Social anxiety disorder in Black American adolescents: Cultural considerations in conceptualization, assessment, and treatment.

Social anxiety disorder (SAD) is characterized by significant distress and avoidance surrounding social and performance situations, with marked interpersonal and academic impairment. This review article highlights cultural considerations relevant to the conceptualization, identification, and treatment of SAD in Black youth. Research evaluating the utility of evidence-based measures to assess SAD suggests they are culturally relevant; however, gaps in knowledge regarding the psychometric properties of even the most widely used instruments are evident. In regard to intervention, cognitive behavioral therapy (CBT) approaches hold promise, yet there is a lack of research on the use of CBT with Black adolescents. Recommendations to incorporate cultural factors into CBT are provided, and future work investigating culturally adapted interventions is needed. Finally, given significant disparities in access and utilization of mental health services among Black youth, strategies to increase treatment engagement, such as school-based services, are important to consider.

Online racial discrimination and mental health among Black undergraduates: The moderating role of gender.

Objective: Online racial discrimination (ORD) is rampant; however, little is known about its associations with mental health among undergraduates. This study explored the relations between ORD and mental health among Black undergraduates. It also investigated gender differences in these relations. Participants: Two hundred seventy-eight Black, cisgender men and women enrolled in a minority-serving public university in the Northeast U.S. Methods: Participants completed measures of ORD, depression, generalized anxiety (GA), and social anxiety (SA) via a Web-based survey. Results: Eighty-five percent of participants experienced at least one ORD incident in the last year. Men and women reported comparable exposure. Gender moderated the relations between ORD and depression and SA, respectively; these associations were stronger for women. Conclusions: Exposure to ORD is prevalent among Black undergraduates and is associated with adverse mental health outcomes, especially for women. Campus mental health interventions should address online discrimination in the context of students' intersecting identities.

The Relationship Between Social Anxiety and Internalized Racism in Black Young Adults.

The study examined the relationships between social anxiety (SA), generalized anxiety (GA), and depression with racial microaggressions and internalized racism (IR) among Black young adults. Given SA's core features, we expected it to have a unique association with IR, and to moderate the connection between racial microaggressions and IR. Participants were 182 Black university students who completed measures of SA, GA, depressive symptoms, racial microaggressions, and IR. Linear regression models indicated that IR was a significant predictor of SA, but not GA or depression. Racial microaggressions were only positively associated with depressive symptoms. SA and racial microaggressions each predicted IR, but no interaction was found. Black young adults with elevated concerns of others' evaluation may be more prone to accepting negative stereotypes about one's racial group.

Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder?

Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.

Identification of Social Anxiety in Schools: The Utility of a Two-Step Screening Process.

Social anxiety disorder (SAD) is highly prevalent yet largely undetected and untreated in adolescents despite the availability of effective treatments. Implementing interventions in schools enhances recognition and access to treatment for SAD. However, without reliable means to accurately identify youth in need of services, school-based interventions are not feasible. The purpose of this study is to evaluate the utility of a two-step, school-based screening approach to identify youth with SAD. Students at three public high schools were screened with self-report questionnaires or nominated by school personnel. Subsequently, a brief telephone assessment of student symptoms was completed with students' parents. Results showed that using both questionnaires and telephone assessments yielded acceptable detection rates, while school staff nominations were not beneficial. This study provides support for the use of a two-step screening procedure consisting of student self-reports followed by brief parent telephone interviews to identify youth with clinically impairing social anxiety. Implications for enhancing school-based detection of and intervention for socially anxious adolescents are discussed.

A Critical Review of Attentional Threat Bias and Its Role in the Treatment of Pediatric Anxiety Disorders.

Threat bias, or exaggerated selective attention to threat, is considered a key neurocognitive factor in the etiology and maintenance of pediatric anxiety disorders. However, upon closer examination of the literature, there is greater heterogeneity in threat-related attentional biases than typically acknowledged. This is likely impacting progress that can be made in terms of interventions focused on modifying this bias and reducing anxiety, namely attention bias modification training. We suggest that the field may need to "take a step back" from developing interventions and focus research efforts on improving the methodology of studying attention bias itself, particularly in a developmental context. We summarize a neurocognitive model that addresses the issue of heterogeneity by broadly incorporating biases toward and away from threat, linking this variation to key neurodevelopmental factors, and providing a basis for future research aimed at improving the utility of threat bias measures and interventions in clinical practice.

Effectiveness of skills for academic and social success (SASS) with Portuguese adolescents.

Social fears are common among adolescents and may considerably impair their lives. Even so, most adolescents do not seek professional help for these difficulties, making it important to promote evidence-based and preventive interventions in community samples. This research presents the effectiveness of an intervention with a group of five female adolescents who reported serious interference of their social fears in their daily life. At post-intervention, effectiveness was noticeable by high recovery, reliable individual change, and intragroup statistical change. The intervention showed impact for measures of social anxiety, avoidance, and assertiveness, and such impact was steady at 3-month follow-up. These findings add to the cumulative and transcultural evidence on the effectiveness of Skills for Academic and Social Success (SASS).

Implementation Science in School Mental Health: Key Constructs in a Developing Research Agenda.

In this paper, we propose an implementation science research agenda as it applies to school mental health (SMH). First, we provide an overview of important contextual issues to be considered when addressing research questions pertinent to the implementation of mental health interventions in schools. Next, we critically review three core implementation components: (a) professional development and coaching for school professionals regarding evidence-based practices (EBPs); (b) the integrity of EBPs implemented in schools; and (c) EBP sustainment under typical school conditions. We articulate research questions central to the next generation of research in each of these areas as well as methods to address such questions. Our intent in doing so is to contribute to a developing blueprint to guide community-research partnerships as well as funding agencies in their efforts to advance implementation science in SMH.

