Using machine learning to increase access to and engagement with trauma-focused interventions for posttraumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) poses a global public health challenge. Evidence-based psychotherapies (EBPs) for PTSD reduce symptoms and improve functioning (Forbes et al., Guilford Press, 2020, 3). However, a number of barriers to access and engagement with these interventions prevail. As a result, the use of EBPs in community settings remains disappointingly low (Charney et al., Psychological Trauma: Theory, Research, Practice, and Policy, 11, 2019, 793; Richards et al., Community Mental Health Journal, 53, 2017, 215), and not all patients who receive an EBP for PTSD benefit optimally (Asmundson et al., Cognitive Behaviour Therapy, 48, 2019, 1). Advancements in artificial intelligence (AI) have introduced new possibilities for increasinfg access to and quality of mental health interventions. AIMS: The present paper reviews key barriers to accessing and engaging in EBPs for PTSD, discusses current applications of AI in PTSD treatment and provides recommendations for future AI integrations aimed at reducing barriers to access and engagement. DISCUSSION: We propose that AI may be utilized to (1) assess treatment fidelity; (2) elucidate novel predictors of treatment dropout and outcomes; and (3) facilitate patient engagement with the tasks of therapy, including therapy practice. Potential avenues for technological advancements are also considered.

Psychometric properties of the Ryerson Social Anxiety Scales in individuals with social anxiety disorder.

BACKGROUND: Although numerous self-report measures of social anxiety exist, most instruments assess symptom severity by examining the range of social situations that provoke anxiety, rather than the distress and impairment associated with social anxiety. The Ryerson Social Anxiety Scales (RSAS; Lenton-Brym, A. P., Rogojanski, J., Hood, H. K., Vorstenbosch, V., McCabe, R. E., & Antony, M. M. (2020). Development and validation of the Ryerson Social Anxiety Scales (RSAS). Anxiety, Stress, & Coping, 33(6), 642-660), a measure assessing breadth of social anxiety inducing situations and severity of associated distress and impairment, was recently developed to fill this gap. The present study is the first to investigate the psychometric properties of the RSAS in a clinical sample. METHOD/DESIGN: Participants included 110 individuals with a principal diagnosis of social anxiety disorder (SAD). A subsample of participants (n = 23) completed cognitive-behavioural group treatment (CBGT) for SAD. RESULTS: The RSAS demonstrated excellent internal consistency. Examination of the correlations between the RSAS and other conceptually related and distinct measures supported the convergent and discriminant validity of the RSAS. The RSAS was also sensitive to changes in severity of social anxiety following CBGT. CONCLUSION: The RSAS is a reliable and valid instrument for assessing the severity of SAD.

Associations Between Social Anxiety, Depression, and Use of Mobile Dating Applications.

This study explores associations between symptoms of social anxiety (SA) and depression with participants' extent of dating app use, self-reported motivations for dating app use, and likelihood of initiating interaction with dating app matches. Three-hundred seventy-four participants completed an online battery of surveys that examined psychopathology and dating app use. SA and depression symptoms were positively associated with participants' extent of dating app use, and symptoms of psychopathology and gender interacted to predict various dating app use motivations. Symptoms of SA and depression predicted lower likelihood of initiating contact with a dating app match among men but not women. This study provides an initial step toward understanding the relationship between SA, depression, and use of dating apps.

Responses to perceived intimate partner rejection among individuals with social anxiety disorder and healthy controls.

Individuals with social anxiety disorder (SAD) demonstrate impaired functioning in intimate relationships, yet little is known about how socially anxious individuals respond to perceived intimate partner rejection. In the present study, individuals with SAD (n = 30) and healthy controls (HCs; n = 33) who were involved in current intimate relationships completed daily diaries each evening for 14 days. Daily diaries assessed the extent to which participants experienced feelings of rejection in their intimate relationships, as well as the extent to which they responded to feelings of rejection by using behaviors characterized by withdrawal ("withdrawal" processes) versus efforts to reaffiliate with their partners ("approach" processes). Results revealed that overall, individuals with SAD exhibited greater use of withdrawal-focused processes, whereas HC participants exhibited greater use of approach-focused processes. However, on days following intimate partner rejection, only individuals with SAD restricted their use of withdrawal-focused processes. These findings provide insight into the nature of rejection concerns and responses to rejection among individuals with SAD as compared with HC participants.

Development and validation of the Ryerson Social Anxiety Scales (RSAS).

