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Background: Altered gaze in social settings is a hallmark of social anxiety; however, little research directly examines gaze in anxiety-provoking contexts among youth with anxiety disorders, limiting mechanistic insight into pediatric anxiety. The present study leveraged mobile eye-tracking technology to examine gaze behavior during a naturalistic stressor in a clinical developmental sample., Methods: Sixty-one youth (ages 8-17 years; 28 with anxiety disorders, 33 non-anxious controls) completed a naturalistic social stress task (public speaking in front of a videotaped classroom audience) while wearing eye-tracking glasses. Gaze behavior and state anxiety were quantified in each group during two task conditions: while giving a speech and while passively viewing the audience., Results: Anxiety-related differences emerged in state anxiety and gaze behavior. First, a significant interaction between diagnostic group and task condition on state anxiety indicated that while anxiety increased among non-anxious controls following the speech, youth with anxiety disorders reported persistently elevated anxiety across all assessments. Second, a significant interaction emerged between social anxiety symptom severity and task condition on gaze time on the audience. While youth overall showed low dwell time on the audience during speech delivery, individuals with greater social anxiety showed longer gaze on the audience during the passive viewing condition. This pattern was specific to dimensional analyses of social anxiety symptom severity., Limitations: The current study was not sufficiently powered to examine age-related differences., Conclusions: These findings highlight anxiety-related differences in gaze behavior in youth, providing new mechanistic insight into pediatric anxiety using mobile eye-tracking., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

People with social anxiety disorder tend to interpret ambiguous social information in a negative rather than positive manner. Such interpretation biases may cause and maintain anxiety symptoms. However, there is considerable variability in the observed effects across studies, with some not finding a relationship between interpretation biases and social anxiety. Poor psychometric properties of interpretation bias measures may explain such inconsistent findings. We evaluated the internal consistency, test-retest reliability, convergent validity, and concurrent validity of four interpretation bias measures, ranging from more implicit and automatic to more explicit and reflective: the probe scenario task, the recognition task, the scrambled sentences task, and the interpretation and judgmental bias questionnaire. Young adults (N = 94) completed interpretation bias measures in two sessions separated by one week. Psychometric properties were poor for the probe scenario and not acceptable for the recognition task. The reliability of the scrambled sentences task and the interpretation and judgmental bias questionnaire was good, and they correlated highly with social anxiety and each other, supporting their concurrent and convergent validity. However, there are methodological challenges that should be considered when measuring interpretation biases, even if psychometric indices suggest high measurement validity. We also discuss likely reasons for poor psychometric properties of some tasks and suggest potential solutions to improve the assessment of implicit and automatic biases in social anxiety in future research., Competing Interests: Declarations. Conflicts of interest: The authors declare no conflicts of interest. Ethics approval: The study was conducted in accordance with the Declaration of Helsinki and its later amendments, and was approved by the ethical committee of Utrecht University (FETC 18-132). Consent to participate: All participants were informed about the general procedure and provided written informed consent. Consent for publication: All participants provided written informed consent for publication of anonymized data., (© 2025. The Author(s).)

High comorbidity and diagnostic overlap between autism spectrum disorder and social anxiety disorder have been documented. We examined if differences in adaptive behavior, essential for daily functioning, could differentiate these conditions among young university students. Eighty-eight autistic and 123 non-autistic undergraduates were categorized into four groups: autistic individuals: with low (n = 26)/high (n = 62) social anxiety (SA) symptoms; non-autistic: with low (n = 63)/high (n = 60) SA. The Adaptive Behavior Assessment System (ABAS) was utilized to assess three domains of adaptive skills essential for daily functioning: conceptual (academic and communication abilities), social (relationships and understanding social cues), and practical (everyday tasks such as self-care and work). Autistic students, regardless of SA level, reported ABAS scores within the low average range for the conceptual adaptive behavior domain, while non-autistic students had average scores. In terms of ABAS social adaptive behavior scores, both autistic and non-autistic groups with high levels of SA had low average scores. Conversely, those with low SA, whether autistic or non-autistic, exhibited average scores. These results were supported by the regression analyses outcomes. While autism traits and social anxiety showed medium (β=-0.37) and small (β=-0.27) effects, respectively, on conceptual adaptive scores, only social anxiety exhibited significant (medium) effects on social (β=-0.41) and practical (β=-0.34) adaptive scores. Reduced conceptual skills, previously linked to communication and executive function, may distinguish autism from social anxiety. Implications for research and practice are discussed., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to this study. No financial, personal, or professional relationships that could influence the work reported in this manuscript have been disclosed., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Social anxiety is a prevalent mental health concern that impacts approximately 12% of the US population. There is a need for targeted mechanism-focused interventions for social anxiety that are also highly scalable. Using a recently developed naturalistic paradigm with simulated teleconferencing interactions as the central treatment element, we developed a new self-guided internet-based intervention for social anxiety called iExposure. This randomized clinical trial aimed at testing two mechanism-driven exposure augmentation strategies for social anxiety. Participants ( N  = 53) were randomized to four sessions of either (a) standard iExposure ( n  = 18), (b) iExposure +Attention Control ( n  = 22), or (c) iExposure + Attention Guidance ( n  = 13) and administered over two weeks. At follow-up across conditions, there were large reductions in communication anxiety d = -1.51 and moderate reductions in social anxiety d = -0.60. The attention control condition led to larger reductions in social anxiety compared to standard iExposure d = -0.81 and attention guidance did not enhance iExposure for general symptoms of social anxiety, d = -0.27. These findings provide preliminary support for the utility of iExposure. Further research is needed with a larger sample to understand its efficacy with regard to the role of attention augmentation strategies.

