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Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10–13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder. • Little is known about maintaining factors of child social anxiety disorder (SAD). • High daily-life reactivity and use of suppression are specific to child SAD. • Maladaptive emotion regulation predicts trait social anxiety one year later. • Treatment should put more focus on reducing maladaptive emotion regulation. [ABSTRACT FROM AUTHOR]

Fear of positive evaluation (FPE) is posited as a core feature of social anxiety disorder (SAD); however, little is known about its role in interpersonal functioning. We examined relationships between FPE and responses to a standardized social affiliation paradigm designed to facilitate positive social connection with an unacquainted conversation partner (trained confederate). The sample included adults with SAD (N = 52), major depressive disorder (MDD; N = 23), comorbid SAD and MDD (N = 36), and non-psychiatric controls (N = 33). Participants completed measures assessing FPE, affect, safety behaviors, and desire for future interaction. Confederates and observers rated participant behavior and their own desire for future interaction. FPE was most elevated in the SAD and comorbid groups, followed by the MDD group, and then non-psychiatric controls. In the full sample, FPE was associated with greater self-reported anxiety and safety behavior use, lower self-reported positive affect and desire for future interaction, lower observer-rated desire for future interaction and approach behaviors, and greater observer-rated anxious behaviors. Within-group correlations revealed that associations were weaker in the SAD only and comorbid groups (cf. control and MDD only groups); however, post-hoc moderation analyses indicated that the relationships between FPE and the outcomes of interest largely held across varying levels of social anxiety and depression severity. Findings underscore the potential role of FPE as a transdiagnostic factor relevant to understanding interpersonal functioning in social anxiety and depression., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Charles T. Taylor declares that in the past 3 years he has been a paid consultant for Bionomics and receives payment for editorial work for UpToDate and the journal Depression and Anxiety. Madeleine Rassaby and Isabella G. Spaulding declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Bivalent Fear of Evaluation (BFOE) model suggests that Social Anxiety Disorder is not only characterized by fear of negative evaluation (FNE), but also fear of positive evaluation (FPE). While FNE has been firmly established, research of the latter is accumulating. To evaluate the role of the BFOE Model, and particularly FPE, validated measures such as the Fear of Positive Evaluation Scale (FPES) are pivotal. Yet, validation of psychometric properties is often at stake or neglected when translating a scale to other languages. This hampers cross-cultural evaluation of questionnaires and related concepts considerably, including the BFOE Model. To illustrate, a freely available, but not validated Dutch version of the FPES was completed, along with other measures by 354 community participants from the Netherlands and Belgium in an online study. The Dutch FPES showed excellent convergent and discriminant validity. In addition, it explained additional variance in social anxiety above and beyond FNE. These results as well as those from the factor analyses were highly comparable with those deriving from evaluations of the original English version. In conclusion, the Dutch FPES showed excellent psychometric properties and is fit for further exploring consistency or differences in the BFOE model across cultures. Based on this case, practice guidelines for international use and validation of measures are discussed, and recommendations are provided., Competing Interests: Declaration of Competing Interest Neither of the authors has any conflict of interest regarding (the publication of) this research., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Social anxiety disorder (SAD) is highly prevalent with significant lifetime impacts, especially when left untreated. Cognitive behavioral therapy is the current gold standard treatment with successful patient outcomes. Cognitive behavioral group therapy (CBGT) is one form that provides unique benefits to participants including normalization of symptoms and social support, as well as providing increased access to treatment at a lower per-session cost. Research on this mode of treatment has been ongoing for over 20 years, but we still have much to learn about its overall efficacy. The goals of this critical review were to summarize and evaluate the most current research, including an analysis of the overall methodological design quality, and provide recommendations for the enhancement of future studies based on best practices. Recent studies included some best practice design elements used in measuring efficacy such as the use of comparison groups, masking procedures, fidelity assessments, and consideration of clinical significance in outcomes. However, many gaps exist such as a lack of consensus around measures and therapy manuals, as well as baseline competencies of facilitators. Future studies should consider incorporating additional best practice elements aligning with study goals to strengthen designs and provide the field with even more confidence in this mode of treatment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Romantic relationships are vital for health, well-being and quality of life, and an increasing percentage of romantic relations begin via use of dating apps and subsequently progress to dates. In the present study we examined dating application use and dates among individuals with SAD (n = 54) and without SAD (n = 54). Our sample included young adults (age range 18 to 33) who were not in a romantic relationship at the time of the study. For both individuals with SAD and without SAD, half of the participants were men, and half were women. We used a daily diary measurement in which participants reported on their dating application use and dates, as well as on concomitant emotions and perceptions for 21 consecutive days. We found that individuals with and without SAD did not differ in the frequency/duration of application use nor in the number of dates attended. However, individuals with SAD experienced dates as more negative compared to individuals without SAD (Cohen's d = 0.65). Interestingly, individuals with SAD did not significantly differ in their experience of dates as positive compared to individuals without SAD. Moreover, use of dating applications/going on dates were associated with increases in shame (Cohen's d = 0.59) and embarrassment (Cohen's d = 0.45) and this was found to a greater extent among individuals with SAD compared to individuals without SAD (Cohen's d = 0.50, 0.39 for shame and embarrassment respectively). Findings are discussed in the context of cognitive behavioral models of SAD and implications for treatment are considered., Competing Interests: Declaration of Competing Interest The authors declare that there were no conflicts of interest with respect to the authorship or the publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The present study examined contextual factors that affect safety behavior use as well as positive emotions when using safety behaviors among individuals with SAD. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling methodology (ESM) measurement in which they reported on daily social interactions, safety behavior use, and emotions. Using multilevel linear modeling we found that both individuals with and without SAD used more safety behaviors when interacting with distant others compared to close others, but this effect was greater for individuals with SAD compared to individuals without SAD. We also found that social anxiety significantly moderated the relationship between safety behaviors in social interactions and positive emotions. Specifically, our findings indicated that individuals with higher levels of social anxiety reported lower levels of positive emotions when using safety behaviors. Implications of our findings for models of psychopathology and for treatment of SAD are discussed., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest regarding the present manuscript. This study did not receive grant funding. This study received ethics approval by the IRB at the University of Haifa (protocol number 276/18). The authors have no conflicts of interest to disclose regarding the present study. The data used in the present manuscript are available at request from the corresponding author., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Fear of positive evaluation (FPE) is becoming recognised as an important component of social anxiety that is distinct from fear of negative evaluation (FNE). While core belief scales exist for fear of negative evaluation (FNE), none has been developed for FPE. Therefore, this paper describes the development and validation of a measure of core beliefs that is specific to FPE. An exploratory factor analysis was performed on 60 initial items with an Australian undergraduate sample, in which a confirmatory factor analysis was performed with an independent Australian general population sample. A series of further analyses were performed to test convergent and divergent validity. The Positive Evaluation Core Beliefs Scale (PECS) emerged as a 17-item two-factor psychometrically valid measure that correlates more strongly with measurement of FPE than FNE. The PECS measure offers a new opportunity for researchers and clinicians to better explore cognitions associated with social anxiety. • A core belief scale for fear of positive evaluation in social anxiety was developed. • Pressure to perform, hiding talents, and hidden self core beliefs account for fear of positive evaluation. • High standards and rank factor core beliefs account for fear of negative evaluation. • Core beliefs differ between fear of positive and negative evaluation. [ABSTRACT FROM AUTHOR]

