Disorders - Social phobia
Romero-
Cerecero, O., Islas-Garduno, A. L., Zamilpa, A., Perez-Garcia, M. D., Tortoriello, J.
Social anxiety is one of the most common disorders found in the population attending the
first level of health care. Galphimia glauca has been used for many years in Mexican traditional medicine to treat \"nervous disorders\". A
standardized extract of this species has been evaluated in clinical studies that have proven its efficacy and safety in patients with generalized
anxiety disorder. In this work, a double-blind clinical trial was carried out, using sertraline as a control. Patients from both sexes (18 to 35
years old) with moderate or severe social anxiety were included. Experimental group was treated daily (orally), for 10 weeks, with an extract from G.
glauca containing 0.374 mg/dose of Galphimine-B (G-B, active compound). Patients in the control group were given sertraline (50 mg) in the same
conditions. All patients were evaluated every two weeks. Another assessment was done one month after the end of the administration period. A total of
34 patients was included, 17 in each group. Women were predominant, and the mean age was 25 +/- 4.7 years. In patients who received the G. glauca
standardized extract, a significant reduction in anxiety was observed, with a value (in the Brief Social Phobia Scale) of 41.1+/-10.3 points at the
start and 11.2+/-5.6 points at the end of treatment, while patients treated with sertraline had a value of 37.7+/-7.3 points at the beginning and
11.1+/-5.2 points at the end. No significant difference was observed between the treated groups. In a similar way, the health scale showed a gradual
and continuous improvement in each of the five evaluations. In conclusion, the 10-week oral administration of G. glauca standardized extract showed
efficacy and safety in patients with social anxiety disorder, without showing a significant difference from patients treated with sertraline.
Copyright © 2018 Ofelia Romero-Cerecero et al.
Evidence-based Complementary and Alternative Medicine, 2018 (no
pagination)(1716939) :
- Year: 2018
- Problem: 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), Antidepressants
(any), Complementary & Alternative
Interventions (CAM), Homeopathic, plant-based medicines
McKinnon, A., Keers, R., Coleman, J. R. I., Lester, K. J., Roberts, S., Arendt, K., etal.
BACKGROUND: Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been
proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the
child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led
CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment
formats. METHOD(S): A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a
primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD).
Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at
preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling
was used to investigate the secondary research question. RESULT(S): In children with primary GAD, SAD or SoAD, there were no significant differences
between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT
compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual
CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-
up data were examined separately. CONCLUSION(S): Data show there may be greater clinical benefit by allocating children with a primary SP to
individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional
resources required. Copyright © 2018 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of
Association for Child and Adolescent Mental Health.
Journal of Child Psychology &
Psychiatry, & Allied Disciplines, 59(7) : 763-772
- Year: 2018
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Controlled clinical 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
Modini, M., Abbott, M. J.
Background and Objectives: Pre-event rumination has a clear role in
maintaining social anxiety according to cognitive models. However, it is unclear what specific strategies can address pre-event rumination for
individuals diagnosed with SAD. The current study aimed to determine the effectiveness of a brief intervention on multiple aspects of pre-event
rumination, state anxiety and performance and threat appraisals. Additionally, the trajectory of pre-event rumination was investigated over four
days. Method(s): Participants with SAD were informed they would be required to complete a speech task in four days' time and were randomised to an
intervention (n = 27) or a non-active control group (n = 25). The intervention group were instructed to \"ban\" pre-event rumination using a
metacognitive therapy technique known as detached mindfulness. All participants completed daily measures of pre-evet rumination that assessed
frequency, uncontrollability, engagement and distress associated with pre-event rumination. On the day of the speech task, participants also
completed state and cognitive measures before delivering the speech task. Result(s): The intervention group reported reduced frequency,
uncontrollability and distress associated with pre-event rumination, compared to the control group. There was no difference between groups for
performance and threat appraisals as well as state anxiety. Rumination is a stable and robust process, with an increase in frequency and associated
distress 24 hours before a feared social situation. Limitation(s): The lack of an active control group precludes comparisons to more traditional
cognitive-behavioural therapy strategies for pre-event rumination. Conclusion(s): Pre-event rumination is a durable process but banning pre-event
rumination using metacognitive therapy techniques shows promise for specifically addressing this maladaptive process. Copyright © 2018 Elsevier
Ltd
Journal of Behavior Therapy and Experimental Psychiatry, 61 : 72-79
- Year: 2018
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Mindfulness based
therapy
McCall, H.C., Richardson,
C.G., Helgadottir, F.D., Chen, F.S.