Background: The extent to which individuals can flexibly allocate their attention towards adaptive cues in the social environment may play an important role in the maintenance of social anxiety. Attentional control (AC) describes the top-down ability to regulate one's attention and cognitive resources. Although low AC has been linked to psychopathology broadly, the specific relation between AC and social anxiety disorder (SAD) remains poorly understood. The present study aimed to clarify the role of AC in SAD by examining unique associations between AC and several facets of social anxiety, above and beyond general psychological distress., Methods: Adults endorsing elevated SAD symptoms (n = 123) were assessed for levels of AC, inhibitory control, social anxiety severity, social anxiety sensitivity, social avoidance/safety behaviors, stress, and depression., Results: Partial correlations revealed that self-reported AC was negatively associated with all dimensions of SAD (rs = -0.20 to -0.29, ps < 0.05) after controlling for symptoms of stress and depression. Similarly, structural equation models showed that latent AC negatively predicted latent social anxiety (β = -0.21, p < .05), even after controlling for latent psychological distress., Limitations: The study used a cross-sectional design, an analogue sample, and solely self-report measures in structural equation models., Conclusions: Results converge to suggest that subjective (but not objective) deficits in AC have a unique relation with several mechanisms involved in the development and maintenance of SAD. These findings partially support the applicability of Attentional Control Theory to SAD and point to AC as a potential treatment target., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alexandra Adamis reports financial support was provided by Vanderbilt Institute for Clinical and Translational Research (VR67441). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n  = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment ( p  < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions ( p  = .041, pseudo- R 2  = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

This study aimed to evaluate the psychometric characteristics of the Social Phobia Inventory (SPIN) by employing network analysis, confirmatory factor analysis, and the Polytomous Rasch Model. A cross-sectional data set was collected comprising 1,530 participants, with 959 being women and 571 being men. The Bootstrap Exploratory Graph Analysis unveiled the presence of two dimensions, with Items 17, 15, 5, 14, 6, and 9 exhibiting the highest strength centrality index. Notably, the Network Comparison Test indicated no differences in Network Invariance and global strength between the networks of women and men. Furthermore, the confirmatory factor analysis results demonstrated that the two extracted dimensions displayed an acceptable goodness of fit. In addition, the reliability coefficient values were acceptable, exceeding the threshold of 0.70. The Rasch analysis results suggested an overall fit, but some items exhibited overlap, suggesting their potential removal. Furthermore, it was recommended to develop new items to address gaps between existing items, particularly for measuring the lower levels of Social Anxiety Disorder. In conclusion, these findings provide robust evidence supporting the reliability and validity of the SPIN as a tool for measuring Social Anxiety Disorder in Algeria., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Social anxiety can make significant life transitions from adolescence to young adulthood particularly stressful. Despite the potential impact, few population-based longitudinal studies have examined the relationship between social anxiety and the timing of key markers of the transition to adulthood. This study investigated the association between social anxiety and the timing of two critical life events: first leaving the parental home and first living with a partner., Methods: Data were drawn from 8,199 adolescents aged 13-19 who participated in the Young-HUNT3 survey (2006-2008) in Norway, linked with event registration data from Statistics Norway through 2020. Social anxiety was assessed via the Short Form of the Social Phobia and Anxiety Inventory for Children, with scores ranging from 1 to 5. Accelerated failure time (AFT) regression analyses with a Weibull distribution were conducted to evaluate the relationship between social anxiety and the timing of first leaving the parental home and first living with a partner., Results: The final analytic sample size was 8,045. The median age for first leaving the parental home was 21, whereas the median age for first starting to live with a partner was 24. Higher levels of social anxiety were modestly associated with delays in both life transitions. Specifically, a one-unit increase in the social anxiety score was associated with an approximate one-month delay in leaving the parental home ( T  = 1.005; p < 0.05) and a two-month delay in first living with a partner ( T  = 1.010; p < 0.001). The predicted mean indicates a difference of 4 months for leaving the parental home and 8 months for first living with a partner, comparing adolescents with the lowest (score of 1) to the highest (score of 5) within the social anxiety spectrum., Conclusion: This study highlights the association between social anxiety and delays in key life transitions from adolescence to early adulthood. Despite these delays, socially anxious adolescents in Norway appear to reach these milestones-leaving the parental home and living with a partner-in their early twenties, similar to their peers. Although the findings are modest, practically, this information may still hold significant value in informing care providers and policymakers to focus on adolescents as a potential period for implementing evidence-based programs aimed at social anxiety. Future research should explore other stress-inducing life events and examine the long-term socioeconomic and health outcomes of adolescents with social anxiety., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Halidu, Moe, Behboudi-Gandevani and Haugan.)

