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Background: Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised., Methods: The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA., Results: The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores., Conclusions: This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Social anxiety disorder is maintained in part by rumination about past social experiences, known as post-event processing. The Extended Post-Event Processing Questionnaire (EPEPQ-15) assesses post-event processing as three correlated factors. Competing against this structure is a bifactor model that has not yet been evaluated for the EPEPQ-15. These models were tested for the conventional state version of the EPEPQ-15 and a new trait version in two separate samples ( N s = 327 and 351). In both samples, the fit of the bifactor model was better than that of correlated factor models. Moreover, the results did not support the group factors, indicating that a unidimensional interpretation of the EPEPQ-15 is most appropriate. The general dimension of the EPEPQ-15 was highly correlated with social interaction anxiety, beliefs related to social anxiety, anticipatory processing, and safety behaviors. These results overall suggest post-event processing is best conceptualized as a unitary construct.

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., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Social anxiety disorder (SAD) is a serious psychiatric condition with a high prevalence, and a typical onset during childhood/adolescence. The condition runs in families, but it is largely unknown which neurobiological characteristics transfer this genetic vulnerability ('endophenotypes'). Using data from the Leiden Family Lab study on SAD, including two generations of families genetically enriched for SAD, we investigated whether social anxiety (SA) co-segregated with changes in intrinsic functional connectivity (iFC), and examined heritability., Methods: Functional MRI data were acquired during resting-state in 109 individuals (56 males; mean age: 31·5, range 9·2-61·5 years). FSL's tool MELODIC was used to perform independent component analysis. Six networks of interest (default mode, dorsal attention, executive control, frontoparietal, limbic and salience) were identified at the group-level and used to generate subject-specific spatial maps. Voxel-wise regression models, with SA-level as predictor and voxel-wise iFC as candidate endophenotypes, were performed to investigate the association with SA, within masks of the networks of interest. Subsequently, heritability was estimated., Findings: SA co-segregated with iFC within the dorsal attention network (positive association in left middle frontal gyrus and right postcentral gyrus) and frontoparietal network (positive association within left middle temporal gyrus) (cluster-forming-threshold z>2·3, cluster-corrected extent-threshold p<0·05). Furthermore, iFC of multiple voxels within these clusters was at least moderately heritable., Interpretation: These findings provide initial evidence for increased iFC as candidate endophenotype of SAD, particularly within networks involved in attention. These changes might underlie attentional biases commonly present in SAD., Funding: Leiden University Research Profile 'Health, Prevention and the Human Lifecycle'., Competing Interests: Declaration of Competing Interest Dr. Bas-Hoogendam has nothing to disclose. Dr. van Steenbergen has nothing to disclose. Dr. Cohen Kadosh has nothing to disclose. Dr. Westenberg has nothing to disclose. Dr. van der Wee has nothing to disclose., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Negative beliefs about other's judgments play an important role in the development and maintenance of social anxiety disorder. The present experiment examined the effects of role-playing followed by role reversal compared to role-playing twice on altering these negative cognitions., Methods: Thirty-six adult social anxiety patients were randomized into two conditions: a role-playing condition in which 18 participants role-played an anxiety-provoking social situation twice, or a role reversal condition in which 18 participants role-played an anxiety-provoking social situation followed by enacting the same situation using role reversal. Before the start of the experiment, patients were asked to report their negative cognitions about the other's judgments. Next, they were asked to rate the believability of these negative cognitions, as well as the probability and cost estimates of negative judgments by the other person, at three time-points: before the first block of role-playing, after the first block of role-playing, and after the second block of the experiment., Results: Results demonstrated that role-playing followed by role reversal had a stronger effect on the most negative cognitions than role-playing twice., Limitations: The most important limitation of the present study is that there was no control group to assess the effects of role-playing alone. Moreover, the second block of the experiment was repetitive in role-playing, however, it was a new task in role reversal., Conclusions: The results support the hypothesis that role reversal is an effective technique that can be used to correct negative cognitions about other's judgments in SAD., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Interest in social anxiety disorder has grown substantially over the past few decades. Most of the available data from United States and European countries emphasized its high prevalence, comorbidity and morbidity and its association with occupational, educational, social affairs, stress, depression and substance use disorder contributing to poor quality of life. Present study was aimed to assess the social anxiety symptoms and to explore its impact on quality of life of secondary school students. Present study included male (n = 200) and female (n = 200) students enrolled at government secondary schools, Abha, Saudi Arabia. Arabic version of Social Phobia Inventory (SPIN) and World Health Organization Quality of Life Questionnaire (WHOQOL) were implemented to assess the social anxiety symptoms and quality of life of the students. Results revealed that 45% of the students showed social anxiety symptoms. Associated factors were younger age, chronic diseases, parent's status, parent's occupation and income. Quality of life was found significantly lower in students with social anxiety symptoms as compared to the students without symptoms. We suggest that the school health program should include routine screening of students for social anxiety disorder. Students diagnosed with social anxiety symptoms should be promptly managed and their quality of life should be improved.

One of the hallmarks of anxiety disorders is impaired cognitive control, affecting working memory (WM). The dorsolateral prefrontal cortex (dlPFC) is critical for WM; however, it is still unclear how dlPFC activity relates to WM impairments in patients. Forty-one healthy volunteers and 32 anxiety (general and/or social anxiety disorder) patients completed the Sternberg WM paradigm during safety and unpredictable shock threat. On each trial, a series of letters was presented, followed by brief retention and response intervals. On low- and high-load trials, subjects retained the series (five and eight letters, respectively) in the original order, while on sort trials, subjects rearranged the series (five letters) in alphabetical order. We sampled the blood oxygenation level-dependent activity during retention using a bilateral anatomical dlPFC mask. Compared to controls, patients showed increased reaction time during high-load trials, greater right dlPFC activity and reduced dlPFC activity during threat. These results suggest that WM performance for patients and controls may rely on distinct patterns of dlPFC activity with patients requiring bilateral dlPFC activity. These results are consistent with reduced efficiency of WM in anxiety patients. This reduced efficiency may be due to an inefficient allocation of dlPFC resources across hemispheres or a decreased overall dlPFC capacity., (Published by Oxford University Press 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Interpretation bias, which involves interpreting ambiguous social events negatively and catastrophising even mildly negative social events, has been suggested as a key maintenance factor of Social Anxiety Disorder. Although some individual studies and narrative reviews have demonstrated a role for negative interpretation bias in social anxiety (disorder), findings have been mixed. Given the lack of a quantitative synthesis of the evidence, the current systematic review and meta-analysis examined the strength of the relationship between interpretation bias and social anxiety. It also investigated potential moderators of this relationship (i.e., types of measures and stimuli, samples, and study designs)., Methods: Five databases (PsycINFO, PubMed, Medline, Scopus, and CINAHL) were searched. Of 46 studies identified, 44 were suitable for meta-analysis (N = 3859)., Results: There was a large effect for the relationship between social anxiety and interpretation bias (g = 0.83). Types of measures (subjective versus objective) and stimuli (verbal versus visual) were identified as significant moderators, with subjective measures and verbal stimuli particularly adept at capturing interpretation bias in socially anxious individuals., Limitations: The effect sizes displayed significant heterogeneity between studies, which likely reflects some publication bias, and thus, the overall effect size may be inflated., Conclusion: Findings may help to refine clinical models and interventions for Social Anxiety Disorder, which in turn may maximise evidence-based interventions that target negative interpretation bias in this disorder., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation and humiliation in social interactions and situations. Virtual reality (VR) treatment is a promising intervention option for SAD., Objective: The purpose of this study was to create a participatory and interactive VR intervention for SAD. Treatment progress, including the severity of symptoms and the cognitive and emotional aspects of SAD, was analyzed to evaluate the effectiveness of the intervention., Methods: In total, 32 individuals with SAD and 34 healthy control participants were enrolled in the study through advertisements for online bulletin boards at universities. A VR intervention was designed consisting of three stages (introduction, core, and finishing) and three difficulty levels (easy, medium, and hard) that could be selected by the participants. The core stage was the exposure intervention in which participants engaged in social situations. The effectiveness of treatment was assessed through Beck Anxiety inventory (BAI), State-Trait Anxiety Inventory (STAI), Internalized Shame Scale (ISS), Post-Event Rumination Scale (PERS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), Brief-Fear of Negative Evaluation Scale (BFNE), and Liebowitz Social Anxiety Scale (LSAS)., Results: In the SAD group, scores on the BAI (F=4.616, P=.009), STAI-Trait (F=4.670, P=.004), ISS (F=6.924, P=.001), PERS-negative (F=1.008, P<.001), SPS (F=8.456, P<.001), BFNE (F=6.117, P=.004), KSAD (F=13.259, P<.001), and LSAS (F=4.103, P=.009) significantly improved over the treatment process. Compared with the healthy control group before treatment, the SAD group showed significantly higher scores on all scales (P<.001), and these significant differences persisted even after treatment (P<.001). In the comparison between the VR treatment responder and nonresponder subgroups, there was no significant difference across the course of the VR session., Conclusions: These findings indicated that a participatory and interactive VR intervention had a significant effect on alleviation of the clinical symptoms of SAD, confirming the usefulness of VR for the treatment of SAD. VR treatment is expected to be one of various beneficial therapeutic approaches in the future., Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://cris.nih.go.kr/cris/search/search&#95;result&#95;st01.jsp?seq=13508., (©Hyun-Jin Kim, Seulki Lee, Dooyoung Jung, Ji-Won Hur, Heon-Jeong Lee, Sungkil Lee, Gerard J Kim, Chung-Yean Cho, Seungmoon Choi, Seung-Moo Lee, Chul-Hyun Cho. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.10.2020.)

The current study developed and examined the performance of a computerized adaptive version of the Social Interaction Anxiety and Social Phobia Scales (SIAS/SPS) and compared results with a previously developed static short form (SIAS-6/SPS-6) in terms of measurement precision, concordance with the full forms, and sensitivity to treatment. Among an online sample of Australian adults, there were relatively minor differences in the performance of the adaptive tests and static short forms when compared with the full scales. Moreover, both adaptive and static short forms generated similar effect sizes across treatment in a clinical sample. This provides further evidence for the use of static or adaptive short forms of the SIAS/SPS rather than the lengthier 20-item versions. However, at the individual level, the adaptive tests were able to maintain an acceptable level of precision, using few items as possible, across the severity continua in contrast to the static short forms.

Objectives: The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD) from an interpersonal perspective. The first specific objective is to compare the disorders with regard to interpersonal problems and general symptom distress. The second specific objective is to examine interpersonal subgroups and pathoplasticity., Design: In a cross-sectional design, patients from an outpatient psychotherapy clinic diagnosed with social anxiety disorder (SAD, n = 299), avoidant personality disorder (AvPD, n = 180), or the comorbid condition of both disorders (AvPD + SAD, n = 29) were assessed before treatment., Methods: Patients filled out the Inventory of Interpersonal Problems (IIP-64) and the Symptom Checklist-Revised (SCL-R-90) before treatment., Results and Conclusions: From an interpersonal perspective, the relationship between the diagnostic groups is well described by the severity continuum hypothesis, with similar interpersonal problems related to Nonassertiveness and lower levels of general interpersonal stress in the SAD group compared to the two AvPD groups. However, other differences in severity do not fit the severity continuum hypothesis, as there are no differences in severity on the global severity index, and, moreover, the SAD group has the most severe problems on the SCL-90 phobic anxiety scale. Interpersonal pathoplasticity is not found in the diagnostic groups or in the full sample. However, three interpersonal subgroups are identified in the full sample, designated as Nonassertive, Friendly-submissive, and Cold-submissive. Implications for treatment are discussed., Practitioner Points: SAD is characterized by a lower level of interpersonal distress compared to AvPD, but the two disorders are similar in having Nonassertiveness as their general interpersonal problem. Contrary to expectation, SAD and AvPD did not differ in general level of symptom severity, and patients with SAD reported more problems with phobic anxiety than AvPD patients did. When understanding SAD and AvPD as different conceptualizations of the same disorder and analysing all patients together, three distinct interpersonal subgroups emerge, which can be identified as Nonassertive, Friendly-submissive, and Cold-submissive., (© 2019 The British Psychological Society.)

Cognitive theories of anxiety suggest that anxious children interpret negatively only those materials specifically related to the content of their anxiety. So far, there are only a few studies available that report on this postulated content-specificity of interpretation processes across different anxiety disorders in children, and most of them focused on social anxiety. Therefore, we examined interpretation bias and its content-specificity in a group of clinically anxious children between the ages of 6-12 years with various anxiety disorders, using an "ambiguous scenarios" task. Children were asked to finish scenarios that were related to either social threat, general threat, or separation threat. In total, 105 clinically anxious children, 21 control children and their mothers were assessed with the ADIS-C/P and the Spence Children's Anxiety Scale. As expected, clinically anxious children provided significantly more negative endings to the scenarios than control children. Within the clinically anxious group, specific interpretation biases were found: Interpretation of scenarios related to social threat, general threat, and separation threat were only predicted by the children's self-reported levels of social anxiety, generalized anxiety, and separation anxiety, respectively. These findings support the content-specificity hypothesis that clinically anxious children display interpretation biases that are specific to fear-relevant stimuli., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

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., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Prior research on attention bias in anxious youth, often utilising a visual dot probe task, has yielded inconsistent findings, which may be due to how bias is assessed and/or variability in the phenomenon. The present study utilises eye gaze tracking to assess attention bias in socially anxious adolescents, and explores several methodological and within-subject factors that may contribute to variability in attention bias. Attention bias to threat was measured in forty-two treatment-seeking adolescents (age 12-16 years) diagnosed with Social Anxiety Disorder. Bias scores toward emotional stimuli (vigilant attention) and bias scores away from emotional stimuli (avoidant attention) were explored. Bias scores changed between vigilance and avoidance within individuals and over the course of stimulus presentation. These differences were not associated with participant characteristics nor with self-reported social anxiety symptoms. However, clinician rated severity of social anxiety, explained a significant proportion of variance in the bias scores for adult, but not the adolescent, stimuli. Variability in attention bias among socially anxious adolescents is common and varies as a function of stimulus duration and type. Results may inform stimulus selection for future research.

Background: Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan., Methods: Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework., Results: The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants., Limitations: We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture., Conclusions: When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD., (Copyright © 2018. Published by Elsevier B.V.)

Background: Research to date has focused on the detrimental effects of negative self-images for individuals with social anxiety disorder (SAD), but the benefits of positive self-images have been neglected., Aims: The present study examined the effect of holding a positive versus negative self-image in mind on anxiety, judgement bias and emotion regulation (ER) in individuals with SAD., Method: Forty-two individuals who met the diagnostic criteria for SAD were randomly assigned to either a positive or a negative self-image group. Participants were assessed twice with a week's interval in between using the Reactivity and Regulation Situation Task, which measures social anxiety, discomfort, judgement bias and ER, prior to and after the inducement of a positive or negative self-image., Results: Individuals in the positive self-image group reported less social anxiety, discomfort and distress from social cost when compared with their pre-induction state. They also used more adaptive ER strategies and experienced less anxiety and discomfort after using ER. In contrast, individuals in the negative self-image group showed no significant differences in anxiety, judgement bias or ER strategies before and after the induction., Conclusions: This study highlights the beneficial effects of positive self-images on social anxiety and ER.

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., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18-50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

The vast majority of research on attentional biases to threat focusses on selective attention, even though several cognitive-behavioral models furthermore assume hypervigilance to be important in this regard. Thus, the current study examined hypervigilance in trait and state social anxiety. We analyzed visual scanpath lengths and fixation counts of participants with Social Anxiety Disorder (SAD) (n = 61) and healthy controls (n = 60) in a combined visual search and eye tracking paradigm, including photographs of facial expressions. Half of all participants were randomly assigned to a state anxiety induction. Interaction effects revealed opposed attentional patterns of participants with SAD as compared to healthy controls considering overall visual scanpath lengths (F(1,117) = 5.32, p = 0.023, η 2 partial  = 0.042). Accordingly, participants with SAD showed signs of hypervigilance in the anxiety induction condition. In contrast, there was no main effect of diagnostic group, indicating that individuals with SAD shift their attentional focus to broad scanning behavior only under conditions of threat. Our results add to the small number of existing studies on hypervigilance in SAD and suggest the topic to be promising for future research.2 partial  = 0.042). Accordingly, participants with SAD showed signs of hypervigilance in the anxiety induction condition. In contrast, there was no main effect of diagnostic group, indicating that individuals with SAD shift their attentional focus to broad scanning behavior only under conditions of threat. Our results add to the small number of existing studies on hypervigilance in SAD and suggest the topic to be promising for future research., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Internet addiction (IA) is currently becoming a serious mental health problem. The aim of this study was to estimate the prevalence of IA among undergraduate medical students and evaluate the relationship of IA with social anxiety, impulsivity, self-esteem, and depression. The study included 392 undergraduate medical students. Evaluations were made with the sociodemographic data form, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Barratt Impulsivity Scale-11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The IA group had significantly higher scores on LSAS, BDI, BAI and lower scores on RSES than the control group but the BIS-11 scores were similar among groups. IAT severity was positively correlated with LSAS, BDI, and BAI and negatively with RSES. No correlation was observed between IAT severity and BIS-11. In the hierarchical linear regression analysis, the avoidance domain of social anxiety was the strongest predictor of the severity of IA. The present study suggests that undergraduate medical students with IA exhibit higher social anxiety, lower self-esteem and are more depressed than those without IA, thus, indicating that social anxiety, rather than impulsivity, seemed to play a prominent role in IA psychopathology., (Copyright © 2018. Published by Elsevier B.V.)

Objective: Eating disorders (EDs) and social anxiety disorder (SAD) are highly co-occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED-SAD are less likely to seek and/or benefit from ED treatment., Method: We used network analysis to conceptualize ED-SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean., Results: We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom., Conclusions: We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples., (© 2018 Wiley Periodicals, Inc.)

People tend to overestimate the intensity and duration of affect (i.e., impact bias) when making predictions about their own and others' responding, termed affective and empathic forecasting, respectively. Research links impact biases to clinical symptoms of affective disorders, but little work has been done to examine how social anxiety is related to affective and empathic forecasting biases. The current investigation included two studies examining these associations in independent samples of young adults with dimensionally distributed social anxiety symptoms. Study 1 (N = 100) examined the associations between social anxiety and affective and empathic forecasts in response to a series of novel hypothetical vignettes in which a second-person narrator (i.e., the self) elicited anger, disgust, or happiness from another person (i.e., the other). Study 2 utilized an innovative experimental paradigm involving N = 68 participant dyads. Overall, results supported the existence of affective and empathic forecasting biases. Further, symptoms of social anxiety were associated with the tendency to overestimate one's own and others' negative affect and underestimate others' positive affect. Such forecasting biases may help to explain the avoidance that is characteristic of individuals with social anxiety and could represent a fruitful target of cognitive behavioral intervention., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Patients with Borderline Personality Disorder (BPD) feel ostracized even when they are included. This might be due to a biased processing of social participation in BPD. We examined whether patients with BPD also process social overinclusion in a biased manner, i.e., whether they feel ostracized even when the degree of social participation is increased., Methods: An EEG-compatible version of Cyberball was used to investigate the effects of inclusion and overinclusion (33% vs. 45% ball receipt) on perceived ostracism, need threat and P3 amplitude, an EEG indicator for expectancy violation. Twenty-nine patients with BPD, 28 patients with Social Anxiety Disorder (SAD) and 28 healthy controls (HC) participated., Results: The P3 amplitude was enhanced for patients with BPD and SAD compared to HCs independent of condition. Both patient groups reported more perceived ostracism relative to HCs in the inclusion but not in the overinclusion condition. Only patients with BPD reported stronger need threat in both conditions., Conclusions: The EEG results imply that being socially included violates the expectations of patients with BPD, irrespective of the actual degree of social participation. However, when overincluded, patients with BPD no longer feel ostracized. Except for need threat, patients with SAD might show a comparable bias in the processing of social participation as patients with BPD.

College students with social anxiety disorder experience more alcohol-related negative consequences, regardless of the amount of alcohol they consume. Social anxiety refers to psychological distress and physiological arousal in social situations due to an excessive fear of negative evaluation by others. The current study examined within-group differences in alcohol-related negative consequences of students who met or exceeded clinically-indicated social anxiety symptoms. In particular, we tested a sequential mediation model of the cognitive (i.e., fear of negative evaluation) and behavioral (protective behavioral strategies) mechanisms for the link between social anxiety disorder subtypes (i.e., interaction and performance-type) and alcohol-related negative consequences. Participants were 412 traditional-age college student drinkers who met or exceeded the clinically-indicated threshold for social anxiety disorder and completed measures of fear of negative evaluation, protective behavioral strategies (controlled consumption and serious harm reduction), and alcohol-related negative consequences. Fear of negative evaluation and serious harm reduction strategies sequentially accounted for the relationship between interaction social anxiety disorder and alcohol-related negative consequences, such that students with more severe interaction social anxiety symptoms reported more fear of negative evaluation, which was related to more serious harm reduction strategies, which predicted fewer alcohol-related negative consequences. Future directions and implications are discussed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

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., (Published by Elsevier Ltd.)

Background: Physiological hyperarousal in social situations is a characteristic of individuals with social anxiety disorder (SAD), but so far it has been rarely studied as a biological risk for SAD. Here, we investigate whether children at high risk for SAD (because of their parents' SAD) display physiological hyperarousal while interacting with a stranger. Also, we examine whether early physiological hyperarousal is related to later child social anxiety., Method: One hundred and seventeen children took part in the stranger-approach task when they were 2.5 and 4.5 years old. Heart rate (HR), heart rate variability (HRV), and electrodermal activity (EDA) were measured before, during, and after the conversation with a stranger. Both parents' lifetime SAD status and SAD severity were assessed before the birth of the child. Both parents and children reported on children's social anxiety symptoms when children were 7.5., Results: Children of parents with the lifetime SAD diagnosis did not differ in their physiological activity from children of parents without lifetime SAD. However, children of parents with more severe SAD displayed heightened EDA throughout the task procedure. Increased HR and reduced HRV during the stranger-approach and elevated EDA throughout the task phases were linked to later child social anxiety., Conclusions: Parents' severity of SAD is related to child physiological hyperarousal early in their childhood. In addition, physiological hyperarousal in early childhood predicts later child social anxiety. Together, these findings suggest that early physiological hyperarousal in social situations may pose a risk for later child social anxiety and that physiological hyperarousal, and EDA in particular, may be a biological mechanism in the intergenerational transmission of SAD., (© 2017 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

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., (Copyright © 2017. Published by Elsevier Ltd.)

Background and Objectives: Cognitive models of social anxiety disorder (SAD) emphasize anticipatory processing as a prominent maintaining factor occurring before social-evaluative events. While anticipatory processing is a maladaptive process, the cognitive mechanisms that underlie ineffective control of attention are still unclear. The present study tested predictions derived from attentional control theory in a sample of undergraduate students high and low on social anxiety symptoms., Methods: Participants were randomly assigned to either engage in anticipatory processing prior to a threat of a speech task or a control condition with no social evaluative threat. After completing a series of questionnaires, participants performed pro-saccades and antisaccades in response to peripherally presented facial expressions presented in either single-task or mixed-task blocks., Results: Correct antisaccade latencies were longer than correct pro-saccade latencies in-line with attentional control theory. High socially anxious individuals who anticipated did not exhibit impairment on the inhibition and shifting functions compared to high socially anxious individuals who did not anticipate or low socially anxious individuals in either the anticipatory or control condition. Low socially anxious individuals who anticipated exhibited shorter antisaccade latencies and a switch benefit compared to low socially anxious individuals in the control condition., Limitations: The study used an analogue sample; however findings from analogue samples are generally consistent with clinical samples., Conclusions: The findings suggest that social threat induced anticipatory processing facilitates executive functioning for low socially anxious individuals when anticipating a social-evaluative situation., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

The gaze of others is known to be a particularly common cause of social anxiety. In the current study, we measured event-related potentials (ERPs) during gaze perception among people with or without high socially anxious tendencies (HSA). The experimental stimuli were grayscale images of the eye region of a face, showing direct or averted eye gaze (leftward gaze or rightward gaze) or closed eyes. We found that negative ERPs at a right occipito-temporal site (N170) and positive ERPs at the fronto-central region (P2) were evoked by eye gaze stimuli. While the N170 was not affected by socially anxious tendencies, the amplitude of the P2 was significantly greater in the HSA group than in the low socially anxious tendencies (LSA) group. Furthermore, P2 latency showed a significant interaction between groups and conditions: the HSA group exhibited shorter P2 latencies in response to direct gaze than averted gaze, while the LSA group did not. These results indicate that the neural processing of eye gaze is strongly influenced by socially anxious tendencies. In particular, the attentional processing of direct gaze is more prominent in individuals with HSA tendencies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.

Social anxiety disorder (SAD) is characterized by information processing biases, however, their underlying neural mechanisms remain poorly understood. The goal of this review was to give a comprehensive overview of the most frequently studied EEG spectral and event-related potential (ERP) measures in social anxiety during rest, anticipation, stimulus processing, and recovery. A Web of Science search yielded 35 studies reporting on electrocortical measures in individuals with social anxiety or related constructs. Social anxiety was related to increased delta-beta cross-frequency correlation during anticipation and recovery, and information processing biases during early processing of faces (P1) and errors (error-related negativity). These electrocortical measures are discussed in relation to the persistent cycle of information processing biases maintaining SAD. Future research should further investigate the mechanisms of this persistent cycle and study the utility of electrocortical measures in early detection, prevention, treatment and endophenotype research., (Copyright © 2017 Elsevier B.V. All rights reserved.)

There is a need for brief, accurate screening scales for social anxiety disorder to enable better identification of the disorder in research and clinical settings. A five-item social anxiety screener, the Social Phobia Screener (SOPHS), was developed to address this need. The screener was validated in two samples: (a) 12,292 Australian young adults screened for a clinical trial, including 1,687 participants who completed a phone-based clinical interview and (b) 4,214 population-based Australian adults recruited online. The SOPHS (78% sensitivity, 72% specificity) was found to have comparable screening performance to the Social Phobia Inventory (77% sensitivity, 71% specificity) and Mini-Social Phobia Inventory (74% sensitivity, 73% specificity) relative to clinical criteria in the trial sample. In the population-based sample, the SOPHS was also accurate (95% sensitivity, 73% specificity) in identifying Diagnostic and Statistical Manual of Mental Disorders-Fifth edition social anxiety disorder. The SOPHS is a valid and reliable screener for social anxiety that is freely available for use in research and clinical settings.

Patients receiving ketamine for refractory depression and anxiety report dissociative symptoms in the first 60 min post-dose. The most commonly used instrument to assess this is the Clinician-Administered Dissociative States Scale (CADSS), developed based on the assessment of patients with dissociative symptoms. Its psychometric properties for ketamine-induced dissociation have not been reported. We evaluated these from a study using 0.25-1 mg/kg ketamine and midazolam (as an active control) in 18 patients with treatment-resistant anxiety. Dissociation ratings were increased by ketamine in a dose-dependent manner. In contrast, midazolam showed no effect on ratings of dissociation. For individual CADSS items, the magnitude of change and the ketamine dose at which changes were observed were not homogenous. The Cronbach alpha for the total scale was high (0.937), with acceptable item-rest correlations for almost all individual items. Purposefully removing items to maximise alpha did not lead to meaningful improvements. Acceptable internal consistency was still observed after removing items which lacked evidence of responsiveness at lower doses. The high Cronbach alpha values identified in this study suggests that the CADSS is an internally consistent instrument for evaluating ketamine-induced dissociation in clinical trials in anxiety, although it does not capture symptoms such as thought disorder.

Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

The N-methyl-D-aspartate receptor antagonist ketamine has rapid onset activity in treatment-resistant depression, post-traumatic stress disorder and obsessive compulsive disorder. Due to similarities in brain network activity in depression and anxiety disorders, we hypothesized that ketamine might also be active in other refractory anxiety disorders. We evaluated the efficacy and safety of ketamine in 12 patients with refractory generalized anxiety disorder and/or social anxiety disorder who were not currently depressed, using an ascending single dose study design (0.25, 0.5, 1 mg/kg administered subcutaneously) at weekly intervals. Within 1 h of dosing, patients reported reduced anxiety, which persisted for up to seven days. A dose-response profile was noted for anxiolytic effects, dissociative side effects, and changes in blood pressure and heart rate, with minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten of 12 patients were treatment responders at 0.5-1 mg/kg. Ketamine was safe and well tolerated in this population. Ketamine may be a potential therapeutic alternative for patients with refractory generalized anxiety disorder/social anxiety disorder. Along with its demonstrated effectiveness in patients with treatment-resistant depression, obsessive compulsive disorder and post-traumatic stress disorder, these data raise the intriguing possibility that ketamine may have broad efficacy in disorders characterized by negative emotional states, and that these disorders may share a common precipitating neurobiology.

Objective: This study examined the effectiveness of manualized cognitive therapy (mCT) following the Clark-Wells approach versus non-manualized cognitive-behavioral treatment-as-usual (CBTAU) for social anxiety disorder (SAD) in routine practice., Methods: Forty-eight private practitioners were recruited within a multi-center trial and either received training in manualized CT for SAD or no such training. Practitioners treated 162 patients with SAD in routine practice (N = 107 completers, n = 57 for mCT, n = 50 for CBTAU). Social anxiety symptoms (Liebowitz Social Anxiety Scale; LSAS) and secondary measures were assessed before treatment, at treatment-hour 8, 15, and 25, at end of treatment, as well as 6 and 12 months after treatment., Results: Patients in both groups showed significant reductions of SAD severity after treatment (d = 1.91 [mCT] and d = 1.80 [CBTAU], within-group effect sizes, intent-to-treat analyses, LSAS observer ratings), which remained stable at follow-up. There were no differences between groups in terms of symptom reduction and treatment duration., Conclusions: The present trial confirms the high effectiveness of CBTAU and mCT for SAD when practitioners conduct the treatments in routine practice. Additional training in the CT manual did not result in significant between-group effects on therapy outcome. Explanations for this unexpected result are discussed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Recent evidence suggests that reduced generosity among individuals with social anxiety disorder (SAD) in behavioral economic tasks may result from constraint in changing behavior according to interpersonal contingencies. That is, people with SAD may be slower to be more generous when the situation warrants. Conversely, more global effects on generosity may be related to interpersonal vindictiveness, a dimension only somewhat related to SAD. A total of 133 participants, 73 with the generalized form of SAD, completed self-report instruments and a behavioral economic task with simulated interpersonal (friend, romantic partner, stranger) interactions. In a separate visit, friends (n = 88) also came to the lab and rated participants on vindictiveness. Interpersonal vindictiveness was associated with reduced initial and overall giving to simulated friends. SAD predicted a lack of increased giving to a simulated friend, and attenuated an increase in giving to simulated known versus unknown players compared to participants without SAD. Friend-reported vindictiveness predicted in the same direction as diagnosis. However, the findings for SAD were less robust than those for vindictiveness. SAD is perhaps weakly related to behavioral constraint in economic tasks that simulate interpersonal interactions, whereas vindictiveness is strongly related to lower overall generosity as well as (via friend report) behavioral constraint. Further study is needed to better characterize the construct of vindictiveness. Our findings dovetail with the suggestion that SAD is related to impairment in the proposed affiliation and attachment system, but further suggest that direct study of that system may be more fruitful than focusing on disorders., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