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis.

BACKGROUND: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. QUESTION: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? METHODS: All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. RESULTS: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. CONCLUSIONS: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Integrating illness concerns into cognitive behavioral therapy for children and adolescents with inflammatory bowel disease and co-occurring anxiety.

PURPOSE: To examine the feasibility and preliminary benefits of an integrative cognitive behavioral therapy (CBT) with adolescents with inflammatory bowel disease and anxiety. DESIGN AND METHODS: Nine adolescents participated in a CBT program at their gastroenterologist's office. Structured diagnostic interviews, self-report measures of anxiety and pain, and physician-rated disease severity were collected pretreatment and post-treatment. RESULTS: Postintervention, 88% of adolescents were treatment responders, and 50% no longer met criteria for their principal anxiety disorder. Decreases were demonstrated in anxiety, pain, and disease severity. PRACTICE IMPLICATIONS: Anxiety screening and a mental health referral to professionals familiar with medical management issues is important.

Self-Disclosure and Mental Health Service Use in Socially Anxious Adolescents.

Social anxiety disorder is highly prevalent in adolescence, persistent into adulthood, and associated with multiple impairments. Despite the development of efficacious treatments for socially anxious youth, few affected adolescents receive such treatment. This study examined service use in a sample of high school students (n = 1,574), as well as predictors of treatment delay and factors associated with adolescents' disclosure of social difficulties. Self-report measures of social anxiety and service utilization were administered by study staff to 10th- and 11th-grade classrooms across three public high schools. Consistent with the literature, results indicated low treatment utilization (14 %) and lengthy delays in treatment initiation. Symptom severity, impairment, and disclosing anxiety to school personnel were significant predictors of service utilization. Several demographic and illness-specific factors were associated with a higher likelihood of disclosing social discomfort. These findings underscore the important role of school personnel in identifying and referring youth with anxiety disorders. Implications are discussed for increasing access to services, including school-wide screenings and training of school personnel to recognize and provide intervention for anxious youth.

Treating adolescents with social anxiety disorder in schools.

As is evident from the topic of this issue, schools can play an important role in addressing the unmet mental health needs of youth. Social anxiety disorder is particularly suited to being treated in the school setting. This article describes an empirically supported school-based intervention for social anxiety disorder, skills for academic and social success, and provides specific strategies to school counselors, teachers and community practitioners for implementing these methods. This article focuses on practical approaches for working with socially anxious adolescents in the school setting and how to increase awareness of social anxiety with parents and school personnel.

Illness-specific anxiety: implications for functioning and utilization of medical services in adolescents with inflammatory bowel disease.

PURPOSE. Adolescents with inflammatory bowel disease (IBD) may be at heightened risk for developing anxiety and depression. This cross-sectional pilot study examined the relationship between anxiety and depression and health-related behaviors. METHODS. Thirty-six adolescents with diagnosed IBD, ages 12-17, and their parents were recruited from two pediatric gastroenterology medical centers. RESULTS. Clinical levels of anxiety (22%) and depressive symptoms (30%) were reported by patients. Regression analyses revealed that IBD-specific anxiety was significantly associated with greater utilization of medical services and worsened psychosocial functioning. PRACTICE IMPLICATIONS. Results provide preliminary support that IBD-specific anxiety may play an important role in disease management, yet concerns are rarely systematically assessed by health professionals.

Treating persistent distress and anxiety in parents of children with cancer: an initial feasibility trial.

Persistent anxiety is common among parents of children with cancer and may affect the family's well-being and adjustment. The goals of this pilot study are to determine the feasibility and potential efficacy of a brief cognitive-behavioral parent intervention aimed at reducing parental distress and anxiety related to their child's cancer diagnosis. Parents of children with cancer, at least 1 month postdiagnosis, were screened at an outpatient oncology clinic, and those reporting elevated levels of distress were offered a 4-session cognitive-behavioral intervention based on a modified version of the Surviving Cancer Competently Intervention Program-Newly Diagnosed. Five parents reporting persistent distress received the intervention. Results revealed decreases in parents' distress, state anxiety, and depressive symptoms, as well as in parents' feelings of burden associated with their children's cancer. This initial study suggests that identification of parents with prolonged heightened psychological distress is feasible and acceptable and that offering them a brief intervention within a pediatric oncology setting may be beneficial.

Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial.

BACKGROUND: Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. METHODS: Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. RESULTS: TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. CONCLUSIONS: The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.

Asthma and social anxiety in adolescents.

OBJECTIVE: To examine the relationship between self-reported social anxiety and asthma in a non-clinical sample of adolescents. STUDY DESIGN: High school students (n = 765) completed the Social Anxiety Scale for Adolescents (SAS-A), the Social Phobia and Anxiety Inventory for Children (SPAI-C), and questions on asthma diagnosis, asthma symptoms, and asthma-related limitations and medical care. Relationships were examined between social anxiety symptoms and asthma, including history of diagnosis, diagnosis plus current symptoms, and severity. RESULTS: Compared with students without an asthma diagnosis and no symptoms, students with a diagnosis and current symptoms reported heightened social anxiety symptoms related to fear of negative evaluations and generalized discomfort in social settings as measured by the SAS-A. Additionally, a greater proportion of students with an asthma diagnosis and current symptoms were in the clinical range of social anxiety on the SAS-A. Differences on the SAS-A by history of asthma diagnosis and by severity were not supported. No differences were found on the SPAI-C for history of asthma diagnosis, diagnosis plus current symptoms or severity. CONCLUSIONS: Students with current asthma symptoms were more likely to report social anxiety, perhaps related to concerns about exhibiting symptoms or taking medication in front of peers. These findings may suggest advantages for medical providers to identify and treat social anxiety in patients with asthma.