Individuals with high social anxiety show a more considerable attentional bias toward self-relevant information and outwardly threatening stimuli than do those with low social anxiety. Some studies have investigated the attentional bias between self-relevant information and external social cues in people with high social anxiety but have not reached consistent conclusions. This study used a modified dot-probe task and collected temporal and electroencephalogram responses to three self-other face pairs among 15 people with high social anxiety and 20 people with low social anxiety. Both groups responded quicker to self-relevant information than external social cues. Others' emotional potencies moderated the attentional bias. Individuals with high social anxiety exhibited larger P1 amplitudes and smaller N170 amplitudes (mainly in the right hemisphere) for all face pairs and larger P2 amplitudes for the self-neutral and other-angry face pairs than those with low social anxiety. These findings suggest that people with social anxiety prioritize allocating attentional resources to self-relevant information, with others' angry faces having the greatest influence on the allocation. Individuals with high social anxiety initially exhibit more attentional vigilance and less structural coding for face pairs, followed by heightened engagement with threatening cues compared to those with low social anxiety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Previous survey studies have consistently shown a strong link between social anxiety and intolerance for uncertainty. However, this association lacks empirical validation from laboratory investigations. To bridge this gap, we conducted a study utilizing the ultimatum game task to assign distinct social connotations (egoistic, altruistic, and uncertain) to three initially neutral faces. Subsequently, we utilized the Approach-Avoidance Task (AAT) paradigm to evaluate participants' approach-avoidance tendencies towards the faces with varying social meanings. Additionally, we collected data on participants' levels of social anxiety and trait anxiety. Our results indicate that both social anxiety and trait anxiety levels impact individuals' avoidance behaviors when faced with socially uncertain cues. This suggests that individuals with higher levels of social anxiety may demonstrate increased sensitivity to uncertainty in social contexts, leading to avoidance behaviors. Crucially, our findings directly underscore the heightened avoidance tendencies of non-clinical individuals with social anxiety towards socially uncertain stimuli, thereby providing new empirical support for research on anxiety disorders related to uncertainty., Competing Interests: Declaration of Competing Interest The corresponding author, on behalf of all authors, declares the absence of any conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Social anxiety disorder (SAD) tends to emerge during adolescence and is more prevalent among those assigned female at birth. Parental social anxiety confers risk for adolescent SAD but less is known regarding protective factors. Research suggests that emotion differentiation (the ability to discriminate between similarly valenced emotions, e.g., fear vs. sadness vs. anger) may be protective, as it is associated with adaptive psychosocial outcomes. However, little work has examined how emotion differentiation influences the development of SAD, particularly during periods of higher risk such as adolescence. In a longitudinal study of adolescent girls at high temperamental risk for SAD (aged 11-14-years; n=114), we tested whether emotion differentiation (derived using negative and positive emotion ratings from 16-day ecological momentary assessments at baseline) moderated the relationship between parental and adolescent social anxiety symptoms across two years. Results revealed significant moderation by negative (but not positive) emotion differentiation (p=.042): Baseline parental social anxiety was positively associated with adolescent social anxiety symptoms at two-year follow-up but only at lower (vs. higher) levels of emotion differentiation, even after controlling for baseline depressive symptoms. Exploratory analyses showed that these effects were unique to avoidance of social situations (p=.014). Findings highlight the protective effects of emotion differentiation and have important clinical implications for understanding and treating SAD., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples., Methods: 641 children and adolescents aged 6-17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis., Results: Participants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks., Conclusions: Paediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The identification of psychopathological markers has been the focus of several scientific fields. The results were inconsistent due to lack of a clear nosology. Network analysis, focusing on the interactions between symptoms, provided important insights into the nosology of mental disorders. These interactions originate several topological properties that could constitute markers of psychopathology. One of these properties is network connectivity, which has been explored in recent years. However, the results have been inconsistent, and the topological properties of psychopathological networks remain largely unexplored and unknown. We compared several topological properties (i.e., connectivity, average path length, assortativity, average degree, modularity, global clustering) of psychopathological networks of healthy and disordered participants across depression (N = 2830), generalized anxiety (N = 13,463), social anxiety (N = 12,814), and obsessive-compulsive disorder (N = 16,426). Networks were estimated using Bayesian Gaussian Graphical Models. The Janson-Shannon measure of divergence was used to identify differences between the network properties. Network connectivity distinguished healthy and disordered participants' networks in all disorders. However, in depression and generalized anxiety, network connectivity was higher in healthy participants. The presence and number of motifs also distinguished the networks of healthy and disordered participants. Other topological properties (i.e., modularity, clustering, average path length and average degree) seem to be disorder-specific. The psychopathological significance of network connectivity must be clarified. Some topological properties of psychopathological networks are promising markers of psychopathology and may contribute to clarifying the nosology of mental disorders., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Castro reports financial support was provided by Fundação para a Ciência e Tecnologia. Joana Cardoso reports financial support was provided by Fundação para a Ciência e Tecnologia. Ana Sofia Araujo reports financial support was provided by Fundação para a Ciência e Tecnologia. Ana Rita Rodrigues reports financial support was provided by Fundação para a Ciência e Tecnologia., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation., Methods: These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT)., Results: Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity., Conclusion: These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Many people dislike the sound of their voices, especially when listening back to audio recordings (voice confrontation). Previous research reports that disliking the sound of one's voice is associated with elevated levels of social anxiety. The present study investigated the relationship between social anxiety and voice dislike and voice misrecognition among a bilingual population: Arabic (L1) and English (L2). Participants (N = 176) completed self-report measures of social anxiety and own voice liking. Additionally, they performed a novel own voice recognition task, assessing their ability to recognise a recording of their voice, differentiating it from digitally altered versions of the same recording. Social anxiety symptomatology was associated with disliking the sound of one's voice, with a larger effect for L1 than L2. Social anxiety was also associated with own voice misrecognition, but only for L1. Highly negative evaluations about the sound of one's voice may represent a vulnerability for social anxiety disorder., (© 2024 The Author(s). International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science.)

