Disorders - Social phobia
Bowler, J. O., MacKintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., Hoppitt, L.
Objective: Computerized cognitive behavioral therapy (cCBT) and cognitive
bias modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other has
not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison
condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. Method: Sixty-three primarily
Caucasian adults (mean age = 22.7, SD = 5.87; 68.3% female) with high social anxiety, randomly allocated to 3 groups: CBM-I (n = 21), cCBT (n = 21),
and a no-intervention control group (n = 21) provided complete data for analysis. Pre-and postintervention (4 sessions lasting 2 weeks, control
participants only attended the pre-post sessions) self-report measures of anxiety, depression, attentional control, and threat-related interpretive
bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using the Scrambled Sentences Test. Results:
Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety, and depression and improved attentional control,
relative to the control group, with no clear superiority of either active intervention. Although both active conditions reduced negative bias on the
Scrambled Sentences Test completed under mental load, CBM-I was significantly more effective at doing so. Conclusions: The results suggest that
although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load. (copyright)
2012 American Psychological Association.
Journal of Consulting
& Clinical Psychology, 80(6) : 1021-1033
- Year: 2012
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Bjornsson, Andri S., Bidwell, L. Cinnamon, Brosse, Alisha L., Carey, Gregory, Hauser, Monika, Mackiewicz-Seghete, Kristen
L., Schulz-Heik, R. Jay, Weatherley, Donald, Erwin, Brigette A., Craighead, W. Edward
Objective: Methods: Results: Conclusions: In this
randomized controlled trial, cognitive-behavioral group therapy (CBGT) for social anxiety disorder (SAD) was compared to group psychotherapy (GPT), a
credible, structurally equivalent control condition that included only nonspecific factors of group treatment (such as group dynamics).Participants
were 45 college students at the University of Colorado with a primary diagnosis of SAD. Each treatment condition comprised eight group sessions
lasting 2‚Äâhr each. Independent assessors (blind to treatment assignment) assessed participants at baseline and posttreatment with the Clinical
Global Impression Scale (CGI) and the Liebowitz Social Anxiety Scale (LSAS).Both treatments were found to be equally credible. There were five
noncompleters in the CBGT condition (21.7%) and only one in the GPT condition (4.3%). There were no statistically significant differences
posttreatment (controlling for pretreatment scores) between the two treatment conditions, and both treatments were found to be efficacious. Effect
sizes for CBGT were similar to earlier studies, and adherence ratings revealed excellent adherence.Treatment of SAD appears to be moving toward
individual CBT, partly because of high attrition rates and underutilization of group dynamics in group CBT. However, group therapy has unique
therapeutic ingredients, and it may be too early to give up on group treatment altogether. Discussion of these findings included future directions
with this treatment modality, especially whether these two types of group treatment could be combined and whether such combination might serve to
decrease attrition, enhance efficacy, and facilitate dissemination.\r© 2011 Wiley Periodicals, Inc.
Depression & Anxiety, 28(11) : 1034-1042
- 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), Other Psychological Interventions
Bergamaschi, Mateus M., Queiroz, Regina Helena
Costa, Chagas, Marcos Hortes
Nisihara, de-Oliveira, Danielle Chaves Gomes, De-Martinis, Bruno Spinosa, Kapczinski, Flavio, Quevedo, Joao, Roesler, Rafael, Schroder, Nadja, Nardi, Antonio E., Martin-Santos, Rocio, Hallak,
Jaime Eduardo Cecilio, Zuardi, Antonio Waldo, Crippa, Jose Alexandre S.
Generalized Social Anxiety Disorder (SAD) is one of the most common anxiety
conditions with impairment in social life. Cannabidiol (CBD), one major non-psychotomimetic compound of the cannabis sativa plant, has shown
anxiolytic effects both in humans and in animals. This preliminary study aimed to compare the effects of a simulation public speaking test (SPST) on
healthy control (HC) patients and treatment-naive SAD patients who received a single dose of CBD or placebo. A total of 24 never-treated patients
with SAD were allocated to receive either CBD (600 mg; n=12) or placebo (placebo; n=12) in a double-blind randomized design 1 h and a half before the
test. The same number of HC (n=12) performed the SPST without receiving any medication. Each volunteer participated in only one experimental session
in a double-blind procedure. Subjective ratings on the Visual Analogue Mood Scale (VAMS) and Negative Self-Statement scale (SSPS-N) and physiological
measures (blood pressure, heart rate, and skin conductance) were measured at six different time points during the SPST. The results were submitted to
a repeated-measures analysis of variance. Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech
performance, and significantly decreased alert in their anticipatory speech. The placebo group presented higher anxiety, cognitive impairment,
discomfort, and alert levels when compared with the control group as assessed with the VAMS. The SSPS-N scores evidenced significant increases during
the testing of placebo group that was almost abolished in the CBD group. No significant differences were observed between CBD and HC in SSPS-N scores
or in the cognitive impairment, discomfort, and alert factors of VAMS. The increase in anxiety induced by the SPST on subjects with SAD was reduced
with the use of CBD, resulting in a similar response as the HC.
Neuropsychopharmacology, 36(6) : 1219-
1226
- Year: 2011
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Heiervang, E, Wergeland, G. J., Fjermestad, K., Haugland, B. S. M., Ost, L.
G., Havik, O. E., Oeding, K., Bjanullstad, J.
F.
Introduction: Efficacy studies of CBT for childhood anxiety disorders have found significant effects for up to 70% of the patients, but less
is known about the effectiveness with youths in routine clinical care. We have therefore studied the effectiveness of the FRIENDS for Life program in
seven child and adolescent mental health outpatient clinics in Western Norway. Method: Subjects were randomized to group or individual treatment,
some with a preceding wait-list period with a mean duration equal to the treatment period of 10 weeks. A total of 183 referred youths aged 8-15 years
with separation anxiety, generalized anxiety or social anxiety disorder were included. There were few exclusion criteria. Pre-, post- and 1 year
follow-up assessments included the Anxiety Disorder Interview Schedule for children and parents, Spence Children's Anxiety Scale and the Short Mood
and Feelings Questionnaire. Results: Significant improvement was observed both for individual and group treatment with regard to diagnostic status,
anxiety symptoms and depressive symptoms, with little change after the wait-list period. Post-treatment around had recovered from their principal
diagnosis. There was a moderate effect size on anxiety and depressive symptoms. Preliminary data show continuing effects at 1 year follow-up, with no
significant effect of treatment format. Discussion: The study is one of the largest studies of CBT for anxiety in children carried out in regular
clinics with regular clinicians. The FRIENDS for Life CBT program seems to be an effective treatment when delivered in ordinary clinical settings,
with equal effects for individual and group formats. Conclusion: Manualised CBT is effective for childhood anxiety disorders in ordinary clinical
care both at short- and long-term (1 year) and may be recommended for clinical use.
European Child & Adolescent
Psychiatry, 20 : S45
- Year: 2011
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, 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)
Ginsburg, Golda S., Kendall, Philip C., Sakolsky, Dara, Compton, Scott N., Piacentini,
John, Albano, Anne Marie, Walkup, John T., Sherrill, Joel, Coffey, Kimberly A., Rynn, Moira A., Keeton, Courtney P., McCracken, James T., Bergman,
Lindsey, Iyengar,
Satish, Birmaher, Boris, March, John
Objective: To report on remission rates in anxious youth who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS). The CAMS, a
multisite clinical trial, randomized 488 children and adolescents (ages 7–17 years; 79% Caucasian; 50% female) with separation, social, and/or
generalized anxiety disorder to a 12-week treatment of sertraline (SRT), cognitive behavioral therapy (CBT), their combination (COMB), or clinical
management with pill placebo (PBO). Method: The primary definition of remission was loss of all study-entry anxiety disorder diagnoses; additional
definitions of remission were used. All outcomes were rated by independent evaluators blind to treatment assignment. Predictors of remission were
also examined. Results: Remission rates after 12 weeks of treatment ranged from 46% to 68% for COMB, 34% to 46% for SRT, 20% to 46% for CBT, and 15%
to 27% for PBO. Rates of remission (i.e., achieving a nearly symptom-free state) were significantly lower than rates of response (i.e., achieving a
clinically meaningful improvement relative to baseline) for the entire sample. Youth who received COMB had significantly higher rates of remission
compared to all other treatment groups. Both monotherapies had higher remission rates compared to PBO, but rates were not different from each other.
