Role of social skills training in adolescents with social anxiety disorder.

Background/Objective: Social skills training (SST) is frequently included in the treatment of social anxiety disorder (SAD) in both children and adolescents, although there is no empirical evidence to support it. Consequently, our objective is to study the role and effects of SST in the treatment of a sample of adolescents with SAD. Method: A total of 108 adolescents diagnosed with generalized social phobia were randomly assigned to two treatment conditions (with and without SST) and a control group waiting list (WLCG). The evaluation included self-report measures, observational tests and blind evaluators. Results: Both interventions significantly reduced the number of social situations feared/avoided with respect to the WLCG, which worsened. Likewise, both interventions were effective but the group with SST obtained better results in the post-test and follow-ups, as well as a lower dropout rate (6:1). Conclusions: The use of SST reduces the dropout rate of treated adolescents and increases the effectiveness of the Intervention Program for Adolescents with Social Phobia.

Antecedentes/Objetivo: El entrenamiento en habilidades sociales (EHS) se incluye frecuentemente en el tratamiento del trastorno por ansiedad social (TAS) tanto en niños como en adolescentes, pese a que no existe evidencia empírica que lo respalde. En consecuencia, nuestro objetivo es estudiar el papel y los efectos que produce el EHS en el tratamiento de una muestra de adolescentes con TAS. Método: Un total de 108 adolescentes diagnosticados con fobia social generalizada fueron asignados aleatoriamente a dos condiciones de tratamiento (con y sin EHS) y a un grupo control lista de espera (GCLE). La evaluación incluyó medidas de autoinforme, tests observacionales y evaluadores ciegos. Resultados: Ambas intervenciones redujeron significativamente el número de situaciones sociales temidas/evitadas respecto del GCLE, que empeoró. Asimismo, ambas fueron eficaces pero el grupo con EHS obtuvo mejores resultados en el post-test y en los seguimientos, así como una tasa menor de abandonos (6:1). Conclusiones: El uso del EHS reduce la tasa de abandono de los adolescentes tratados e incrementa la eficacia del Programa de Intervención en Adolescentes con Fobia Social.

Autonomic markers associated with generalized social phobia symptoms: heart rate variability and salivary alpha-amylase.

The study of autonomic nervous system changes associated with generalized social phobia (GSP) disorder has increased in recent years, showing contradictory results. The present study aimed to evaluate how young people with GSP reacted before, during, and after exposure to the Trier Stress Social Test (TSST), focusing on their autonomic changes (heart rate variability (HRV) and salivary alpha-amylase (sAA)) compared to a control group (non-GSP). Some psychological variables were also considered. Sex was specifically studied as a possible modulator of autonomic fluctuations and psychological state. Eighty young people were randomly distributed into two counterbalanced situations: stress condition (N = 18 and 21 for GSP and non-GSP, respectively) and control condition (N = 21 and 20 for GSP and non-GSP, respectively), where cardiovascular variables were continuously recorded. Psychological questionnaires about mood and perceived stress were filled out, and five saliva samples were collected to analyze sAA. GSP participants showed higher values on low- and high-frequency ratios (HR domains), compared to non-GSP people, during exposure to the TSST, but no differences were observed after the stressor. Furthermore, the two groups did not differ in sAA. Importantly, positive affect in GSP participants was modulated by sex. The present study suggests that the balance between high- and low-frequency domains of HRV is a key cardiovascular marker reflecting the stress response of GSP people, as well the importance of sex in positive affect when facing a stressful situation.

No effects of psychosocial stress on memory retrieval in non-treated young students with Generalized Social Phobia.

Generalized Social Phobia (GSP) is a common anxiety disorder that produces clear social life disruptions. There is no consensus on the specific processes involved in its development, but the role of the hypothalamic-pituitary-adrenal (HPA) axis has been suggested. This study analyzed the effects of the cortisol response to the Trier Social Stress Test (TSST) on the memory retrieval of pictures with different emotional valences in 45 non-treated young students with GSP and 50 non-anxious (NA) subjects (mean=19.35years, SD=0.18). No differences were found in the cortisol response of GSP and NA subjects to the TSST and control sessions. In addition, psychosocial stress impaired memory retrieval in both the GSP and NA groups, with no differences between them. Regarding the sex factor, no effects were found in the cortisol response to the TSST. However, during the encoding session, GSP men had higher cortisol levels than GSP women and NA subjects. There was also a significant interaction between sex and stress exposure on memory retrieval. Women recognized more unpleasant and neutral pictures than men; however, under stress, the women's advantage disappeared, and the men's performance improved. Sex also interacted with social phobia on positive mood, with GSP women exposed to the TSST showing the lowest positive mood. These results suggest that GSP subjects do not present an HPA axis sensitization to psychosocial stress, and they emphasize the importance of Sex in understanding stress effects on memory.

Community versus clinical cognitive-behavioral intervention in young-adult Spanish population with generalized social phobia / Intervención cognitivo-conductual comunitaria versus intervención clínica en jóvenes adultos españoles con fobia social generalizada

Ei objetivo del estudio es mejorar los resultados informados por las revisiones sobre el tratamiento de adultos con Fobia social generalizada. La muestra la integraron 91 participantes con Fobia social generalizada (EM: 19.90 años; DT: 1.05) asignados aleatoriamente a tres condiciones experimentales, evaluados antes y después del tratamiento, y a los 6, 12, y 24 meses en los grupos tratados. Los resultados muestran (a) la efectividad de la detección en el contexto comunitario versus la intervención clínica, en el corto y medio plazo, y (b) una mejora significativa de los efectos del tratamiento, frente a los de las revisiones de las intervenciones clínicas ad hoc, tanto en los abandonos como en las tasas de recuperación. Ello permite concluir que esta modalidad de aplicación del tratamiento cognitivo-conductual puede ser una estrategia complementaria a la convencional con la que mejorar los resultados actuales de la intervención psicológica en este trastorno.