Background: Adolescents in less economically developed areas are susceptible to social anxiety, so finding ways to effectively prevent and intervene in social anxiety could be a major step forward for poverty alleviation. However, little is known about the inner workings of social anxiety in this group. Exploring the risk and protective factors of social anxiety among adolescents in less developed rural areas is crucial for maintaining their mental health and improving their social adaptability. The purpose of this study is to explore the relationships among perceived social support, core self-evaluation, shyness and social anxiety among rural secondary school students and analyze the risk and protective factors of social anxiety., Methods: A total of 626 rural secondary school students are investigated with the Perceived Social Support Scale (PSSS), Core Self-Evaluation Scale (CSES), Shyness Scale (SS) and Social Avoidance and Distress Scale (SADS). Structural equation modeling is used to analyze the mediating effects of core self-evaluation and shyness., Results: The results reveal that (1) the perceived social support and core self-evaluation of rural secondary school students are significantly negatively correlated with social anxiety, whereas their shyness is significantly positively correlated with social anxiety. There are significant gender differences in perceived social support, core self-evaluation, shyness and social anxiety. (2) There is a significant chain mediating effect of core self-evaluation and shyness between perceived social support and social anxiety, and the mediation model is cross-gender consistent., Conclusions: These results confirm that perceived social support and core self-evaluation are protective factors against social anxiety in rural secondary school students and that shyness is a risk factor for social anxiety. Moreover, perceived social support can indirectly affect social anxiety through core self-evaluation and shyness. Prevention and intervention of social anxiety can be carried out in three ways: improving the perceived ability of social support, enhancing positive self-evaluation, and reducing shyness and avoidance behaviors., Competing Interests: Declarations. Ethics approval and consent to participate: The present study was conducted with the permission of the Academic Ethics Committee of Chongqing University of Arts and Sciences and participants’ guardians. Written informed consent was obtained from all the participants and their parents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To assess the prevalence and severity of paruresis ('shy bladder syndrome') in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis., Design: We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined 'mild' and 'severe' paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a 'mild' and 'severe' paruresis diagnosis., Setting: We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites., Results: We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18-30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of 'mild' paruresis was 25.8% and of 'severe' paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19, <0.001). The adjusted odds of 'mild' paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06), lower for those with a lower RSES score (OR 0.90; 95% CI 0.85 to 0.96), lower for those for a lower school toilet experience score (OR 0.88; 95% CI 0.78 to 0.99) and higher for those with at least one anxiety disorder (OR 3.164; 95% CI 1.52 to 6.59). The adjusted odds of 'severe' paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18-7.56))., Conclusion: Large organisations should consider measures to help manage anxiety and improve toilet experiences. These could include resources and signposting to manage anxiety disorders and single-occupancy toilets and toilets in quiet areas to limit anxiety associated with shy bladder syndrome., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents., Methods: Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829., Results: In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %)., Conclusion: These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Among adolescents, symptoms of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are not only clinically significant but also continuingly increasing. During adolescence, individuals begin to establish distinct, self-determined lifestyle patterns. This study seeks to identify the associations between such lifestyle factors and the prevalence of GAD and SAD symptoms., Methods: The analyzable sample was based on a cross-sectional, nationally representative survey of Finnish 14-18 year old students from comprehensive schools, general upper secondary schools, and vocational institutions. The sample consisted of 60,252 boys and 71,118 girls, with the mean age of 16.05 years (standard deviation 1.06). Symptoms were identified using the GAD-7 (cutpoint of 10), the Mini-SPIN (cutpoint of 6), and the PHQ-2 (cutpoint of 3). Logistic regression models for both GAD and SAD symptoms were stratified by comorbidity group variables., Results: GAD symptoms were closely related to excessive internet use and decreased sleep duration among adolescents, regardless of comorbidity with depression or SAD. SAD symptoms were associated with excessive internet use and a lack of intense exercise, independent of comorbid depression or GAD., Conclusions: The findings underscore the importance of considering lifestyle factors when developing interventions to mitigate GAD and SAD symptoms in adolescents. Interventions and policy recommendations aiming at improving adolescents' health behaviour and mental health should take into account the intertwining of these factors., Competing Interests: Declarations Ethics approval and consent to participate Informed consent was obtained from all the participants of the study. For the participants under 18 years of age, informed consent was obtained from their respective guardians. Pupils and students fill out the survey anonymously during a school lesson. Responding to the survey is voluntary, and participants give informed consent by answering the survey. Guardians of participants under 18 years old are informed in advance, and guardians of participants under 15 years old have an option to decline their child’s participation. The study was conducted according to the guidelines of the Declaration of Helsinki. The institutional review board of the Finnish Institute for Health and Welfare has evaluated the School Health Promotion study research plan. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking., Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of "being there," during VR exposure with anxiety measures and treatment response was examined., Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured., Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η 2 =0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response., Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents., (©Gesa Beele, Paula Liesong, Sabine Bojanowski, Kristian Hildebrand, Malte Weingart, Julia Asbrand, Christoph U Correll, Nexhmedin Morina, Peter J Uhlhaas. Originally published in JMIR Mental Health (https://mental.jmir.org), 05.11.2024.)

Social rejection is a common and unavoidable experience for users of dating apps. Research suggests that socially anxious individuals may be particularly likely to use dating apps to establish intimate relationships, given their preference for online (vs. face-to-face) communication. However, social anxiety (SA) symptoms are associated with heightened negative affect and decreased prosocial behavior following social rejection, suggesting that exposure to dating app rejection has deleterious consequences in this population. This study examined whether SA symptoms and social rejection (vs. acceptance) feedback interact to predict participants' negative and positive affect and social engagement with dating app matches. Participants ( N = 128) evaluated for SA symptoms were randomly assigned to receive high or low match rate feedback on a simulated dating application task. SA symptoms were negatively associated with positive affect following high match rate feedback and positively associated with negative affect following low match rate feedback. SA symptoms were negatively associated with self-reported likelihood of contact initiation with matches. Results suggest that high socially anxious individuals are more susceptible to negative repercussions of social rejection on dating applications.