Background: Extant self-report measures of social anxiety primarily assess the breadth of social situations in which respondents feel anxious, rather than assessing severity in terms of the distress and impairment that individuals experience due to their social anxiety symptoms. This paper describes the development and validation of the Ryerson Social Anxiety Scales (RSAS; Rogojanski et al., 2019; see Appendix), a new measure for assessing both the breadth of situations that trigger social anxiety and the severity (i.e., distress and impairment) associated with social anxiety, across two studies. Method/Design: Two samples of university students (N = 501 total) completed demographic and self-report symptom measures. In Study 1, participants completed the RSAS and several other measures of psychological symptoms. In Study 2, participants completed the same measures and were also assessed for the presence of Social Anxiety Disorder (SAD) using a semistructured clinical interview. Results: Across both samples, the RSAS demonstrated excellent internal consistency and incremental validity. It consistently emerged as a unique predictor of psychosocial impairment. In Study 2, increases in RSAS scores were associated with increased odds of having SAD. Conclusions: The RSAS has robust psychometric properties and fills an important gap among available measures for assessing SAD severity.

Can Self-Report Measures of Readiness for Change and Treatment Ambivalence Predict Outcomes in Cognitive Behavioral Therapy for Generalized Anxiety Disorder?

Clients with generalized anxiety disorder (GAD) that demonstrate observer-coded treatment ambivalence benefit from the addition of motivational interviewing (MI) to cognitive behavioral therapy (CBT; Button, Westra, Constantino, & Antony, 2016). While observer-coded assessment of ambivalence and readiness for change is resource-intensive, the present study investigates the use of more efficient self-report measures to predict treatment outcomes. Participants (N = 85) with GAD received CBT or MI-CBT and completed self-report measures of readiness for change (Change Questionnaire, Miller & Johnson, 2008) and ambivalence (Treatment Ambivalence Questionnaire, Purdon, Rowa, Gifford, McCabe, & Antony, 2012). Greater self-reported baseline readiness for change was associated with lower posttreatment worry and symptom severity and faster reduction in worry. Self-reported ambivalence was not associated with outcomes. Patients with less concern about adverse consequences of treatment who received CBT experienced greater increases in readiness for change than those receiving MI-CBT. We discuss implications for using these measures in clinical settings.

Autobiographical memory retrieval and appraisal in social anxiety disorder.

Individuals with social anxiety disorder (SADs; n = 41) and healthy controls (HCs; n = 40) were administered the Waterloo Images and Memories Interview, in which they described mental images that they tend to experience in both anxiety-provoking and non-anxiety-provoking social situations. Participants then recalled, in as much detail as possible, specific autobiographical memories of salient aversive and non-aversive social experiences that they believed led to the formation of these images. Audio-recorded memory narratives were transcribed and coded based on the procedure of the Autobiographical Interview, which provides a precise measure of the degree of episodic detail contained within each memory. Participants also rated the subjective properties of their recalled memories. Results revealed that participants across the two groups retrieved equivalent rates of both aversive and non-aversive social memories. However, SAD participants' memories of aversive events contained significantly more episodic detail than those of HCs, suggesting that they may be more highly accessible. Moreover, participants with SAD appraised their memories of aversive experiences as more distressing and intrusive than HCs, and perceived them as having a significantly greater influence on their self-perception. In contrast, no group differences were observed for memories of non-aversive events. Findings have the potential to shed new light on autobiographical memory in SAD, with implications for psychotherapeutic intervention.

Theory of mind ability in high socially anxious individuals.

BACKGROUND/OBJECTIVES: Research has demonstrated an association between social anxiety and impaired Theory of Mind (ToM). We assess whether ToM deficits occur even at a subclinical level of social anxiety and whether group differences in ToM performance are consistent with interpretation bias. We also explore potential reasons as to why socially anxious individuals may perform differently on ToM tasks. METHODS/DESIGN: Undergraduate participants high (HSA; n = 78) and low (LSA; n = 35) in social anxiety completed a task of ToM decoding, the Reading the Mind in the Eyes (MIE), a task of ToM reasoning, the Movie for the Assessment of Social Cognition (MASC), and a post-task questionnaire about their experience completing the MASC. RESULTS: HSAs performed marginally worse than LSAs on the MIE on neutrally valenced trials, and their pattern of errors may be consistent with a negative interpretation bias. HSAs and LSAs did not differ overall in performance on the MASC, though HSAs reported experiencing more confusion and distress than LSAs during the task, and this distress was associated with more MASC errors for HSA participants only. These results provide insight into the nature of ToM ability in socially anxious individuals and highlight important avenues for future research.