The bivalent fear of evaluation (BFOE) model of social anxiety divides fear of evaluation into two distinct valences: fear of positive evaluation (FPE) and fear of negative evaluation (FNE). However, there is evidence that the two most widely utilized and psychometrically supported measures of FNE and FPE contain items which are ambiguous with regard to valence of evaluative fear. To formally address this, the BFOE Scale (BFOES) was developed, by merging items from measures of FNE and FPE into a single scale with an integrated response format. The present studies examined the psychometric profile of the BFOES across a large pooled archival dataset (N = 2216), which included approximately 10 % (n = 224) patients with social anxiety disorder (SAD). The factorial validity, internal consistency, and construct validity of the BFOES were examined. Additionally, item response theory analyses were employed for the purpose of merging items from self-report scales which utilized different Likert-type response formats. Results from both studies provided support for the psychometric profile of the BFOES. The implications of the BFOES for the assessment of social anxiety, and theoretical models of fear of evaluation and SAD, are discussed. • A novel, consolidated measure of fears of evaluation is proposed. • The Bivalent Fear of Evaluation Scale demonstrated strong psychometric properties. • Item-response theory analyses supported a 5-point Likert-type response scale. • The BFOE Scale is a promising measure that warrants further assessment. • Results provide additional support for the Bivalent Fear of Evaluation model. [ABSTRACT FROM AUTHOR]

Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT. • Effective treatments for avoidant personality disorder (AVPD) are highly needed. • Patients with both social anxiety disorder (SAD) and AVPD are severely impaired. • Group schema therapy (GST) and cognitive behavioral therapy (GCBT) were compared. • Both GST and GCBT significantly improved SAD symptoms and manifestations of AVPD. • Treatment effects did not differ, but significantly more patients completed GST. (80) [ABSTRACT FROM AUTHOR]

Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = −0.10–0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (−0.13–0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (−4.62–0.67). A significant reduction in depression severity occurred in MEMI (−0.63–−0.60) but not SM (−0.31–−0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings. • MEMI (vs. SM) notably improved state depression, anxiety, and mindfulness. • MEMI and SM enhanced SAD, worry, repetitive thinking, and trait mindfulness. • Depression severity was reduced in the MEMI but not the SM arm. • Brief MEMI might be efficacious for targeting pathological worry but not SAD. • MEMIs for SAD must be high-intensity and have exposure therapy to be efficacious. [ABSTRACT FROM AUTHOR]

Individuals with social anxiety disorder (SAD) experience a range of interpersonal problems and studies have found that nonverbal synchrony (the coordination between interaction partners' movements) may be impaired in dyads in which one individual has SAD (Asher et al., 2020). In the present study, we examined the temporal dynamics of nonverbal synchrony during "getting aquatinted" conversations of individuals with and without SAD. Specifically, participants (n = 146) formed either SAD dyads (dyads in which one individual had SAD and the other did not; n = 37 dyads), or control dyads (dyads in which both individuals did not have SAD; n = 36 dyads). Dyads were randomized to either small talk or closeness-generating (i.e., intimate) conversations. We found that during conversations, nonverbal synchrony followed a repeating pattern of increases and decreases that was best modeled by a sinusoidal wave (explained variance = 63.74 %). We found significant Diagnosis × Social Context interactions in the temporal dynamics of nonverbal synchrony (i.e., in the parameters of sine waves). Specifically, we found that for SAD dyads (but not control dyads), the average sine wave amplitude which indicates increases and decreases in nonverbal synchrony was greater during small talk conversations compared to closeness-generating conversations. In addition, we found that among control dyads (but not SAD dyads), the average vertical offset of sine waves (i.e., the average level of nonverbal synchrony) during closeness-generating conversations was greater compared to small talk conversations. The findings are interpreted within the context of the social anxiety literature as capturing two distinct social-anxiety related processes, and suggest that when examined temporally (rather than averaged), nonverbal synchrony may be an important implicit biomarker of SAD. • We examined nonverbal synchrony during conversations of individuals with and without SAD. • Conversations were either small-talk or intimate, closeness-generating conversations. • Nonverbal synchrony over time was best modeled by a sinusoidal wave (r2 = 63.74 %). • Different temporal patterns of nonverbal synchrony emerged based on diagnosis and social context. • When examined temporally, nonverbal synchrony may be an implicit marker of SAD. [ABSTRACT FROM AUTHOR]

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p =.006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed. • Meta-analysis of treatment effects for pre-event and post-event rumination in SAD. • Systematic review included 25 studies and 1432 total participants. • Significant and large treatment effects for pre-event and post-event rumination. • Larger effect sizes for treatments that directly target pre-event rumination. • Baseline social anxiety and depression moderated treatment effects. [ABSTRACT FROM AUTHOR]

The present study examined nonverbal synchrony (i.e., synchrony between individuals' movement) during diagnostic interviews of individuals with and without social anxiety disorder (SAD). Specifically, 42 individuals with SAD and 42 individuals without SAD underwent a structured clinical interview, and videos of clinical interviews were analysed using Motion Energy Analysis (an objective machine-based video analysis) to quantify each individuals' movement as well as dyadic synchrony. Results indicated that interviews of individuals with SAD had significantly lower levels of nonverbal synchrony compared to interviews of individuals without SAD. In addition, interviews of individuals with SAD had lower levels of pacing compared to interviews of individuals without SAD (pacing refers to synchrony in which the interviewer initiates movement to which the participant responds). Analyses with social anxiety represented as a continuum of severity (vs. a diagnostic dichotomy) resulted in similar findings. Thus, individuals with SAD synchronized with interviewers' movement to a lesser extent compared to individuals without SAD, and social anxiety was associated with diminished synchrony. Implications for psychopathology and diagnosis of SAD are discussed. • We examined nonverbal synchrony in diagnostic sessions of individuals with/without SAD. • We used Motion Energy Analysis to objectively assess videos. • We found lower levels of nonverbal synchrony for individuals with SAD (vs. no SAD). • We found lower levels of pacing for individuals with SAD (vs. no SAD). • Implications for psychopathology and diagnosis of SAD are discussed. [ABSTRACT FROM AUTHOR]

Remote cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) has the potential to improve access to treatment by reducing economic, geographic, and psychological barriers. The aim of this study was to use a meta-analytic approach to examine the efficacy of the different remote CBT methods for treating SAD. A systematic electronic database search was used to identify 31 studies (n = 2905; mean age range: 24.73–41.65 years; mean female representation = 60.2 %). Pooled within-group analyses indicated large effect sizes from pre-treatment to post-treatment (Hedges' g = 1.06; 95 % CI: 0.96–1.16) and pre-treatment to follow up (g = 1.18; 95 % CI: 1.03–1.33) for remote CBT. Internet-delivered CBT (g = 1.08; 95 % CI: 0.98–1.19) and application-delivered CBT (g = 1.19; 95 % CI: 0.75–1.64) produced large within-group effect sizes. Bibliotherapy-delivered CBT (g = 0.79; 95 % CI: 0.45–1.13) produced medium within-group effect sizes. Pooled between-group findings indicate that remote CBT treatments were more effective than passive control (g = 0.87; 95 % CI: 0.70–1.03) and non-CBT remote treatments (g = 0.41; 95 % CI: 0.17–0.66), and were at least as effective, or slightly more effective, than face-to-face CBT treatments (g = 0.34; 95 % CI: 0.14–0.54). These findings have important implications for the dissemination of remote and stepped-care treatments for SAD. • Remote CBT for SAD has been shown to be efficacious in both high and low intensity formats. • All delivery formats of low intensity remote CBT produce large effect sizes. • The amount of clinician guidance in low intensity treatments does not moderate outcomes. • Future research investigating high intensity CBT for SAD is urgently needed. [ABSTRACT FROM AUTHOR]

Cannabis use and social anxiety disorder (SAD) are prevalent during emerging adulthood. Previous work has demonstrated that SAD is related to cannabis use in adults; however, less is known about what correlates relate to this association in emerging adults. A subsample of individuals ages 18-25 years old from the NESARC-III (N = 5194) was used to (a) evaluate the association between cannabis use and SAD and (b) examine what correlates may be associated with cannabis use and SAD in emerging adulthood. Weighted cross-tabulations assessed sociodemographics and lifetime psychiatric disorder prevalence estimates among the emerging adult sample. Multinomial logistic regressions examined associations between sociodemographics and psychiatric disorders and four groups (i.e., no cannabis use or SAD; cannabis use only; SAD only; cannabis use + SAD). The prevalence of co-occurring cannabis use and SAD was 1.10%. Being White, a part-time student, or not a student were associated with increased odds of having co-occurring cannabis use + SAD (OR range: 2.26-3.09). Significant associations also emerged between major depressive disorder, bipolar I disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder and co-occurring cannabis use + SAD (AOR range: 3.03-19.05). Results of this study may have implications for better identifying and screening emerging adults who are at risk of co-occurring cannabis use and SAD., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

• GAD, SAD, and depression involve distinct interpersonal problems on self-report. • Interpersonal specificity between the disorders is not shown on informant-report. • Each disorder predicted distinct patterns of self-informant discrepancy. • Interpersonal specificity may reflect biases in self-perceptions in each disorder. Despite attention on overlap and distinction between generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD), interpersonal specificity (distinct, prototypical interpersonal features) between the disorders has been understudied. There is emerging evidence for such specificity (e.g., Erickson et al., 2016), but most studies relied on self-report, and not all studies controlled for shared variance between the disorders, complicating interpretation of findings. The present study extended the literature by examining unique interpersonal correlates of GAD, SAD, and MDD symptoms on self- and informant-report, and how self-informant agreement (both mean-level and correlation) in perception of interpersonal affiliation, dominance, and distress varied as a function of the symptoms. 369 college-aged participants (43% with clinical-level symptoms for at least one of the disorders (GAD, SAD, MDD), 57% non-disordered) and up to three of their significant others rated participants' interpersonal problems (interpersonal behaviors that were difficult to engage in or engaged in excessively). We found evidence for exploitable tendencies in GAD, socially avoidant and nonassertive tendencies in SAD, and coldness in MDD based on self-report, but not on informant-report. Although self-other correlation was positive across outcomes, participants endorsed higher affiliation and interpersonal distress and lower dominance relative to informants. GAD, SAD, and MDD symptoms showed distinct moderating effects on these self-informant discrepancies. GAD symptoms predicted over-endorsing affiliation, SAD predicted under-endorsing dominance and affiliation, and MDD predicted no discrepancies in affiliation and dominance. The results speak to potential differentiation of the disorders based on distinct patterns of self-other discrepancy in interpersonal perceptions. [ABSTRACT FROM AUTHOR]