Social anxiety disorder (SAD) and alcohol use disorders (AUD) co-occur frequently and there is preliminary evidence that alcohol might reduce social anxiety. It is, however, unclear which mechanisms contribute to the anxiety reducing effect, particularly regarding key aspects of social anxiety such as deficits in social performance. We compared self-rated and physiological measures of anxiety as well as self- and observer-rated social performance in a sample of 62 individuals with SAD and 60 nonanxious control participants during a speech task after receiving either alcohol, an alcohol-free placebo drink or orange juice. SAD patients reported more anxiety during the speech task than did control participants. Furthermore, SAD patients underestimated their performance in comparison to observer ratings. Alcohol reduced self-report anxiety only in SAD patients, while observers rated all participants as less competent when intoxicated. Although individuals with SAD experience a reduction in anxiety when drinking alcohol, simultaneous decreases in social performance might contribute to negative reactions from others and consequently increase the risk of further alcohol use to cope with these negative reactions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are co-morbid and associated with similar neural disruptions during emotion regulation. In contrast, the lack of optimism examined here may be specific to GAD and could prove an important biomarker for that disorder., Method: Unmedicated individuals with GAD (n = 18) and age-, intelligence quotient- and gender-matched SAD (n = 18) and healthy (n = 18) comparison individuals were scanned while contemplating likelihoods of high- and low-impact negative (e.g. heart attack; heartburn) or positive (e.g. winning lottery; hug) events occurring to themselves in the future., Results: As expected, healthy subjects showed significant optimistic bias (OB); they considered themselves significantly less likely to experience future negative but significantly more likely to experience future positive events relative to others (p < 0.001). This was also seen in SAD, albeit at trend level for positive events (p < 0.001 and p < 0.10, respectively). However, GAD patients showed no OB for positive events (t 17 = 0.82, n.s.) and showed significantly reduced neural modulation relative to the two other groups of regions including the medial prefrontal cortex (mPFC) and caudate to these events (p < 0.001 for all). The GAD group further differed from the other groups by showing increased neural responses to low-impact events in regions including the rostral mPFC (p < 0.05 for both)., Conclusions: The neural dysfunction identified here may represent a unique feature associated with reduced optimism and increased worry about everyday events in GAD. Consistent with this possibility, patients with SAD did not show such dysfunction. Future studies should consider if this dysfunction represents a biomarker for GAD.

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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

Background and Objectives: One-Session Treatment (OST) for specific phobias has been shown to be effective in reducing phobia severity; however, the effect of different types of co-occurring anxiety disorders on OST outcomes is unknown. The present study examined (1) the effects of co-occurring generalized anxiety disorder (GAD), social anxiety disorder (SAD), or another non-targeted specific phobia (OSP) on the efficacy of OST for specific phobias, and (2) the effects of OST on these co-occurring disorders following treatment., Methods: Three groups of 18 youth (7-15 years) with a specific phobia and comorbid GAD, SAD, or OSP were matched on age, gender, and phobia type. Outcome measures included diagnostic status and severity, and clinician rated improvement., Results: All groups demonstrated an improvement in their specific phobia following treatment. Treatment was equally effective regardless of co-occurring anxiety disorder. In addition, comorbid anxiety disorders improved following OST; however, this effect was not equal across groups. The SAD group showed poorer improvement in their comorbid disorder than the GAD group post-treatment. However, the SAD group continued to improve and this differential effect was not evident six-months following treatment., Limitations: The current study sample was small, with insufficient power to detect small and medium effect sizes. Further, the sample only included a portion of individuals with primary GAD or SAD, which may have attenuated the findings., Conclusions: The current study demonstrated that co-occurring anxiety disorders did not interfere with phobia treatment. OST, despite targeting a single specific phobia type, significantly reduced comorbid symptomatology across multiple anxiety disorders., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Though research indicates that individuals with social anxiety disorder may experience elevated levels of thwarted belongingness and perceived burdensomeness, two interpersonal risk factors critical for the development of suicidal desire, it remains unclear why. The current investigation considered how shame and depression may help to explain the relationship between social anxiety and interpersonal suicide risk factors. Participants (N=259), recruited using Amazon.com's Mechanical Turk, completed measures of social anxiety, interpersonal suicide risk factors, shame, and depression. Social anxiety was associated with greater thwarted belongingness and perceived burdensomeness. In addition, shame partially explained the association between social anxiety and thwarted belongingness, though the indirect effect was no longer significant after considering depression as a moderator. As predicted, shame was found to fully explain the association between social anxiety and perceived burdensomeness and this indirect effect was most pronounced among individuals with high comorbid depression. The clinical implications of these findings are discussed., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)