The study investigates how to improve the results reported by the reviews on the effects of clinical interventions 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.

Terapia para la eficacia social y tratamiento de adultos-jóvenes españoles con fobia social generalizada / Social effectiveness therapy for the treatment of young spanish adults with generalized social phobia

El propósito de este estudio es adaptar y validar para su aplicación en población adulta española el tratamiento Terapia para la Eficacia Social (Turner, Beidel, Cooley, Woody y Messer, 1994). Se presentan los resultados obtenidos con un grupo experimental-tratamiento compuesto por 16 participantes que fueron comparados con un grupo de control-lista de espera, todos con fobia social generalizada (APA, 2000). La evaluación se realizó antes y después del tratamiento en ambos grupos, así como en dos medidas de seguimiento en el grupo experimental. Los resultados en el grupo experimental muestran la eficacia a corto y a largo plazo de la adaptación realizada de la Terapia para la Eficacia Social en todas las medidas que evalúan la ansiedad y evitación social; por el contrario, los integrantes del grupo de control no alcanzaron mejoría en ninguna de las variables evaluadas.

The objective of this study is to adapt and validate for use in the adult Spanish population the treatment known as social effectiveness therapy (Turner, Beidel, Cooley, Woody, and Messer, 1994). We present results that were obtained by comparing an experimental-treatment group consisting of 16 participants with a waiting list control group, all with generalized social phobia (APA, 2000). The evaluation was carried out before and after the treatment in both groups as well as in two follow-ups with the experimental group. The results in the experimental group show the short and long-term efficacy of social effectiveness therapy for all measures that assess social anxiety and avoidance. In contrast, the members of the control group did not experience improvement in any of the variables evaluated.

Functional magnetic resonance imaging during emotion recognition in social anxiety disorder: an activation likelihood meta-analysis.

BACKGROUND: Social anxiety disorder (SAD) is characterized by abnormal fear and anxiety in social situations. Functional magnetic resonance imaging (fMRI) is a brain imaging technique that can be used to demonstrate neural activation to emotionally salient stimuli. However, no attempt has yet been made to statistically collate fMRI studies of brain activation, using the activation likelihood-estimate (ALE) technique, in response to emotion recognition tasks in individuals with SAD. METHODS: A systematic search of fMRI studies of neural responses to socially emotive cues in SAD was undertaken. ALE meta-analysis, a voxel-based meta-analytic technique, was used to estimate the most significant activations during emotional recognition. RESULTS: Seven studies were eligible for inclusion in the meta-analysis, constituting a total of 91 subjects with SAD, and 93 healthy controls. The most significant areas of activation during emotional vs. neutral stimuli in individuals with SAD compared to controls were: bilateral amygdala, left medial temporal lobe encompassing the entorhinal cortex, left medial aspect of the inferior temporal lobe encompassing perirhinal cortex and parahippocampus, right anterior cingulate, right globus pallidus, and distal tip of right postcentral gyrus. CONCLUSION: The results are consistent with neuroanatomic models of the role of the amygdala in fear conditioning, and the importance of the limbic circuitry in mediating anxiety symptoms.

Coping Strategies for Stress in Patients with Social Phobia-Comparison of Generalized and Nongeneralized Social Phobia / 신경정신의학

OBJECTIVES: The purposes of this study were to understand the difference of coping strategies for stress and to compare the degree of social avoidance, subjective distress and fear of negative evaluation between patients with generalized and nongeneralized social phobia. METHODS: Forty-six outpatients meeting the criteria of DSM-IV social phobia at the Department of Psychiatry Kangbuk Samsung Hospital were included. They were classified as generalized type (n=30) and nongeneralized type (n=16) according to the number of difficult situations. Social Phobia Scale (SPS), Social Avoidance and Distress Scale (SADS) and Brief-Fear of Negative Evaluation (BFNE) scales were administered to both groups. To evaluate the coping strategies for stress, we used 'Multidimensional Coping Scale'. RESULTS: 1) The group of generalized social phobia showed significantly lower scores on emotional expression and religious seeking and showed higher scores on passive withdrawal in multidimensional coping scales than the group of nongeneralized social phobia. 2) The group of generalized social phobia reported greater subjective fear of situation in which the patients were exposed to scrutiny by others than did the group of nongeneralized social phobia. The group of generalized social phobia tended to report severer anxiety and to avoid social situation that may be embarrassing far greater than did in group of nongeneralized social phobia. 3) In both groups, social avoidance and distress were positively correlated with passive withdrawal and emotional support and negatively correlated with active coping. Fear for negative evaluation was positively correlated with fatalism and negatively correlated with positive interpretation. CONCLUSION: Efficient and active intervention to change unproductive coping strategy such as passive withdrawal is essential in the treatment of social phobia patients. Also this study suggests that interventions designed to modify behaviors and cognitions in emotional support seeking and fatalism could improve symptoms.