• We examined pupil dilation to emotional faces in adolescent with social anxiety disorder (SAD). • SAD was characterized by an atypical time course of the pupil dilation response compared to healthy controls. • I Larger pupil dilation to happy faces at baseline predicted worse outcome of cognitive behavioral therapy. Atypical attention to potential social threats, such as emotional faces, may be one of the core mechanisms underlying social anxiety disorder (SAD). Pupil dilation is an index of locus coreuleus-noradrenergic activity, and closely linked to attention. In the present study, pupil dilation was studied in adolescents with SAD (N = 26; 22 Female) before the onset of a 12-week cognitive behavioral treatment, and in healthy controls (N = 23). Stimuli were faces with angry or happy emotional expressions. Contrary to our hypothesis, the SAD group did not show hyper-responsiveness to angry compared to happy faces. Instead, an atypical time course of the pupil dilation response was found, resulting in an attenuated response during late time stages. Larger pupil dilation amplitude to happy faces before treatment was related to worse treatment response. These results contribute significantly to our understanding of the mechanisms underlying adolescent SAD. [ABSTRACT FROM AUTHOR]

• Gaze avoidance in social anxiety disorder (SAD) examined using covert eye-tracking. • Tracked gaze to video feedback stimuli per bivalent fear of evaluation (BFOE) model. • Fears of positive and negative evaluation related to state anxiety during stimuli. • SAD participants showed reduced eye gaze during both positive and negative stimuli. • Gaze avoidance is a biobehavioral marker of SAD and supports the BFOE model. Gaze avoidance is an important feature of social anxiety disorder (SAD) and may serve as a biobehavioral marker of SAD. The purpose of the present study was to replicate and extend findings on gaze avoidance in SAD via eye tracking during a computerized social simulation. Patients with SAD (n = 27) and a (sub)sample of demographically-matched healthy controls (HC; n = 22) completed a computerized, dynamic social simulation task involving video clips of actors giving positive and negative social feedback to the participant. All participants were unknowingly eye tracked during the simulation, and post-study consent was obtained to examine responses. Consistent with the bivalent fear of evaluation (BFOE) model of social anxiety, fear of positive evaluation related systematically to state anxiety in response to positive social feedback, and fear of negative evaluation related systematically to state anxiety in response to negative social feedback. Moreover, compared to HCs, SAD patients exhibited significantly greater global gaze avoidance in response to both the positive and negative video clips. Our results provide strong additional support for gaze avoidance as a biobehavioral marker of SAD, as well as additional support for the BFOE model. Implications for the assessment and treatment of SAD are discussed. [ABSTRACT FROM AUTHOR]

Highlights • Therapist-led Virtual Reality (VR) exposure therapy reduced public speaking anxiety. • Internet-administered, self-led VR exposure therapy reduced public speaking anxiety. • Results were maintained or improved at six and twelve month follow-ups. Abstract Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n = 25 + 25 participants were randomized to either one-session therapist-led VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen's d = 1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d = 1.35) decreases in self-reported PSA. Results were maintained or improved at six- and twelve-month follow-ups. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously impractical one-session format, and in a novel self-led, at-home format. [ABSTRACT FROM AUTHOR]

The present study examined differences in the experience of pride between individuals with and without social anxiety disorder (SAD), and is the first to examine both the effects of context on pride and the temporal relationship between pride and anxiety in participants' daily lives. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not. Both groups completed an experience sampling measurement (ESM) to assess the levels of pride and anxiety and the nature of interpersonal contexts in which these emotions were experienced every day for 21 consecutive days. Using multilevel linear modeling, our findings suggest that pride is diminished among individuals with SAD, that situations percieved as highly neagative and positive, or as highly meaningful and positive are associated with the highest levels of pride, and that the experience of pride is associated with subsequent reductions in anxiety among individuals with SAD. These findings point to the role of pride in the disorder and can be used to inform and enhance therapeutic interventions for SAD. • We examined pride in social anxiety disorder and its role in maintaining the disorder. • We used an experience sampling procedure to measure emotions and contexts for 21 days. • Individuals with SAD experienced less pride than individuals without SAD. • Social contexts significantly affected the experience of pride. • Among individuals with SAD, pride predicted subsequent reductions in anxiety. [ABSTRACT FROM AUTHOR]

Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects. • Without intervention, PEP remains elevated over prolonged periods of time. • PEP can be reduced with a number of brief interventions. • State anxiety, intolerance of uncertainty, and safety behaviour use predict PEP. • Positive metacognitive beliefs increase engagement in PEP over time. [ABSTRACT FROM AUTHOR]

The Bivalent Fear of Evaluation (BFOE) Model suggests that fears of negative and positive evaluation are core cognitive vulnerability and maintenance factors for social anxiety disorder The aim of this study was to experimentally assess cognitive and emotional effects of positive and negative feedback in social anxiety. False positive or negative feedback (vs no feedback) was provided following a speech task to high and low socially anxious individuals to investigate impacts on state anxiety and repetitive negative thinking (N = 152, M age = 22.13, 69 % female). Measures were completed prior to the speech and after the false feedback but prior to an anticipated discussion with the group about participants' feedback and performance. High socially anxious participants reporting higher state anxiety and repetitive negative thinking than low socially anxious participants. There were no feedback type by group interactions, indicating that high socially anxious individuals experienced heightened social anxiety and repetitive negative thinking regardless of feedback type (or the absence of feedback). Exploratory analyses revealed that state fear of negative evaluation but not state fear of positive evaluation uniquely predicted both outcomes. Implications for theory and clinical practice are discussed. • Manipulated feedback type (positive, negative, none) following a speech in high and low socially anxious (SA) individuals. • Dependent variables were state anxiety and repetitive negative thinking. • High SA group reported higher state anxiety and repetitive negative thinking than low SA group in all three conditions • There were no feedback type by group interactions. • State fear of negative evaluation but not state fear of positive evaluation predicted both outcomes across conditions. [ABSTRACT FROM AUTHOR]

Individuals with social interaction anxiety, a facet of social anxiety disorder, withdraw from or avoid social encounters and generally avoid risks. However, a subset engages in health risk sexual behavior (HRSB). Because sensation seeking, emotion dysregulation, and impulsivity predict engagement in HRSB among adolescents and young adults, the present study hypothesized that latent classes of social interaction anxiety and these personality traits would differentially predict likelihood of engagement in HRSB. Finite mixture modeling was used to discern four classes: two low social interaction anxiety classes distinguished by facets of emotion dysregulation, positive urgency, and negative urgency (Low SIAS High Urgency and Low SIAS Low Urgency) and two high social interaction anxiety classes distinguished by positive urgency, negative urgency, risk seeking, and facets of emotion dysregulation (High SIAS High Urgency and High SIAS Low Urgency). HRSB were entered into the model as auxiliary distal outcomes. Of importance to this study were findings that the High SIAS High Urgency class was more likely to engage in most identified HRSB than the High SIAS Low Urgency class. This study extends previous findings on the heterogeneity of social interaction anxiety by identifying the effects of social interaction anxiety and personality on engagement in HRSB. [ABSTRACT FROM AUTHOR]

Individuals with Social Anxiety Disorder (SAD) have difficulty engaging in social situations because their actions are predicated on minimizing the subjectively biased high potential for rejection. That is, individuals with SAD frequently perceive social situations as challenging, and their performance as subpar. Yet when individuals perceive themselves as succeeding in challenging situations, they typically report these situations as enjoyable and rewarding. This subjective experience of succeeding in a challenging situation has been studied as flow (Csikszentmihalyi, 1975; 2000). Thirty-three adults with SAD and 34 matched healthy controls completed a baseline assessment, along with daily and experience sampling entries for 14 days. Results were analyzed using three-level generalized linear mixed effects models, with observations nested within days, nested within participants. Although individuals with and without SAD experienced the same frequency of flow in daily life, social situations led to proportionally more flow in participants with SAD than healthy controls. Both results were unexpected, and reasons for them are explored at length. Several experiential variables (positive emotions during and importance ascribed to the event) predicted the probability of flow during each situation. These results offer intervention-relevant suggestions for how individuals may benefit from seeking out challenging situations that offer maximal rewards. [ABSTRACT FROM AUTHOR]

Background Prior studies examining the effect of d -cycloserine (DCS) on homework compliance and outcome in cognitive-behavior therapy (CBT) have yielded mixed results. The aim of this study was to investigate whether DCS facilitates the effects of homework compliance on symptom reduction in a large-scale study for social anxiety disorder (SAD). Methods 169 participants with generalized SAD received DCS or pill placebo during 12-session exposure-based group CBT. Improvements in social anxiety were assessed by independent raters at each session using the Liebowitz social anxiety scale (LSAS). Results Controlling for LSAS at the previous session, and irrespective of treatment condition, greater homework compliance in the week prior related to lower LSAS at the next session. However, DCS did not moderate the effect of homework compliance and LSAS, LSAS on homework compliance, or the overall augmenting effect of DCS on homework compliance. Furthermore, LSAS levels were not predictive of homework compliance in the following week. Conclusion The findings support the general benefits of homework compliance on outcome, but not a DCS-augmenting effect. The comparably small number of DCS-enhanced sessions in this study could be one reason for the failure to find a facilitating effect of DCS. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is highly prevalent and associated with high levels of impairment and distress. Therapies for SAD leave many patients symptomatic at the end of treatment, and little is known about predictors or mechanisms of treatment outcome. Given the interpersonal dysfunction fundamental to SAD, this study investigated whether prominent interpersonal features of SAD (submissive behavior, childhood maltreatment, suppression of anger, and depression) predicted attrition and response to pharmacotherapy and whether the working alliance mediated these relationships. This is the first study to examine the role of the working alliance in pharmacotherapy for SAD. One hundred thirty-eight treatment-seeking individuals with a primary diagnosis of SAD received 12 weeks of open treatment with paroxetine. Higher levels of depression predicted greater severity of SAD at the end of treatment, and higher levels of submissive behavior and childhood emotional maltreatment predicted a greater probability of attrition from treatment. The psychiatrist-assessed working alliance mediated response to pharmacotherapy for individuals who reported a history of emotional maltreatment. These results identify variables that predict pharmacotherapy outcome and emphasize the importance of the working alliance as a mechanism of treatment response for those with a history of emotional maltreatment. Implications for person-specific treatment selection are discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The self is a multi-faceted and temporally dynamic construct reflecting representations and beliefs about identity in the past, present, and future. Clinical studies have shown that individuals with Posttraumatic Stress Disorder (PTSD) and Social Anxiety Disorder (SAD) exhibit alterations in self-related processing but these studies have focused primarily on memory. Few studies in PTSD and SAD have examined self-related processing for the present and future, and no studies have directly compared these processes across these two disorders. Individuals diagnosed with PTSD ( n = 21), SAD ( n = 21), and healthy controls ( n = 21) completed cognitive tasks related to the past, present, and future. Disorder congruent temporal alterations were found across both disorders. Further, regression analyses revealed that trauma-related memories were significantly predicted by future goals related to the trauma, whereas social anxiety-related recall was predicted by current socially anxious self-views. Thus, although self-related processing may be common in PTSD and SAD, those aspects of the self most strongly associated with disorder-congruent recall differ by disorder. Self-alterations may be modifiable and developing a better understanding of past, present, and future self-processing might aid in the development of interventions that target these process. [ABSTRACT FROM AUTHOR]

Social experiences are an integral part of normative development for youth and social functioning difficulties are related to poor outcomes. Youth with anxiety disorders, and particularly social anxiety disorder, experience difficulties across many aspects of social functioning that may place them at risk for maladjustment. The goal of this paper was to compare social experiences of youth across anxiety diagnoses and examine whether treatment is helpful in improving social functioning. Ninety-two children (age 7–12 years; 58% male; 87.0% White) with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, and/or social anxiety disorder participated in cognitive behavioral therapy. At both pre- and post-treatment, children with social anxiety disorder self-reported greater loneliness than youth without social anxiety disorder, though levels of peer victimization and receipt of prosocial behavior were similar across groups. Parents reported greater social problems for youth with social anxiety disorder compared to those without social anxiety disorder. All youth experienced improved social functioning following treatment per child- and parent-reports. The results call for an increased focus on the social experiences of youth with anxiety disorders, and particularly loneliness, for children with social anxiety disorder. The results document ways that evidenced-based practice can improve social functioning for youth with anxiety disorders. [ABSTRACT FROM AUTHOR]

Individuals with social anxiety disorder (SAD) have difficulty forming social relationships. The prevailing clinical perspective is that negative emotions such as anxiety inhibit one’s capacity to develop satisfying social connections. However, empirical findings from social psychology and affective neuroscience suggest that positive emotional experiences are fundamental to establishing new social bonds. To reconcile these perspectives, we collected repeated measurements of anxiety, positive emotions (pleasantness), and connectedness over the course of a controlled relationship formation encounter in 56 participants diagnosed with SAD (64% female; M age = 23.3, SD = 4.7). Participants experienced both increases in positive emotions and decreases in anxiety throughout the interaction. Change in positive emotions was the most robust predictor of subsequent increases in connectedness, as well as a greater desire to engage one’s partner in future social activities, above and beyond reductions in anxiety (medium to large sized effects). Those findings suggest that anxiety-based models alone may not fully explain difficulties in relationship formation in SAD, and underscore the potential value of considering positive emotional experiences in conceptual and treatment models of SAD. [ABSTRACT FROM AUTHOR]

Few empirical studies have examined subtypes of social anxiety disorder (SAD) in youth, and limited consensus resides on the nature of potential subtypes. Identifying subtypes, based on both fear and avoidance patterns, can help improve assessment and treatment of SAD. Subtypes of fear and avoidance were examined in a sample comprising 131 youth (age 8–15 years) diagnosed with SAD using the Anxiety Disorders Interview Schedule for children and parents (ADIS-C/P). Exploratory factor analysis of fear responses revealed three factors, defining fear subtypes linked to: (1) performance, (2) observation, and (3) interaction situations, respectively. Exploratory factor analysis of avoidance responses showed these were best represented by one avoidance factor. Few youth qualified exclusively for either of the fear subtypes, thus calling into question the clinical utility of these subtypes. Nevertheless, the findings indicate distinct contributions of fear and avoidance in SAD presentation. This finding might help clinicians target and improve treatment of the disorder. [ABSTRACT FROM AUTHOR]

The proposed research seeks to introduce a novel model relating Social Anxiety Disorder (SAD) and suicide outcomes (i.e., passive suicidal ideation, active suicidal ideation, and suicide attempts) in diverse adolescents. This model posits that family cohesion is one pathway by which suicide risk is increased for socially anxious youth, and predicts that the relationships between these variables may be of different strength in Latino and White subgroups and across gender. Data from a sample of Latino ( n = 1922) and non-Hispanic White (hereafter referred to as White throughout) ( n = 5648) male and female adolescents who participated in the National Comorbidity Survey-Adolescent were used for this study. Analyses were conducted using generalized structural equation modeling. Results showed that the mediation model held for White females. Further examination of direct pathways highlighted SAD as a risk factor unique to Latinos for active suicidal ideation and suicide attempt, over and above comorbid depression and other relevant contextual factors. Additionally, family cohesion showed a strong association with suicide outcomes across groups, with some inconsistent findings for White males. Overall, it appears that the mechanism by which SAD increases risk for suicidality is different across groups, indicating further need to identify relevant mediators, especially for racial/ethnic minority youth. [ABSTRACT FROM AUTHOR]

Considerable research has shown that social anxiety disorder (SAD) is accompanied by various negative cognitive biases, such as social feedback expectancy bias, memory bias, and interpretation bias. However, whether the memory bias in individuals with SAD is actually a manifestation of response bias, and whether such response bias is associated with deficits in face discrimination, remains unclear. In the present study, we investigated response bias (i.e., a tendency to recognize more negative evaluations) to faces with positive (social acceptance) or negative (social rejection) social evaluations in individuals with SAD and healthy controls (HCs) using event-related potentials (ERPs). Behavioral results revealed significant group differences in response bias in the forced-choice recall task, but no difference in overall memory accuracy. ERP results demonstrated that HCs showed a larger N170 to faces that had rejected them as compared to those that had accepted them, but this effect was not evident in the SAD group. Further analysis showed that response bias was correlated with the ΔN170 (rejected – accepted) amplitude. We concluded that the response bias in individuals with SAD is resulted from impairments in early discrimination of social faces, as reflected by the absent early N170 differentiation effect, which was associated with their combined negative biases. [ABSTRACT FROM AUTHOR]

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups. [ABSTRACT FROM AUTHOR]

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed. • We reviewed the literature on emotions in social anxiety disorder (SAD). • We included studies on emotional intelligence/knowledge/clarity/differentiation. • We also focused on discrete emotions (e.g., anger, loneliness, pride, and envy). • We discuss areas for future research and potential contributions to extant models. [ABSTRACT FROM AUTHOR]

Trials of cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) have struggled to identify replicable moderators of treatment outcome. This could be due to a genuine lack of effects, or a spurious finding caused by methodological factors such as inadequate testing of theory-driven moderators, use of small homogenous samples, failure to model non-linear relationships, and over-reliance on significance testing. We probed explanations for the field's failure to detect moderators by testing whether 15 theory-driven and atheoretical variables moderated treatment outcome in a large heterogeneous sample treated with group CBT for SAD. Moderation was not assessed by only using p -values for linear models, but also by considering effect sizes, plots, and non-linear relationships. Despite using a comprehensive approach to assess moderation, only two variables – the baseline severity of SAD symptoms and fear of negative evaluation (FNE) – were found to moderate social anxiety symptom trajectories. FNE had a non-linear relationship with symptom change that would have been missed using common research methods. Our findings suggest both a genuine lack of effects and limitations of research methods have contributed to the field's inability to identify moderators. We provide suggestions that may increase the likelihood of future researchers detecting genuine effects. • Replicable moderators of change in social anxiety treatment have been hard to find. • Explanations include methodological limitations or a genuine lack of effects. • We evaluated 15 potential moderators of change in group CBT for social anxiety. • We addressed numerous methodological limitations of prior studies. • Both weak effects and poor methods may have hampered efforts to detect moderators. [ABSTRACT FROM AUTHOR]

Although overgeneralization seems to be a hallmark of several anxiety disorders, this until now has not been investigated in social anxiety disorder (SAD). Therefore, we examined fear generalization in 26 SAD patients and 29 healthy controls (HC) using two faces as conditioned stimuli (CS+, CS−), and a loud scream and a fearful face as unconditioned stimulus (US). Generalization was tested by presenting both CS and four morphs of the two faces (generalization stimuli [GSs]), while ratings, heart rate (HR) and skin conductance responses (SCR) were recorded. Results revealed that SAD patients rated all stimuli as less pleasant and more arousing compared to HC. Moreover, ratings and SCR indicated that both groups generalized their acquired fear from the CS+ to GSs. Remarkably, only SAD patients showed generalization in HR responses (fear bradycardia). Overall, SAD seems not to be characterized by strong overgeneralization but discrepancies in fear responses to both conditioned and generalized threat stimuli. [ABSTRACT FROM AUTHOR]

The contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD). In a large college sample (N = 1409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD. Participants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen's d = 1.32, 1.62 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD. A measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these disorders. • Tested theories on the transdiagnostic nature of contrast avoidance across three disorders • We tested those with and without probable generalized anxiety disorder (GAD, social anxiety disorder (SAD) and major depressive disorder (MDD) • Probable GAD, SAD, and MDD vs. controls scored significantly higher on the Contrast Avoidance Questionnaire-General Emotion scale (CAQ-GE) • Area under the curve, a test of predictive accuracy for the CAQ-GE, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. • A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD and 50.5 opimized predictive accuracy for probable MDD • Sensitivity to and avoidance of a negative emotional contrast appears to be a transdiagnostic feature of GAD, MDD, and SAD. [ABSTRACT FROM AUTHOR]

Cognitive Behavioural Therapy (CBT) is effective in treating Social Anxiety Disorder (SAD). However, less is known about whether gains achieved in disorder-specific and secondary outcomes (e.g., depression, general anxiety, quality of life, and self-esteem) are maintained 12 months or longer. A systematic literature search yielded 25 relevant studies that administered CBT to participants with SAD. Multivariate meta-analyses of post-treatment assessments, found that CBT was superior to control conditions in reducing social anxiety (g =.74), depression (g =.52), general anxiety (g =.69) and improving quality of life (g =.39). The within-groups effect sizes revealed that 12 months or more after CBT treatment, symptoms continued to improve for social anxiety (g av =.23) and quality of life (g av =.17), and gains were maintained for depressive (g av =.06) and general anxiety symptoms (g av =.03). However, meta-analyses of long-term outcomes lack comparison groups. Moderation was non-significant for the treatment model, format, number of sessions, treatment duration, or inclusion of booster sessions. Future research may investigate what drives improvement after treatment cessation and how CBT affects other co-occurring symptomatology. Taken together, CBT produces many benefits for SAD and individuals with co-occurring symptoms can benefit from extant SAD-focused treatments. • Social anxiety outcomes continue to improve 12 months or longer after CBT treatment. • Moderate gains in general anxiety and depressive symptoms after CBT treatment are maintained long term. • Gains in symptoms of social anxiety are evident regardless of the treatment model, format, and duration of CBT. [ABSTRACT FROM AUTHOR]

Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome. In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT ( n = 20) or a waitlist period ( n = 20) and were compared to healthy controls ( n = 21). Self-reported depersonalization was measured immediately after each stress test. Depersonalization significantly decreased following CT, especially in treatment responders (η p 2 = 0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety. Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy. [ABSTRACT FROM AUTHOR]

Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58–16.07) were significantly (p = 0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96–8.16) and SAD (5.92 points; 95% CI: 4.64–7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies. [ABSTRACT FROM AUTHOR]

This meta-analysis investigated the efficacy of technology-assisted interventions for individuals with social anxiety disorder (SAD). A systematic literature search in the databases Medline, PsychInfo, and Web of Science revealed 37 randomized controlled trials (2991 participants) that were grouped into internet delivered cognitive behavior therapy (ICBT; 21 trials), virtual reality exposure therapy (VRET; 3 trials), and cognitive bias modification (CBM; 13 trials). Patients undergoing ICBT and VRET showed significantly less SAD symptoms at postassessment than passive control conditions ( g = 0.84 and 0.82, respectively). Compared to active control conditions, ICBT had a small advantage ( g = 0.38) and VRET showed comparable effects (p > 0.05). CBM was not more effective than passive control conditions, except when delivered in the laboratory ( g = 0.35). While the efficacy of CBM was limited, substantial evidence for ICBT and preliminary evidence for VRET suggests that both can effectively reduce SAD symptoms indicating the potential of technology-assisted interventions for SAD. [ABSTRACT FROM AUTHOR]

Cognitive models posit that social anxiety disorder (SAD) is associated with and maintained by biased attention allocation vis-à-vis social threat. However, over the last decade, there has been intense debate regarding whether AB in SAD results from preferential engagement with or difficulty in disengaging from social threat. Further, recent evidence suggests that AB may merely result from top-down attentional impairments vis-à-vis non-emotional material. Consequently, uncertainty still abounds regarding both the relative importance and the mutual interactions of these different processes and SAD symptoms. Inspired by novel network approaches to psychopathology that conceptualize symptoms as complex dynamic systems of mutually interacting variables, we computed weighted directed networks to investigate potential causal relations among laboratory measures of attentional components and symptoms of social anxiety disorder. Global and local connectivity of network structures revealed that the three most central variables were the orienting component of attention as well as both avoidance and fear of social situations. Neither preferential attention engagement with threat nor difficulty disengaging from threat exhibited high relative importance as predictors of symptoms in the network. Together, these findings suggest the value of extending the network approach beyond self-reported clinical symptoms to incorporate process-level measures from laboratory tasks to gain new insight into the mechanisms of SAD. [ABSTRACT FROM AUTHOR]

Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n = 233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen’s d ≥ 1.01; avg. reduction ≥ 30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen’s d ≥ 1.25; avg. reduction ≥ 39%), generalised anxiety disorder (Cohen’s d ≥ 0.86; avg. reduction ≥ 36%) and panic disorder (Cohen’s d ≥ 0.53; avg. reduction ≥ 25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders. [ABSTRACT FROM AUTHOR]

The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n = 106), social anxiety disorder (n = 88), or generalized anxiety disorder (n = 62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and 'trans-therapy' process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders. [ABSTRACT FROM AUTHOR]

Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g = 0.84, 95% CI [0.72; 0.97] and general psychopathology: g = 0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats. [ABSTRACT FROM AUTHOR]

Meta-analyses indicate that cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) leads to substantial symptom alleviation. Although there is an emphasis on engaging in exposure and cognitive restructuring during treatment, the longitudinal relationship between skill use and symptom alleviation is not well understood. Furthermore, treatment response may be attenuated by pre-existing patient vulnerabilities. This study examined the longitudinal association of skill use (i.e. exposure (EX), thought record use (TR)), symptom reduction and the potential moderating influence of perfectionism during a 12-session, manual-based CBT for SAD intervention for 100 patients (51% female) meeting DSM-IV criteria for SAD. Results obtained from Latent Difference Score (LDS) models indicated that the frequency of both EX and TR skill use led to subsequent symptom alleviation; however, this varied based on the type of skill used. Further, although both EX and TR interventions were associated with subsequent symptom reduction, the association of EX and subsequent symptom alleviation was greater than the association of TR and subsequent symptom alleviation. Finally, higher pre-treatment perfectionism was associated with greater initial skill use, followed by significantly reduced skill use in later sessions. These preliminary results suggest that perfectionistic individuals demonstrate differential engagement in EX and TR interventions during treatment. [ABSTRACT FROM AUTHOR]

The subjective experience of anxiety plays a central role in cognitive behavioral models of social anxiety disorder (SAD). However, much remains to be learned about the temporal dynamics of anxiety elicited by feared social situations. The aims of the current study were: (1) to compare anxiety trajectories during a speech task in individuals with SAD ( n = 135) versus healthy controls (HCs; n = 47), and (2) to compare the effects of CBT on anxiety trajectories with a waitlist control condition. SAD was associated with higher levels of anxiety and greater increases in anticipatory anxiety compared to HCs, but not differential change in anxiety from pre- to post-speech. CBT was associated with decreases in anxiety from pre- to post-speech but not with changes in absolute levels of anticipatory anxiety or rates of change in anxiety during anticipation. The findings suggest that anticipatory experiences should be further incorporated into exposures. [ABSTRACT FROM AUTHOR]

Individuals with social anxiety disorder (SAD) experience functional impairment in social, educational, and occupational arenas, contributing to poor quality of life. Previous research using the Quality of Life Inventory (QOLI) has identified four distinct domains of quality of life among individuals with SAD: Achievement, Personal Growth, Social Functioning, and Surroundings. The present study was designed to investigate how fear of negative evaluation (FNE) and fear of positive evaluation (FPE) relate to the four QOLI domains among individuals with SAD. We also examined the relationships of FNE and FPE to Satisfaction and Importance ratings on the QOLI. Individuals with SAD ( N = 129) completed a battery of questionnaires prior to initiating treatment. FNE and FPE showed distinct relationships with the four QOLI domains, even after controlling for demographic characteristics and comorbid depression. Both FNE and FPE were associated with ratings of Satisfaction with the QOLI domains, but neither was associated with ratings of Importance. Our findings highlight the differential impacts of FNE and FPE on SAD. Treatment implications are discussed. [ABSTRACT FROM AUTHOR]

Social anxiety disorder is associated with interpersonal dysfunction, but it is not clear why people with the disorder feel unsatisfied with their relationships. One possibility is that higher social anxiety could lead to changes in sensitivity to interpersonal traits. We examined whether social anxiety moderates the types of interpersonal evaluations people make regarding warmth and dominance. We developed vignettes in which central characters systematically varied in dominance and warmth and asked two samples of participants (undergraduate students, n = 176, and online workers, n = 403) to rate their willingness to interact with, and the social desirability of, these characters. Participants in general reported stronger desire to interact with warmer and less dominant characters, and rated warmer and more dominant characters as being more socially desirable. People with higher social anxiety exhibited greater tolerance for colder and more submissive characters on both rated dimensions. The perceived similarity of the characters accounted for the bulk of these effects. Participants indicated a higher desire to interact with characters more similar to themselves, and people with higher social anxiety were more likely to rate submissive and cold characters as being like themselves. The results have implications for clinical interventions for social anxiety disorder. [ABSTRACT FROM AUTHOR]