Background: Treatment rates for social anxiety,
a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered
interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as
stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to
address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules
incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user's symptoms, and automatic email
reminders and time limits are used to encourage adherence. Objective: The purpose of this study was to conduct a randomized controlled trial to
investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclinical sample of university students. As a
secondary aim, we also investigated whether Overcome Social Anxiety would increase life satisfaction in this sample. Methods: Following eligibility
screening, participants were randomly assigned to a treatment condition or a wait-list control condition. Only those assigned to the treatment
condition were given access to Overcome Social Anxiety; they were asked to complete the program within 4 months. The social interaction anxiety scale
(SIAS), the fear of negative evaluation scale (FNE), and the quality of life enjoyment and satisfaction questionnaire-short form (Q-LES-Q-SF) were
administered to participants from both conditions during baseline and 4-month follow-up lab visits. Results: Over the course of the study,
participants assigned to the treatment condition experienced a significant reduction in social anxiety (SIAS: P < .001, Cohen d = 0.72; FNE: P <
.001, Cohen d = 0.82), whereas those assigned to the control condition did not (SIAS: P = .13, Cohen d = 0.26; FNE: P = .40, Cohen d = 0.14).
Additionally, a direct comparison of the average change in social anxiety in the 2 conditions over the course of the study showed that those assigned
to the treatment condition experienced significantly more improvement than those assigned to the control condition (SIAS: P = .03, Cohen d = 0.56;
FNE: P = .001, Cohen d = 0.97). Although participants assigned to the treatment condition experienced a slight increase in life satisfaction, as
measured by Q-LES-Q-SF scores, and those assigned to the control condition experienced a slight decrease, these changes were not statistically
significant (treatment: P = .35, Cohen d = -0.18; control: P = .30, Cohen d = 0.18). Conclusions: Our findings indicate that Overcome Social Anxiety
is an effective intervention for treating symptoms of social anxiety and that it may have further utility in serving as a model for the development
of new interventions. Additionally, our findings provide evidence that contemporary Web-based interventions can be sophisticated enough to benefit
users even when delivered as stand-alone treatments, suggesting that further opportunities likely exist for the development of other Web-based mental
health interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Medical Internet Research, 20(3) : ArtID e91
- Year: 2018
- 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), Technology, interventions delivered using technology (e.g. online, SMS)
Liu, H., Li, X., Han,
B., Liu, X.
BACKGROUND: Cognitive bias modification (CBM), a set of techniques for modifying bias in information processing-is
considered a novel intervention for social anxiety disorder (SAD), which has drawn considerable interest from researchers. However, the effects of
CBM on SAD are not consistent. Some studies have demonstrated significant positive effects compared to control groups, while others have found no
such effects.\rAIMS: We conducted a meta-analysis aimed at quantitatively assessing the effects of CBM on SAD at post-test.\rMETHOD: Through a
systematic literature search by two independent raters, 34 articles (36 randomized studies) including 2,550 participants were identified. A
multilevel modeling approach was employed to assess the effects of CBM on SAD, and to explore the potentially crucial procedures and sample
characteristics that enhance the effectiveness of benign training.\rRESULTS: In general, there were small but significant effects of CBM on the
primary symptoms of SAD (g = 0.17), cognitive bias (CB) toward threat (g = 0.32), and reactivity in stressful situations (g = 0.25), but non-
significant effects on secondary symptoms. However, the interpretation modification program was more effective than was attentional bias modification
in reducing SAD primary symptoms and negative CB. Laboratory training procedures produced larger primary symptom reductions compared to Internet-
based training, whereas the percentage of contingency and feedback about training performance boosted cognitive effects only. Finally, the following
groups were more likely to benefit from CBM: younger participants (primary symptoms and cognitive effects), women (primary symptom effects), and
samples with stronger CB (stressor effects). The quality of the randomized controlled trials was less than desirable, as there was some indication of
publication bias in our study.\rCONCLUSIONS: Current findings broadly supported cognitive theories of SAD that consider a bidirectional or mutually
reinforcing relationship between symptoms and CBs. However, the small therapeutic effect observed here indicates that it is necessary to develop more
reliable and efficient CBM interventions that are specific to SAD.
PLoS
ONE, 12(4) : e0175107
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., Lynch, F. L., Porta, G., Iyengar, S.
Importance: Anxiety and depression affect 30% of youth but
are markedly undertreated compared with other mental disorders, especially in Hispanic populations.\rObjective: To examine whether a pediatrics-based
behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health
care.\rDesign, Setting, and Participants: This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral
therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and
Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of
separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a
consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for
anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse,
intellectual disability, or unstable serious physical illness.\rInterventions: The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral
therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and
check-in calls to support accessing care from master's-level coordinators.\rMain Outcomes and Measures: The primary outcome was clinically
significant improvement on the Clinical Global Impression-Improvement scale (score <=2). Secondary outcomes included the Pediatric Anxiety Rating
Scale, Children's Depression Rating Scale-Revised, and functioning.\rResults: A total of 185 patients were enrolled in the study (mean [SD] age,
11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n=95), compared with those in the ARC
group (n=90), had significantly higher rates of clinical improvement (56.8% vs 28.2%; chi21=13.09, P<.001; number needed to treat, 4), greater
reductions in symptoms (F2,146=5.72; P=.004; Cohen f=0.28), and better functioning (mean [SD], 68.5 [10.7] vs 61.9 [11.9]; t156=3.64; P<.001; Cohen
d=0.58). Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%) (chi21=14.90;
P<.001; number needed to treat, 2). Effects were robust across sites.\rConclusions and Relevance: A pediatric-based brief behavioral intervention for
anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially
strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care.\rTrial Registration:
clinicaltrials.gov Identifier: NCT01147614.
JAMA Psychiatry, 74(6) : 571-
578
- Year: 2017
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Ye, H.
The purpose of
this study was to examine the effects of a Mindfulness-Based Stress Reduction (MBSR) program on reduced stress and perceived anxiety. 27 students
with social anxiety, aged 16-40 years, from a China university were randomized to MBSR with routine care group (MBSR group, n = 14) and routine care
group (non-MBSR group, n = 13). As expected, an increase in anxiety symptoms during the social situations led to more perceived anxiety in the non-
MBSR group, but not in the MBSR group, due to the MBSR program. However, the MBSR group had significantly decreased anxiety and avoidance symptoms
compared to the non-MBSR group. The results in this trial show that MBSR can protect students with social anxiety from an increase in perceived
anxiety during the social situations. Copyright © 2018, Anka Publishers. All rights reserved.
NeuroQuantology, 15(4) : 101-106
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Mindfulness based
therapy
Sanchez,
R., Brown, E., Kocher, K., DeRosier, M.
OBJECTIVE: The purpose of this study was to investigate whether a computer-
based game to improve social skills and mental health in children with social skills deficits would be efficacious. The program, Adventures aboard
the S.S. GRIN, translates a proven in-person intervention into a nine-episode interactive online adventure game that provides opportunity for
knowledge acquisition and skill practice. MATERIALS AND METHODS: Participants (children aged 7-11 years with social skills challenges) were randomly
assigned to immediate treatment group (n=33) or waitlist control group (n=36). Children in the immediate treatment condition completed the game at
home over the course of 9 weeks. Before playing the game and again within 1 week of game completion, children completed surveys about social
literacy, social anxiety, bullying, social self-efficacy, and social satisfaction. RESULTS: Children who played Adventures improved significantly
more from pretest to posttest than children who did not play the game in social literacy, social anxiety, bullying victimization, and social
satisfaction. CONCLUSION: Online interactive games can be effective in improving mental health for children who struggle with social skills. For
children who can access them, serious games have the potential to increase the reach of effective programs by overcoming the logistical and
implementation barriers (such as cost, travel, and accessibility) that limit traditionally delivered mental health interventions.
Games for health journal, 6(1) : 19-
27
- Year: 2017
- 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), Skills training, Technology, interventions delivered using technology (e.g. online, SMS)
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)