Purpose: To explore the differences in mental health symptom profiles, trauma profiles, childhood trauma and comorbidities in patients with PTSD and those without PTSD., Materials and Methods: A cross-sectional study was carried out on 110 adult patients with trauma backgrounds attending a mental health outpatient clinic in Southern Oslo, Norway. In addition to self- report questionnaires, several standardized validated diagnostic tools were used to assess mental disorders. Multiple linear regression models were used to assess the association between trauma history, the mental health symptom profile of the patients, and PTSD diagnosis. Bivariate logistic regression was used to examine if childhood trauma/adversities were associated with PTSD., Results: Patients diagnosed with PTSD had significantly higher rates of comorbid major depressive disorder, panic disorder, agoraphobia disorder, and social phobia compared to those without PTSD. We also found a positive association between PTSD diagnosis and all the different mental health symptoms domains of the Symptom Checklist-90-Revised instrument. When adjusted for age, gender, education, smoking habits, immigration, relationship, and employment status, these associations persisted with varying effects. We did not find any association between PTSD and childhood trauma/adversities, however, sexual abuse trended towards an association., Conclusion: Adult trauma patients with PTSD may have more comorbid disorders and mental health symptoms. Childhood trauma may be less critical for the PTSD diagnosis in this group. In clinical practice, personalized treatment plans addressing both the symptom burden and its comorbidities may be beneficial.

Lay Abstract: The nature of social anxiety has been widely researched in non-autistic people. This existing research has allowed therapists to develop effective therapy for social anxiety in non-autistic people. Meanwhile, some research suggests that autistic people may have different experiences of anxiety compared to non-autistic people. In addition, there is some evidence that modified therapy may help autistic people with social anxiety, although we also know that many autistic people feel failed by existing mental health services.This article provides a detailed picture of social anxiety in autistic people. This includes similarities and differences compared to non-autistic people. In terms of similarities, people often described feeling afraid that others would judge them, and this would have negative consequences. In terms of differences, autistic people commonly reported a clash between their traits and their social environment, which caused them distress and discomfort. This included factors only rarely reported by non-autistic people (such as struggling with too much sensory stimulation or inaccessible forms of communication and encountering discrimination for these problems). Based on this, we propose a 'distinct' model of social anxiety with particular relevance to autistic people. In addition, many participants reported negative experiences in therapy for social anxiety. They thought therapists wrongly viewed their fears of social situations as irrational and ungrounded. They thought therapists did not adapt the therapy process in an individualised way and did not understand neurodiversity or recognise neurodivergence.Standard approaches for social anxiety may not always suit autistic people, so this needs further exploration. We highlight several practical recommendations for therapists offering therapy for social anxiety to autistic people., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Lay Abstract: Research has shown that some autistic people have severe difficulties in recognising other people's faces. However, little is understood about how these difficulties impact the daily life and the mental well-being of autistic people. In this study, we asked 60 autistic adults with varying degrees of face recognition ability to complete two tests of face recognition, a questionnaire about social anxiety and a bespoke survey which asked participants about their experiences of face recognition and social interaction. We found that participants who had poor face recognition reported experiencing higher levels of social anxiety compared to those with average or better face recognition skills. More than half felt that their face recognition difficulties affected their social interactions, and over a third believed it hindered their ability to make friends. These findings suggest that face recognition difficulties may contribute to social anxiety among autistic individuals., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Avoidant personality disorder (AvPD) and social phobia (SP) are associated with high personal and societal costs. While psychotherapy can be efficient, many patients drop out during treatment. Little is known about what can be done to increase a patient's readiness for psychotherapy. However, research highlights the fields of collaborative and therapeutic assessment as a possible means to enhance readiness for psychotherapy., Methods: We conducted a randomized controlled feasibility and superiority trial on patients with SP or AvPD who were to initiate psychotherapeutic treatment in outpatient mental health services. Patients were randomized 1:1 to either assessment as usual or modified collaborative assessment (MCA), provided as a pre-treatment intervention before psychotherapy initiation. MCA included the collaborative administration of a battery of psychological tests designed to assess the patient's psychopathology more systematically. The tests were administered in collaboration with the patient, and detailed oral and written feedback was provided. We investigated the feasibility of the MCA intervention regarding acceptability, patient satisfaction, and adherence. We also investigated MCA's effect on readiness for psychotherapy, as assessed with the University of Rhode Island Change Assessment Scale (URICA), and outcomes relating to symptomatology and dropout rates., Results: All three prespecified feasibility outcomes were met. At the end of treatment, no significant difference was observed in any other outcome, except client satisfaction, which favored MCA (- 7.42 (95% CI - 11.75; - 3.09; p = 0.002))., Discussion: We found that MCA was feasible, and patients were highly satisfied with the intervention. It is relevant to investigate another implementation of MCA., Trial Registration: ClinicalTrials.gov NCT05018312. Registered on August 24, 2021., (© 2024. The Author(s).)

