Disorders - Social phobia
Davis, M. L., Papini, S., Rosenfield, D., Roelofs, K., Kolb, S., Powers, M. B., Smits, J. A. J.
This manuscript details a randomized controlled study designed to test the efficacy of power posing (i.e., briefly holding postures associated with dominance and power) as an augmentative strategy for exposure therapy for social anxiety disorder (SAD). Seventy-three individuals diagnosed with SAD were assigned to one of three conditions: power posing, submissive posing, or rest (no posing) prior to participating in an exposure therapy session. Participants were assessed for between-group differences in pre- and post-manipulation salivary hormone levels, within-session subjective experiences of fear, and pre- and 1-week post-treatment SAD severity outcome measures. Though the intervention resulted in decreased SAD symptom severity one week later, analyses revealed no significant between-group differences on any tested variables. Accordingly, this study provides no evidence to suggest that power posing impacts hormone levels or exposure therapy outcomes. Copyright © 2017 Elsevier Ltd
Journal of Anxiety Disorders, 52 : 1-7
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
de-Hullu, E., Sportel, B., Nauta, M. H., de-Jong, P. J.
Background and Objectives: This two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. Methods: In this RCT, moderately socially anxious adolescents (N = 240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design. Results: Primary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire. Limitations: There was a substantial (50%) though seemingly non-selective attrition at follow-up. Conclusions: This RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Behavior Therapy and Experimental Psychiatry, 55 : 81-89
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Attention/cognitive bias modification
Spence, S. H., Donovan, C. L., March, S., Kenardy, J. A., Hearn, C. S.
The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition. Copyright © 2016 Elsevier Ltd
Behaviour Research and Therapy, 90 : 41-57
- Year: 2017
- 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)
Modini, M., Abbott, M. J.
Background and objectives: According to cognitive models of Social Anxiety Disorder (SAD), negative rumination is a key maintaining factor in the vicious cycle of social anxiety. However, there is a scarcity of research investigating treatment effects on rumination in social anxiety, as well as other key cognitive variables. The current study aimed to determine the effectiveness of a brief intervention on a range of cognitive processes, most notably negative rumination. Additionally, predictors of negative rumination and state anxiety are also investigated. Methods: Participants with a diagnosis of SAD were randomly allocated to an intervention (n = 24) or control group (n = 23). Participant's initially completed trait and state based measures with the intervention group also completing a brief cognitive intervention. One-week later participants completed state anxiety and cognitive measures before and after a speech task. Finally, one-week post-speech task participants completed further trait and state based measures. Results: While the brief cognitive intervention had positive effects on some of the cognitive processes measured at different time points of the study, levels of negative rumination remained stable. Predictors of negative rumination and state anxiety were consistent with cognitive models of SAD. Limitations: The brief nature of the intervention and temporal stance of the intervention (delivered one-week before the speech) may have impacted outcomes. Conclusions: Cognitive technique can potentially impact a range of key processes that maintain SAD, however, more powerful and tailored interventions are needed that address the different processes at play before, during and after a social situation for socially anxious individuals. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Behavior Therapy and Experimental Psychiatry, 55 : 73-80
- Year: 2017
- 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)
Reiss, N., Warnecke, I., Tolgou, T., Krampen, D., Luka-Krausgrill, U., Rohrmann, S.
Background: Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied. Methods: Students suffering from test anxiety were recruited at two German universities (n = 180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up. Results: A repeated-measures ANOVA for participants with complete data (n = 59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p < .001). Limitations: Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings. Conclusions: Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Affective Disorders, 208 : 483-489
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Self-help
, Relaxation
Renner, K. A., Valentiner, D. P., Holzman, J. B.
