reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus (p < 0.001, uncorrected), and increased ECD uptake in the right posterior cingulate gyrus (p < 0.001, uncorrected). These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Psychopharmacology, 25(1) : 121-130
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Nilsson, Jan-Erik, Lundh, Lars-Gunnar, Faghihi, Shahriar, Roth-Andersson, Gun
Background and objectives: According to cognitive models, negatively biased processing of the publicly observable self is an important aspect of social phobia; if this is true, effective methods for producing corrective feedback concerning the public self should be strived for. Video feedback is proven effective, but since one’s voice represents another aspect of the self, audio feedback should produce equivalent results. This is the first study to assess the enhancement of audio feedback by cognitive preparation in a single-session randomized controlled experiment. Method: Forty socially anxious participants were asked to give a speech, then to listen to and evaluate a taped recording of their performance. Half of the sample was given cognitive preparation prior to the audio feedback and the remainder received audio feedback only. Cognitive preparation involved asking participants to (1) predict in detail what they would hear on the audiotape, (2) form an image of themselves giving the speech and (3) listen to the audio recording as though they were listening to a stranger. To assess generalization effects all participants were asked to give a second speech. Results: Audio feedback with cognitive preparation was shown to produce less negative ratings after the first speech, and effects generalized to the evaluation of the second speech. More positive speech evaluations were associated with corresponding reductions of state anxiety. Social anxiety as indexed by the Implicit Association Test was reduced in participants given cognitive preparation. Limitations: Small sample size; analogue study. Conclusion: Audio feedback with cognitive preparation may be utilized as a treatment intervention for social phobia. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Behavior Therapy & Experimental Psychiatry, 42(4) : 497-503
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Biofeedback, neurofeedback, audio/video feedback
Melfsen, S., Kuhnemund, M., Schwieger, J., Warnke, A., Stadler, C., Poustka, F., Stangier, U.
Background: Although literature provides support for cognitive behavioral therapy (CBT) as an efficacious intervention for social phobia, more research is needed to improve treatments for children.Methods: Forty four Caucasian children (ages 8-14) meeting diagnostic criteria of social phobia according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; APA, 1994) were randomly allocated to either a newly developed CBT program focusing on cognition according to the model of Clark and Wells (n = 21) or a wait-list control group (n = 23). The primary outcome measure was clinical improvement. Secondary outcomes included improvements in anxiety coping, dysfunctional cognitions, interaction frequency and comorbid symptoms. Outcome measures included child report and clinican completed measures as well as a diagnostic interview.Results: Significant differences between treatment participants (4 dropouts) and controls (2 dropouts) were observed at post test on the German version of the Social Phobia and Anxiety Inventory for Children. Furthermore, in the treatment group, significantly more children were free of diagnosis than in wait-list group at post-test. Additional child completed and clinician completed measures support the results.Discussion: The study is a first step towards investigating whether CBT focusing on cognition is efficacious in treating children with social phobia. Future research will need to compare this treatment to an active treatment group. There remain the questions of whether the effect of the treatment is specific to the disorder and whether the underlying theoretical model is adequate.Conclusion: Preliminary support is provided for the efficacy of the cognitive behavioral treatment focusing on cognition in socially phobic children. Active comparators should be established with other evidence-based CBT programs for anxiety disorders, which differ significantly in their dosage and type of cognitive interventions from those of the manual under evaluation (e.g. Coping Cat). (copyright) 2011 Melfsen et al; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental Health, 5 :
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Mall, A. K., Mehl, A., Kiko, S., Kleindienst, N., Salize, H. J., Hermann, C., Hoffmann, T., Bohus, M., Steil, R.
High social anxiety is a risk factor for the incidence of social anxiety disorder (SAD). Early diagnosis and intervention may prevent more severe psychiatric courses. Self-help programs may be a convenient, accessible, and effective intervention. This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety. A total of 24 highly socially anxious individuals were randomly assigned to a DVD-based self-help program or to a wait-list control group. The self-help program is based on the cognitive model according to Clark and Wells (1995; adapted to German by Stangier, Clark, & Ehlers, 2006) and comprises eight sessions. ANOVAs based on an intention-to-treat model were used for data analyses. The self-help program was well accepted; just one person withdrew during the intervention. There were significant Time null Group interactions on all primary outcome measures. For the intervention group moderate to high within-groups effect sizes up to Cohen's d= 1.05 were obtained. Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention. The newly developed DVD-based self-help program seems to be a promising intervention for highly socially anxious individuals as it reduces social anxiety symptoms. (copyright) 2011.
Behavior Therapy, 42(3) : 439-448
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Self-help
Rakowska, Jadwiga Malgorzata
The aim of this study was to test the effects of brief strategic therapy in people with social phobia distinguished by the presence or absence of DSM anxious personality disorder. A group of 120 outpatients with social phobia, 60 of them with comorbid DSM anxious personality disorder, were randomly assigned to 10 weeks of brief strategic therapy or minimal supportive therapy. Outcome analyses were conducted on the intent-to-treat sample at posttreatment and 3-month follow-up using self-report interpersonal sensitivity and phobic anxiety measures, and at 6-month follow-up using social phobia diagnostic status. Brief strategic therapy was superior to minimal supportive therapy in patients with social phobia only. It was not significantly better in patients with comorbid personality disorder. It was concluded that 10 weeks of brief strategic therapy shows promise as a cost-effective method for management of social phobia. It has limited value as a method for management of social phobia with personality disorder.
Psychotherapy Research, 21(4) : 462-471
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Supportive therapy, Other Psychological Interventions
Schneier, Franklin R.
INTRODUCTION: Social anxiety disorder (SAD) is one of the most common psychiatric disorders, with a lifetime prevalence of 5-12%. Fears of scrutiny and embarrassment in social and public situations are accompanied by anxiety symptoms, avoidance behavior, and impairment in social and work functioning. Several classes of medication, as well as cognitive-behavioral therapies, have evidence for efficacy in the treatment of SAD, but only a minority of individuals with the disorder receives treatment. AREAS COVERED: This review focuses on the evidence-based treatment of SAD with medications including serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, other antidepressants, benzodiazepines, alpha-delta calcium-channel agents, and beta-adrenergic blockers. It discusses clinical considerations in the selection and monitoring of treatments, including issues of safety, duration of treatment, comorbidity, and integration of medication with psychotherapeutic treatment. For this review, a PubMed literature search was conducted during July, 2010. EXPERT OPINION: Medications in several classes have been demonstrated efficacious in the treatment of SAD. Treatment selection and implementation require attention to clinical diagnosis, patient education, and appropriate monitoring.
Expert Opinion on Pharmacotherapy, 12(4) : 615-625
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Scharfstein, Lindsay A., Beidel, Deborah C., Finnell, Laura Rendon, Distler, Aaron, Carter, Nathan T.
In a randomized trial for children with social phobia (SP), Social Effectiveness Therapy for Children (SET-C; a treatment consisting of exposure and social skills training) and fluoxetine were more effective than pill placebo in reducing social distress and behavioral avoidance, but only SET-C demonstrated significantly improved overall social skill and social competence. In the current study, the authors examined the specific social skills enhanced by SET-C using a recently developed coding schema. At posttreatment, children treated with SET-C displayed a more effective ability to manage the conversational topic (pragmatic social behaviors) and more appropriate motor movement, facial orientation, and posture (paralinguistic social behaviors) than children treated with fluoxetine or placebo. In contrast, children treated with fluoxetine displayed no more pragmatic or paralinguistic skill than children given a pill placebo. There were no group differences on ratings of voice volume and vocal inflection (speech and prosodic social behaviors). Furthermore, only children treated with SET-C improved from pre- to posttreatment on all three skill variables. Findings suggest that pharmacological interventions that only target reduction in anxious arousal may not have an impact on social skill deficits and may not be adequate to optimally treat SP. The relationship of social skill to social avoidance and the importance of social skills training to enhance social competence in the treatment of childhood SP are discussed.
Behavior Modification, 35(5) : 451-467
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Other Psychological Interventions
Tillfors, Maria, Andersson, Gerhard, Ekselius, Lisa, Furmark, Tomas, Lewenhaupt, Susanne, Karlsson, Anders, Carlbring, Per
Internet-based cognitive behavior therapy (CBT) has been shown effective for university students with social anxiety disorder (SAD) and public speaking fears. The aim of this study was to investigate whether the promising results can be transferred to high school students suffering from this condition. A total of 19 speech-anxious high school students with SAD were randomized either into 9 weeks of Internet-delivered CBT or to a wait-list control group. Significant improvements were found on measures of social anxiety, general anxiety, and depression. Effects were maintained at 1-year follow-up. The average within- and between-group effect sizes (Cohen’s d) for the primary social anxiety scales at posttest were 0.98 and 1.38, respectively. However, the average number of completed modules in the CBT program was low. Although compliance can be improved, the results suggest that Internet-based guided self-help is effective in the treatment of high school students with SAD. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Cognitive Behaviour Therapy, 40(2) : 147-157
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Tran, G. Q., Zaturenskaya, M., Black, J. J., Heffner, J. L., Smith, J. P.
Introduction: Co-occurring hazardous drinking and social anxiety are prevalent co-occurring problems among college students. Competing causal models have been proposed to account for the high comorbidity of social anxiety disorder and alcohol dependence in epidemiological studies. With data from a randomized clinical trial (Tran, 2008), we tested two competing causal models: change in social anxiety temporally preceding change in alcohol problems in Model 1 and change in alcohol problems temporally preceding change in social anxiety in Model 2. Methods: Forty-one undergraduate hazardous drinkers with moderate-to-high social anxiety (39% women, 90% Caucasian, median age = 19), comprised our intention-to-treat (ITT) sample, of whom 34 began their interventions. Participants were randomized to receive either an integrated alcohol-anxiety intervention (n = 21) or an alcohol psychoeducation (n = 20). Two multiple regression models were conducted to test two competing causal models. In Model 1, change in social anxiety between pretreatment and 1-month follow-up was tested as a predictor of change in alcohol problems between pretreatment and 4-month follow-up. In Model 2, change in alcohol problems between pretreatment and 1-month was tested as a predictor of change in social anxiety between pretreatment and 4-month follow-up. In both regression models, treatment condition was entered as a covariate to control for the greater efficacy of the integrated alcohol-anxiety intervention compared to the alcohol psychoeducation. Results: The results provided support for both social anxiety and alcohol problems as temporal predictor of each other's symptom change in socially anxious hazardous drinkers who received a brief intervention. In Model 1, there were significant main effects of pre-1 month social anxiety change and treatment condition on pre-4 month alcohol problem change. In Model 2, there was a significant main effect of pre-1 month alcohol problem change but not treatment condition on pre-4 month social anxiety change. Conclusion: Study findings suggest that social anxiety and alcohol problems have reciprocal effects on each other. These results support the need to provide integrated brief interventions for both problem areas on college campuses where social anxiety and hazardous drinking are both prevalent and frequently co-occur.
Alcoholism: Clinical & Experimental Research, 35 : 146A
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., Connor-Smith, J. K.
Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths ((chi)21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(10) : 1043-1052
- Year: 2010
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Piet, J., Hougaard, E., Hecksher, M. S. & Rosenberg, N. K.
Twenty-six young participants, 18-25 years, with social phobia (SP) were randomly assigned to eight 2-hour sessions of group mindfulness-based cognitive therapy (MBCT) and twelve 2-hour sessions of group cognitive-behavioral therapy (CBT) in a crossover design with participants receiving treatments in reversed order. Outcome was assessed after treatments, and at 6- and 12-month follow-ups. MBCT achieved moderate-high pre-post effect sizes (d=0.78 on a composite SP measure), not significantly different from, although numerical lower than those of CBT (d=1.15). Participants in both groups further improved in the periods following their first and second treatment until 6-months follow-up (pre-follow-up ds = 1.42 and 1.62). Thus, MBCT might be a useful, low cost treatment for SP, although, probably, less efficacious than CBT.
Scandinavian Journal of Psychology, 51 : 403 - 410
- Year: 2010
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Mindfulness based therapy
Orr, E. M. J., Moscovitch, D. A.
Video feedback (VF) with cognitive preparation (CP) has been widely integrated into cognitive-behavioral therapy (CBT) protocols for social anxiety disorder (SAD) due to its presumed efficacy in improving negative self-perception. However, previous experimental studies have demonstrated that improvements in negative self-perception via VF. +. CP do not typically facilitate anxiety reduction during subsequent social interactions - a troubling finding for proponents of cognitive models of social anxiety. We examined whether VF. +. CP could be optimized to enhance participants' processing of corrective self-related information through the addition of a post-VF cognitive review (CR). Sixty-eight socially anxious individuals were randomly assigned to perform two public speeches in one of the following conditions: a) exposure alone (EXP); b) CP. +. VF; and c) CP. +. VF. +. CR. Those in the CP. +. VF. +. CR condition demonstrated marginally significant reductions in anxiety from speech 1 to speech 2 relative to those who received EXP - an improvement not shown for those in the CP. +. VF condition. Furthermore, only those who received CP. +. VF. +. CR demonstrated significant improvements in self-perception and performance expectations relative to EXP. Decreases in anxiety among participants who received CP. +. VF. +. CR relative to EXP were fully mediated by improvements in self-perception. Implications are discussed in the context of cognitive models of social anxiety and mechanisms of exposure-based learning. (copyright) 2010 Elsevier Ltd.
Behaviour Research & Therapy, 48(8) : 728-737
- Year: 2010
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions, Biofeedback, neurofeedback, audio/video feedback