Background: Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables., Methods: This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables., Results: The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness., Limitations: The present study is cross-sectional, therefore unable to confirm causal interpretations., Conclusion: Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality., Competing Interests: Declaration of competing interest None. Declaration of Generative AI and AI-assisted technologies in the writing process None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Individuals with high social interaction anxiety (SIA) and depression often behave submissively in social settings. Few studies have simultaneously examined the associations between objectively assessed submissive behaviors and SIA or depression, despite their high comorbidity and unknown mechanisms regarding submissiveness., Methods: A sample of 45 young adults self-reported trait SIA and depression, state positive/negative affect (PA/NA) before and after a virtual social interaction. Participants engaged in a four-minute conversation with a confederate who was trained to behave neutrally. Mutual eye gaze, via eye-tracking, and vocal pitch were assessed throughout the interaction., Results: Depression and SIA were positively correlated with NA, poorer self-rated performance, and vocal pitch. Highly socially anxious women engaged in less mutual eye gaze than highly socially anxious men. Also, vocal pitch was inversely associated with mutual eye gaze and positively related to NA and (nonsignificantly) to self-ratings of poor performance. Finally, our data partially replicated past research on the use of vocal pitch during social stress to detect social anxiety disorder., Limitations: The current sample is relatively homogenous in educational attainment, age, and race. All research confederates were women. Future research should examine whether these archival data replicate with the latest telecommunication technologies., Conclusion: Our findings highlight nuanced relationships among SIA, depression, emotions, self-perceptions, and biobehavioral indicators of submissive behavior-in response to an ambiguously negative/positive social interaction. Sex/gender may interact with these effects, emphasizing considerations for research method designs., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Mental health literacy (MHL) is an important part of the help-seeking process, yet there is a lack of knowledge about the MHL of adolescents in the Caribbean. This region is important to study as it is underrepresented in mental health research globally. The aim of this study is to explore the ability of adolescents in Bermuda to recognize depression and social phobia (social anxiety) and their beliefs about the sources of help for a peer with these mental health problems. This cross-sectional study surveyed middle and high school students aged 10-19 years in Bermuda. Online surveys conducted between November 2022 and June 2023 gathered demographic data including age, gender and race, and assessed the ability to recognize depression and social anxiety from descriptions provided in randomly assigned vignettes, and beliefs about sources of help. Across 15 middle and high schools, 2423 adolescents (out of 3593 eligible participants) completed all demographic and MHL survey questions (1139 males, 1272 females). Recognition rates for depression and social anxiety were 60% and 53%, respectively. Compared to females, males endorsed a greater variety of help sources. Reporting symptoms of depression or anxiety reduced the likelihood of endorsing multiple sources of help. MHL of adolescents in Bermuda is sub-optimal, particularly for social anxiety. Mental health promotion programs may be useful in improving recognition rates., (© The Author(s) 2024. Published by Oxford University Press.)

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.)

Fear of negative (FNE) and positive (FPE) evaluation constitute distinct components of social anxiety and relate to altered affectivity. It is unclear whether individuals with strong FNE/FPE overreact to social stressors only or to more unspecific ones as well. The present set of three studies (n = 109 and n = 97 healthy individuals in study 1/2, n = 49 patients with social anxiety disorder in study 3) assessed whether reactivity to various daily stressors and non-specific momentary stress/emotions assessed through ecological momentary assessment depend on individuals' level of FPE/FNE. Almost all relationships with FPE/FNE were explained by depressive symptoms, except for a unique association of FNE with reactivity to stressors from the distant social network. Relationships of FNE with momentary global stress and emotions were mixed, but again explained by depressive symptoms. More depressive symptoms were associated with higher stress, negative affect, and most stressor types as well as lower positive affect in all studies. These results show that for social stressors from the distant social network, FNE has explanatory power. They further document the role of depressive affect for reactivity to a wide range of everyday stressors and question the need for specific instruments assessing FPE/FNE unless stressors are explicitly social-evaluative in nature., Competing Interests: Declaration of Competing Interest None., (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.)

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.)

Individuals exhibiting high social anxiety (HSA) typically encounter challenges in identifying threatening stimuli with varying levels of intensity in different social scenes, ultimately affecting their social interactions. However, it is not well understood how social scenes, emotional intensity, and interaction influence the recognition of threat stimuli among HSA individuals (HSAs). To address this issue, a face recognition task was administered to 20 HSA participants and 22 individuals exhibiting low social anxiety (LSA) in this study. Results indicated that during the social scene presentation stage, HSAs produced larger P2 amplitude than LSA individuals (LSAs) no matter the valence of the scenes. During the face recognition stage, HSAs had smaller N170 amplitude than LSAs and exhibited lower recognition time for 2 % disgusted faces compared to LSAs. Furthermore, the consistency between scenes and faces led to faster recognition of disgusted faces in HSAs, but not in LSAs. Consequently, our findings suggested that HSAs exhibited unique cognitive processing patterns in social scenes, manifested by increased attention to scenes and decreased attention to faces. In addition, the emotional congruence between the scene and the faces could facilitate the recognition of faces by HSAs., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2024 Elsevier B.V. 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.)

Social anxiety disorder is a prevalent mental health condition that significantly impairs social interactions, academic performance, and professional functioning in children, adolescents, and youth. This study aimed to investigate the global prevalence of social anxiety disorder across these developmental stages. Six electronic databases (PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar) were systematically searched for studies related to the prevalence of social anxiety disorder in children, adolescents and youth. Random-effects models were employed for data analysis and Comprehensive Meta-Analysis Version 2.0. Heterogeneity was assessed using the I 2 index. A total of 38 studies were included in the final analysis. The global prevalence of social anxiety disorder was estimated to be 4.7% in children, 8.3% in adolescents, and 17% in youth. These findings suggest a progressive increase in the prevalence of SAD across these developmental stages. Considering the prevalence of social anxiety disorder in this study, policymakers can use the findings of this study to inform and develop effective prevention strategies for individuals and communities most susceptible to this disorder., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Individuals diagnosed with hemifacial spasm (HFS) frequently undergo noticeable alterations in their facial appearance. Such changes can detrimentally influence both their physical and psychological well-being. While prior studies have identified self-esteem and fear of negative evaluation (FNE) as key elements in social anxiety, their role in studies concerning body image and its correlation with social anxiety has been seldom explored. This research seeks to explore how self-esteem and FNE concurrently mediate the relationship between body image and social anxiety among Chinese individuals with HFS., Methods: Chinese patients with HFS (n=151) completed a cross-sectional questionnaire on the first day of admission that assessed body image, social anxiety, self-esteem, and FNE over the past week. Path analysis was used to test the hypothesis of the mediation model., Results: The hypothesized model showed that FNE was positively correlated with body image and social anxiety, while negative associations were found among body image, self-esteem and social anxiety. Self-esteem and FNE play a mediating role between body image and social anxiety., Conclusion: Our findings suggest that self-esteem and FNE may be important psychological pathways that affect body image and social anxiety in Chinese patients with HFS. Supplementing mental health services that help increase self-esteem and reduce FNE should be considered to improve the psychological quality of patients with HFS., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Cognitive behaviour therapy based on the Clark and Wells (1995) model is a first-line treatment for neurotypical people seeking support for social anxiety. While autistic people frequently report high social anxiety, it is unclear how appropriate the model is for this population., Methods: Over 300 autistic and non-autistic adults completed an online survey measuring key variables of the Clark and Wells model (socially-related negative thoughts, safety behaviours, self-focused attention). Using multiple regression and structural equation modelling, we assessed whether these variables accounted for the link between autism and social fears., Results: In multiple regression, autistic people experienced greater social fears than expected based on Clark and Wells variables, and safety behaviours were less predictive of social fears in autistic people. In structural equation modelling, Clark and Wells variables only mediated half the link between autistic traits and social fears. In exploratory analysis, we found that distress relating to uncertainty was an additional variable that needed to be taken into consideration in the relationship between autistic traits and social fears., Conclusion: The Clark and Wells variables were relevant in autism, but did not fully explain elevated social fears in autistic people, which suggests that other factors are also important in accounting for social anxiety in autistic people. This means that therapy informed by the model may not be optimal for autistic people. We recommend further research developing adapted therapy for social anxiety in autistic people., (© 2023. The Author(s).)