Predictors of remission were younger age, nonminority status, lower baseline anxiety severity, absence of other internalizing disorders (e.g.,
anxiety, depression), and absence of social phobia. Conclusions: For the majority of children, some symptoms of anxiety persisted, even among those
showing improvement after 12 weeks of treatment, suggesting a need to augment or extend current treatments for some children. (PsycINFO Database
Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Consulting & Clinical Psychology, 79(6) : 806-
813
- Year: 2011
- 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), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Lester, K. J., Field, A. P.,
& Muris, P. E. H. M.
Using an
experimental bias modification task, an interpretation bias towards or away from threat was induced about animal or social situations in a sample of
103 children split into a young (7-10 years) and old age group (11-15 years). Children rapidly learned to select outcomes of ambiguous situations
which were congruent with their assigned modification condition. Following positive modification, children's threat interpretation biases
significantly decreased, while threat biases increased (non-significantly) after negative modification. Bias modification effects also varied as a
function of age with children appearing particularly vulnerable to acquiring biases about stimuli that were congruent with the normative fears for
their age group. Weak age-related modification-congruent effects on younger but not older children's anxiety vulnerability in response to a
behavioral task were also observed. However, no consistent effects of bias modification on avoidance behavior were found.
Journal of Anxiety Disorders, 25(5) : 697-705
- Year: 2011
- Problem: Social phobia (social anxiety disorder), Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Davis-III,
TE., May, Anna., Whiting, Sara E.
Research on treatments for childhood anxiety disorders has increased greatly in
recent decades. As a result, it has become increasingly necessary to synthesize the findings of these treatment studies into reviews in order to draw
wider conclusions on the efficacy of treatments for childhood anxiety. Previous reviews of this literature have used varying criteria to determine
the evidence base. For the current review, stricter criteria consistent with the original Task Force (1995) guidelines were used to select and
evaluate studies. Studies were divided by anxiety disorder; however, many studies combine various anxiety disorders in their samples. As a result,
these were included in a combined anxiety disorder group. Using more traditional guidelines, studies were assigned a status of well-established,
probably efficacious, or experimental based on the available literature and the quality of the studies. While some treatments do meet the criteria
for well-established status, it is clear from this examination that gaps remain and replication is necessary to establish many of these treatments as
efficacious. In addition, there still appears to be a lack of research on the effects of treatment on the physiological and cognitive aspects of fear
and anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Clinical Psychology Review, 31(4) : 592-
602
- Year: 2011
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Dogaheh, Ebrahim Rezaei, Mohammadkhani, Parvaneh, Dolatshahi, Behrooz
Previous studies have established the efficacy of group and individual formats of cognitive-
behavioral therapy in reducing fear of negative evaluation in social anxiety disorder, but the effectiveness of the group and individual therapies
has not been widely assessed. This study was conducted to compare the effectiveness of cognitive-behavior group therapy to individual cognitive-
behavioral therapy in social anxiety disorder. 28 patients were randomly allocated to two groups of 14. Each group participated in 12 weekly
sessions. The final sample was 22 participants after drop-out. Pretest and posttest data were collected using the Brief Fear of Negative Evaluation
Scale and the Beck Depression Inventory-II. Controlling for pretest fear of negative evaluation and depression, cognitive-behavioral group therapy
was more effective than individual cognitive-behavioral therapy in reducing fear of negative evaluation, but the clinical significance and
improvement rates of the two treatment formats were equivalent. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Psychological
Reports, 108(3) : 943-954
- 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), Other service delivery and improvement
interventions
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-navØve 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