A clinical protocol based on contemporary cognitive behavioral treatment for social anxiety was developed and examined. Previously published instructions for conducting a focus-of-attention behavioral experiment targeting self-focused attention and safety behaviors during exposure were used to create a structured protocol. Individuals (n = 45) with high levels of social anxiety and public-speaking anxiety were randomly assigned to either a focus-of-attention behavioral experiment (FABE) or an Exposure-Only Control (EOC) condition. During four exposure trials, those in the FABE condition (n = 24) were alternately instructed to engage in self-focused attention vs. externally focused attention and to eliminate safety behaviors. Those in the EOC condition (n = 21) were not so instructed. At post-intervention, individuals in the FABE condition showed significantly less self-focused attention and anxiety, and better observed performance as rated by audience members. Focus-of-attention statistically mediated the effect of condition on anxiety. For those in the FABE condition, the degree of association between focus-of-attention and anxiety during the intervention predicted less self-focused attention post-intervention. The FABE appears to be a useful procedure for implementing part of the contemporary cognitive behavioral treatment model. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Cognitive Behaviour Therapy, 46(1) : 60-74
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Oldham-Cooper, R., Loades, M.
Background: Coping Cat (CC), a generic cognitive-behavioral intervention for anxiety disorders in children and young people, is recommended in the United Kingdom for social anxiety disorder (SAD), generalized anxiety disorder, separation anxiety (SA), and specific phobias (SP), with disorder-specific approaches generally favored in treatment of anxiety disorders in adults. Objectives: To compare CC with disorder-specific cognitive-behavioral therapy (CBT) interventions based on anxiety-related treatment outcomes. Study Selection: Primary research articles describing treatment of children and young people aged 7-17 for SAD, generalized anxiety disorder, SA, and SP, using CC or disorder-specific CBT. Results: Ten studies implemented CC and four implemented disorder-specific CBT. One study compared CC with a disorder-specific approach. There was a lack of data to support use of CC in treatment of SPs. However, CC was equally effective as disorder-specific treatments for SA and SAD. Conclusions: A lack of data exists for disorder-specific CBT interventions compared to CC. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Child and Adolescent Psychiatric Nursing, 30(1) : 6-17
- Year: 2017
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Strawn, J. R., Compton, S. N., Robertson, B., Albano, A. M., Hamdani, M., Rynn, M. A.
Objective: This is a feasibility study evaluating the safety, tolerability, and potential anxiolytic efficacy of the alpha2 agonist guanfacine extended-release (GXR) in children and adolescents with generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia/social anxiety disorder. Methods: Youth aged 6-17 years with a primary diagnosis of GAD, SAD, and/or social anxiety disorder were treated with flexibly dosed GXR (1-6 mg daily, n = 62) or placebo (n = 21) for 12 weeks. The primary aim of this study was to determine the safety and tolerability of GXR in youth with anxiety disorders, which involved the analysis of treatment-emergent adverse events (TEAEs), the emergence of suicidal ideation and behaviors, vital signs, and electrocardiographic/laboratory parameters. Exploratory efficacy measures included dimensional anxiety scales (Pediatric Anxiety Rating Scale [PARS] and Screen for Child Anxiety Related Emotional Disorders [SCARED]), as well as the Clinical Global Impression-Improvement (CGI-I) scale. As this was an exploratory study, no inferential statistical analyses were performed. Results: GXR was safe and well tolerated. Treatment-related mean +/- standard deviation changes in heart rate (GXR: 1.8 +/- 12 beats per minute [bpm] decrease; placebo: 0.5 +/- 11 bpm decrease), systolic blood pressure (GXR: 2.3 +/- 11 mm Hg decrease; placebo: 1.7 - 11 mm Hg decrease), or diastolic blood pressure (GXR: 1.3 +/- 9 mm Hg decrease; placebo: 0.9 -7 mm Hg increase) were similar between treatment groups. TEAEs, including headache, somnolence/fatigue, abdominal pain, and dizziness, were consistent with the known safety profile of GXR.No differences were observed between treatment groups for PARS and SCARED scores, although at endpoint, a higher proportion of subjects receiving GXR versus placebo demonstrated CGI-I scores <=2 (54.2% vs. 31.6%), as rated by the clinician investigator. Conclusions: GXR was well tolerated in pediatric subjects with GAD, SAD, and/or social anxiety disorder. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Child and Adolescent Psychopharmacology, 27(1) : 29-37
- Year: 2017
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Terburg, D., Syal, S., Rosenberger, L. A., Heany, S. J., Stein, D. J., van-Honk, J.