Background: Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD)., Methods: Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart., Results: There was evidence of same-symptom lagged effects (bs = 0.08-0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity., Limitations: Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD., Conclusions: Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Loneliness is linked to negative mental health outcomes like depression and social anxiety. However, it is unclear how loneliness and these conditions are connected. This study aims to address two questions: (a) Are there pathways connecting loneliness to these conditions? (b) What symptoms play a role in these pathways? Using network analyses, the study examined a representative sample of 962 adults from the UK (mean age = 46, females = 492). The network analysis revealed four dimensions: depression, social anxiety and two dimensions for loneliness (isolation and social connectedness). Two distinct pathways were identified for the transmission of symptoms between loneliness, social anxiety and depression. The depression-isolation pathway involved a node representing the perceived loss of social connections. The social anxiety-social connectedness pathway was characterised by intimate interaction contexts. These findings suggest that loneliness is associated with different symptom pathways, potentially contributing to comorbidity between loneliness, social anxiety and depression., (© 2024 The Authors. International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science.)

Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1-week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14-17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group-based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

The use of analogue samples, as opposed to clinical groups, is common in mental health research, including research on social anxiety disorder (SAD). Recent observational and statistical evidence has raised doubts about the validity of current methods for establishing analogue samples of individuals with clinically significant social anxiety. Here, we used data from large community samples of clinical and nonclinical participants to determine new cutoff scores on self-report measures of social anxiety symptoms and symptom-related impairment. We then examined whether using these newly determined cutoff scores alone or in combination improves the identification of individuals who have SAD from those who do not, revealing the most ideal cutoff combination to be 34 or above on the Social Phobia Inventory and 11 or above on the Sheehan Disability Scale. Finally, we compared the effects of our new cutoff scores with old cutoff scores by extracting analogue samples of participants with high social anxiety from historical data on seven large groups of undergraduate Psychology research participants from the authors' institution spanning the past 5 years (2018-2023). We observed that the new combined cutoff scores identified markedly fewer students as having high social anxiety, lending credibility to their utility. We also observed a striking increase in levels of social anxiety symptoms in the undergraduate population from before to after the COVID-19 pandemic. Of note, most participants were under 30 and identified as Caucasian or Asian women, indicating that future research is needed to examine whether our findings generalize to diverse populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Social anxiety (SA) is characterized by concerns about the expected occurrence (probability) and anticipated distress (cost) of social threats. Unclear is whether SA correlates specifically with biased expectations of belongingness or status threats., Aims: We aimed to discern if SA is uniquely tied to biased expectancies of either belongingness or status threats., Materials and Methods: We assessed 757 participants' perceptions of exclusion and put-down scenarios, analysing associations between SA and threat perceptions., Discussion: Our findings support the status-sensitivity hypothesis, suggesting individuals with high SA are particularly attuned to the perceived cost of status threats, potentially informing treatment approaches., Conclusion: Understanding SA's link to status concerns enhances therapeutic strategies, emphasizing the need to address status-related situations, cognitions, and emotions in interventions., (© 2024 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Social Anxiety Disorder (SAD) is an anxiety disorder characterized by excessive fear of scrutiny in social situations. Health students are more susceptible to SAD due to academic demands. They may resort to self-medication, particularly beta-blockers (BBs) for managing physical symptoms of SAD. The study aims to investigate the prevalence of beta-blocker use and its relationship with social anxiety disorder among health students at Umm Al-Qura University., Methods: In this cross-sectional study, 461 undergraduate health students participated in a questionnaire with 30 questions divided into three sections: The Social Phobia Inventory (SPIN), BBs usage behavior questionnaire, and demographic characteristics., Results: The study found 56.2% had SAD. A total of 7.8% of the sample reported using BBs, and no significant correlation was found between the usage of BBs and the SAD score (P = 0.085)., Conclusion: The study revealed significant relationships between the presence of SAD with gender, history of mental conditions, and correlation between the use of BBs with history of mental conditions. Although BBs usage is low among health students, the prevalence of SAD is alarming. The results could raise awareness about the need for early detection of SAD among health students., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Quronfulah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT-ED or post-treatment outcomes in CBT-ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target., Method: ED clients (N = 226) aged ≥16 years were treated with CBT-ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post-treatment., Results: Baseline SAD was a weak moderator of early and post-treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology., Discussion: Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre-treatment. SAD symptoms reduced over CBT-ED, but protocol enhancements such as exposure-based strategies that directly target co-occurring social-evaluative concerns may help achieve larger reductions in SAD symptoms., Public Significance: Eating disorders often co-occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by-product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

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., Competing Interests: Declaration of Competing Interest This study was part of a larger study for which Julian Schmitz and Brunna Tuschen-Caffier received funding by the German Research Foundation (grant numbers SCHM3056/2-1, TU78/5-1)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Social anxiety disorder is a common psychiatric condition that severely affects quality of life of individuals and is a significant societal burden. Although many risk factors for social anxiety exist, it is currently unknown how social fear sensitivity manifests biologically. Furthermore, since some individuals are resilient and others are susceptible to social fear, it is important to interrogate the mechanisms underpinning individual response to social fear situations. The microbiota-gut-brain axis has been associated with social behaviour, has recently been linked with social anxiety disorder, and may serve as a therapeutic target for modulation. Here, we assess the potential of this axis to be linked with social fear extinction processes in a murine model of social anxiety disorder. To this end, we correlated differential social fear responses with microbiota composition, central gene expression, and immune responses. Our data provide evidence that microbiota variability is strongly correlated with alterations in social fear behaviour. Moreover, we identified altered gene candidates by amygdalar transcriptomics that are linked with social fear sensitivity. These include genes associated with social behaviour (Armcx1, Fam69b, Kcnj9, Maoa, Serinc5, Slc6a17, Spata2, and Syngr1), inflammation and immunity (Cars, Ckmt1, Klf5, Maoa, Map3k12, Pex5, Serinc5, Sidt1, Spata2), and microbe-host interaction (Klf5, Map3k12, Serinc5, Sidt1). Together, these data provide further evidence for a role of the microbiota-gut-brain axis in social fear responses., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Social anxiety disorder (SAD) remains an understudied potential link between the cancer experience and adolescent and young adult (AYA) cancer survivors' poor psychosocial outcomes. We investigated the frequency and duration of, as well as factors associated with, symptoms of SAD among AYAs with cancer. Methods: This longitudinal, mixed-methods study involved online surveys (including a validated screening tool for SAD) at recruitment and 6 months later, and a structured clinical interview. Results: Twenty-eight AYAs (aged 12-30 years, <1-year postdiagnosis, 50% male) completed the first survey ( M  = 6 months postdiagnosis). About 32% reported clinically significant SAD symptoms. Fourteen completed the follow-up survey ( M  = 12 months postdiagnosis), of which 9 (62%) reported persistent or worse symptoms of SAD significantly associated with emotional distress, physical appearance concerns, negative social cognitions, and depression. Conclusion: A subset of AYAs with cancer may experience clinically significant SAD symptoms that can affect their psychosocial well-being. Further work on how to best identify and support AYAs with SAD is needed.

Background: Cognitive therapy for social anxiety disorder (CT-SAD) has extensive empirical support and is recommended in several national guidelines. However, ensuring access to evidence-based psychological therapies such as CT-SAD remains a global challenge. An internet-delivered version of this treatment protocol (iCT-SAD) has recently been developed in the UK as a way to overcome this challenge, demonstrating comparable outcomes to face-to-face CT-SAD whilst requiring less therapist time per client. Initial findings also suggest its cross-cultural transferability, but the previous studies in other cultural settings used the English language programme and only included English-fluent participants as a second language. It is not yet known what outcomes can be achieved once the programme has been translated and adapted for a different cultural context. Therefore, this trial aims to evaluate the clinical efficacy of Japanese iCT-SAD when combined with treatment as usual (TAU) in clients with SAD., Methods: This two-arm, parallel-group, superiority randomised controlled trial will recruit 60 Japanese participants with SAD, randomly assigning them to either Japanese iCT-SAD + TAU or TAU alone at a ratio of 1:1. The primary outcome measure is the self-report Liebowitz Social Anxiety Scale, and secondary.outcomes include other measures of social anxiety symptoms and processes, general mood and functioning, and response to treatment. We will also assess treatment acceptability and gather participant feedback. Assessments will take place at baseline (week 0), mid-treatment (week 8), and post-treatment (week 15), with a further 3-month follow-up (week 27) for the iCT-SAD + TAU arm. The primary analyses will be conducted on an intent-to-treat basis, comparing the primary and secondary outcome measures between groups using linear mixed-effect models, along with additional mediation analysis., Discussion: Investigating the efficacy of translated and culturally adapted iCT-SAD in different cultural contexts is an important step in evaluating the global reach of internet interventions. This trial will provide valuable insights into the effects of iCT-SAD combined with usual care, and how this treatment could be delivered in routine clinical settings in Japan., Trial Registration: International Standard Randomized Controlled Trials (ISRCTN), ISRCTN82859645, registered on January 19, 2024. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052702, registered on November 6, 2023., (© 2024. The Author(s).)

Background: According to the cognitive behavioral model of social anxiety, attentional bias to negative emotional information causes and maintains anxiety. The goal of attentional bias modification (ABM) is to reduce anxiety by reducing attention bias to negative emotional information., Method: We used questionnaires and experiments to explore the improvement effect of ABM training on social anxiety in college students. In Study 1, we used dot-probe tasks to investigate the attentional bias to negative emotional information and the relationship with social anxiety severity in college students. In Study 2, college students with high social anxiety were divided into two groups: attentional bias modification training task group (ABM) and attention control condition task group (ACC). The ABM group received a continuous intervention for 10 days to observe changes in social anxiety levels and attentional bias scores in the pretest and posttest stages., Results: The results showed that the correlation of attentional bias to negative emotional information and social anxiety severity was significant. Meanwhile, the high social anxiety participants responded more quickly to negative emotional information. After the intervention, social anxiety levels and attentional bias scores of the training group were significantly reduced., Conclusions: The results showed that attentional bias modification training can reduce attentional bias to negative emotional information in college students with social anxiety and effectively improve their social anxiety., (© 2024. The Author(s).)

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety., (Copyright © 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)