Neuro-evolutionary theories describe social anxiety as habitual subordinate tendencies acquired through a recursive cycle of social defeat and submissive reactions. If so, the steroid hormone testosterone might be of therapeutic value, as testosterone is a main force behind implicit dominance drive in many species including humans. We combined these two theories to investigate whether the tendency to submit to the dominance of others is an implicit mechanism in social anxiety (Study-1), and whether this can be relieved through testosterone administration (Study-2). Using interactive eye-tracking we demonstrate that socially anxious humans more rapidly avert gaze from subliminal angry eye contact (Study-1). We replicate this effect of implicit subordination in social anxiety in an independent sample, which is subsequently completely abolished after a single placebo-controlled sublingual testosterone administration (Study-2). These findings provide crucial evidence for hormonal and behavioral treatment strategies that specifically target mechanisms of dominance and subordination in social anxiety. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Psychoneuroendocrinology, 72 : 205-211
- Year: 2016
- Problem: Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Olivares-Olivares, P. J., Olivares, J., Macia, D., Macia, A., Montesinos, L.
The study investigates how to improve the results reported by the reviews on the effects of clinical inter- ventions in adults with Generalized Social Phobia. The sample was composed of 91 participants (median age = 19.90 years, SD = 1.05) randomly assigned to three experimental conditions. The evaluations were conducted before and after treatment in all three groups and at 6-, 12-, and 24-month follow-up for the treatment groups. The results show (a) the effectiveness of the cognitive-behavioral strategy of detection and intervention, in a community context, versus clinical intervention both for the short and medium term; and (b) a significant improvement over the percentages of dropouts and of rates of complete recovery from the disorder. These findings allow us to conclude that the cognitive-behavioral strategy of detection and intervention, in a community context is shown to be a complementary intervention to the conventional and with high efficiency ratios. Copyright © 2016 by Sociedad Chilena de Psicologia Clinica.
Terapia Psicologica, 34(1) : 23-30
- Year: 2016
- 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)
, Other Psychological Interventions
Nilsson, J.-E. C., Lundh, L.-G.
Background and Objectives: Socially anxious individuals tend to underestimate their performance largely due to attentional bias. Video and audio feedback (AF) with cognitive preparation (CP) have shown to improve socially anxious individuals' evaluation of their performance in previous studies. In the present study, it was hypothesized that one of the three steps in CP, reduced self-focus (RS), is sufficient to cause an improved voice evaluation after AF. This was tested in a single-session randomized controlled experiment. Method: Forty-one 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 were instructed to reduce their self-focus prior to AF, the rest received AF only. RS involved asking participants to listen to the audio recording as though they were listening to a stranger. Generalization effects were assessed by a second speech. Results: AF with RS led to more improved voice evaluations than AF-only after the first speech, and the effects remained in the evaluation of the second speech. More positive speech evaluations were associated with corresponding reductions of performance anxiety. Limitations: small sample, analogue study. Conclusion: One component of cognitive preparation-(RS)-appears to be sufficient to cause significant effects on voice evaluation in socially anxious individuals. If the results are replicated in clinical samples, AF with RS may be a promising intervention in the treatment of social anxiety. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Cognitive Behaviour Therapy, 45(2) : 150-162
- Year: 2016
- 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
Norton, A. R., Abbott, M. J.
Imagery rescripting (IR) aims to alter negative meanings associated with distressing autobiographical memories. The current study aimed to extend demonstrated benefits of IR for social anxiety disorder (SAD), including direct comparison of IR with cognitive restructuring (CR) to assess the relative impact of these interventions on symptoms and processes. SAD individuals (N = 60) were randomly allocated to IR, CR or Control conditions, and completed two speech tasks (before and after) their assigned intervention. Participants completed measures of symptomatology and state affective/cognitive variables in relation to the intervention and speech tasks. Results support the benefits of IR for SAD, with both IR and CR yielding large and equivalent reductions in trait social anxiety. However, IR and CR may function via differing pathways. Outcomes suggest that IR may be most effective in the treatment of SAD when delivered across multiple sessions or preceded by CR to target verbal and imaginal self-representations. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Anxiety Disorders, 40 : 18-28
- Year: 2016
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions