Generalized social phobia. Reliability and validity

OBJECTIVE: To investigate the reliability and validity of DSM-III-R "generalized" social phobia by examining interrater agreement and comparing patients with generalized and "nongeneralized" social phobia on demographic characteristics, clinical variables, and familial social phobia. DESIGN: Two senior clinicians classified 129 patients attending an anxiety clinic as having DSM-III-R social phobia that is generalized (fears most social situations) or nongeneralized (less than most) based on independent narrative review. RESULTS: Good reliability was achieved (kappa = 0.69). Patients with generalized social phobia were more often single, had earlier onsets of social phobia, had more interactional fears, and had higher rates of atypical depression and alcoholism. Familial social phobia was more common among patients with generalized social phobia than patients with nongeneralized social phobia and controls, with no difference between the latter two groups. CONCLUSIONS: Generalized social phobia (1) can be distinguished reliably from nongeneralized social phobia, (2) is a valid subtype, and (3) may characterize a familial form of the disorder.     

Sleep Deprivation in social phobia and generalized anxiety disorder

BACKGROUND: Sleep deprivation has been shown to improve depressive symptoms in some patients with major depressive disorder, but it has not been tested in patients with generalized anxiety disorder (GAD) or social phobia (SP). METHODS: To determine if sleep deprivation altered anxiety or depressive symptoms in patients with GAD (n = 7) or SP (n = 8), we sleep deprived patients and normal controls (n = 18) for one night. RESULTS: On one measure of anxiety, GAD patients improved compared with controls, but there were otherwise no significant change differences between controls and SP or GAD patients. CONCLUSIONS: The lack of benefit is consistent with previous findings that sleep deprivation provides no benefit to patients with other anxiety disorders. Sleep deprivation may be a biological intervention that distinguishes anxiety from affective disorders.     

Exposure and anxiety management in the treatment of social phobia.

Divided 45 18–65 yr old social phobia outpatients into 3 groups of 15 Ss each: Group 1 received exposure with anxiety management. Group 2 received exposure with a nonspecific "filler" treatment instead of anxiety management. Group 3 served as a waiting-list control. Results show that Groups 1 and 2 improved more than Group 3 and the improvement was maintained for 6 mo. At the end of treatment, Group 1 had lower scores than Group 2 on 2 cognitive measures of social anxiety. Six months later, Group 1 had lower scores on 4 additional measures. No S in Group 1 requested additional treatment within a year, while 40% of Group 2 did so. It is suggested that anxiety management increases the effect of exposure treatment because it helps Ss adapt to unpredictable situations, relaxation and distraction are useful techniques, and emphasis on self-help and rationale are important. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children.

The development, reliability, and validity of a new instrument, the Social Phobia and Anxiety Inventory for Children (SPAI-C), is described. The results indicate that the SPAI-C has high test–retest reliability and internal consistency. In addition, an assessment of concurrent and external validity indicates statistically significant correlations with commonly used self-report measures of general anxiety and fears and parental reports of children's anxiety and social competence. The results of a factor analysis indicate that the scale consists of three factors: Assertiveness/General Conversation, Traditional Social Encounters, and Public Performance. Finally, scores on the SPAI-C successfully differentiate socially anxious and non-socially-anxious children. The instrument appears to be a reliable and valid measure for childhood social anxiety and fear and may prove useful for improving clinical assessment and documenting treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional imagery in simple and social phobia: Fear versus anxiety.

In a 1st study, 60 phobic volunteer Ss reacted psychophysiologically with greater vigor to imagery of their own phobic content than to other fearful or nonaffective images. Imagery heart rate responses were largest in Ss with multiple phobias. For simple (dental) phobics, cardiac reactivity was positively correlated with reports of imagery vividness and concordant with reports of affective distress; these relationships were not observed for social (speech) phobics. In a 2nd study, these phobic volunteers were shown to be similar on most measures to an outpatient clinically phobic sample. In an analysis of the combined samples, fearful and socially anxious subtypes were defined by questionnaires. Only the fearful subtype showed a significant covariation among physiological responses, imagery vividness, and severity of phobic disorder. This fearful–anxious distinction seems to cut across diagnostic categories, providing a heuristic perspective from which to view anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of childhood social phobia: Construct, convergent, and discriminative validity of the Social Phobia and Anxiety inventory for Children (SPA-C).

The Social Phobia and Anxiety Inventory for Children (SPAI-C) has shown initial promise to assess childhood social fears. In this study, convergent validity was determined by comparing scores on the SPAI-C to daily diary ratings of social distress. Social phobic children scored significantly higher on the SPAI-C, reported more distressing events, and rated these events as more distressful when compared with normal peers. A positive relationship was found between SPAI-C scores and daily diary ratings. Discriminative validity was determined by comparing SPAI-C scores of social phobic children with normal controls and children with externalizing disorders. The SPAI-C successfully differentiated children with social phobia from those with externalizing disorders or no disorder. Finally, internal consistency and factor analytic outcome data are presented. Results are discussed in terms of the SPAT-C's usefulness as a clinical and research tool. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiology of fear imagery: Differences between focal phobia and social performance anxiety.

Studied 11 spider phobics and 16 speech anxious undergraduates who imaged fear scenes with spider and public-speaking content and a series of standard scenes that were constructed to vary in degree of emotional arousal and movement. Phobic levels were determined by the Fear Survey Schedule, the Speech Anxiety Questionnaire, and the Spider Fear Questionnaire. Both S groups did not differ on Taylor Manifest Anxiety Scale scores. Heart rate, skin conductance, and ocular activity were recorded. Spider phobics rated all imagery contents as more vivid and reported more scene movement than speech anxious Ss. Both groups responded to their own fear scenes with higher ratings of emotion and a greater physiological response than to the other group's fear scenes. The arousal response of spider phobics to relevant fear scenes was greater than that of speech anxious Ss. The data suggest that the outcome of imagery-based therapies may be partly determined by type of fear. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation of changes in anxiety and depression during treatment of social phobia.

To investigate the interactive process of changes in social anxiety and depression during treatment, the authors assessed weekly symptoms in 66 adult outpatients with social phobia (social anxiety disorder) who participated in cognitive- behavioral group therapy. Multilevel mediational analyses revealed that improvements in social anxiety mediated 91% of the improvements in depression over time. Conversely, decreases in depression only accounted for 6% of the decreases in social anxiety over time. Changes in social anxiety fully mediated changes in depression during the course of treatment. The theoretical and clinical implications of these findings for the relationship between anxiety and depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing social validity in clinical treatment research: Issues and procedures.

Social validity is a term coined by behavior analysts to refer to the social importance and acceptability of treatment goals, procedures, and outcomes. This article discusses dimensions of social validity, methods used to evaluate various aspects of social validity, and the applicability of these concepts and methods in clinical treatment research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopharmacologic treatment of panic, generalized anxiety disorder, and social phobia

The anxiety disorders discussed in this article are common, affecting 5% to 10% of the general population. They may cause significant distress and disability and are often complicated by substance abuse and depression. Fortunately, these disorders can be treated successfully in the majority of patients, with alleviation of the most distressing symptoms and significant improvement in occupational and social functioning. Systematic research studies during the past decade have identified both specific medication-responsive anxiety syndromes and a variety of psychopharmacologic agents effective in their management. Psychopharmacologic treatment, often in combination with cognitive-behavioral therapies, can be tailored for the individual patient based on that patient's specific anxiety syndrome, comorbid disorders, and vulnerability to side effects. Careful monitoring of target symptoms can be used to assess the efficacy of treatment. Future research will help to develop new classes of antianxiety agents for currently treatment-resistant patients, and to investigate further the necessary duration of psychopharmacologic treatment.     

Frequency and comorbidity of social anxiety and social phobia in adolescents. Results of a Bremen adolescent study

Using data from the Bremen Adolescent Study, this report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 German adolescents of 12-17 years of age. The adolescents were randomly selected from 36 schools in the city and provincial government area of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents had met the DSM-IV criteria for social phobia at some time in their life. More girls than boys were diagnosed as suffering from social phobia. The incidence of the disorder increased with age. The lifetime frequency of social fears is much higher. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia very often co-occurred with depressive disorders, somatoform disorders and disorders caused by excessive or inappropriate consumption of substances. Over 94% of those with social phobia and 54.4% with any social fears were severely impaired in their daily life during the worst episode. Despite the high level of psychosocial impairment, only a small portion of the cases received professional help.     

Effects of focus of attention on anxiety levels and social performance of individuals with social phobia.

Self-focused attention has been linked to social anxiety and poor social performance, but the causal direction of this relationship has not been established. For this study, focus of attention was manipulated during a speech task, conducted in pairs for 38 individuals with generalized social phobia. Results indicated that intensifying self-focused attention increased anticipated anxiety and anxious appearance, regardless of whether the individual was giving a speech or passively standing before the audience. The self-focus manipulation also increased self-reported anxiety during the task, but only for individuals assigned to a passive role. Contrary to expectation, self-focused attention did not affect any measure of social performance. These results indicate that self-focused attention may play a causal role in exacerbating social anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of change in methadone maintenance: Assessing the convergent validity of two measures.

This study compared 2 alternate measures of stage of change as conceived by J. O. Prochaska and C. C. DiClemente (see record 1983-26480-001). A sample of 276 methadone maintenance patients completed both categorical and dimensional measures of stage of change regarding quitting illicit drug use. The categorical measure places participants into 1 of 5 stages based on their stated intentions regarding future illicit drug use. The University of Rhode Island Change Assessment scale (URICA) provides continuous scores on 4 stage-of-change scales. Confirmatory factor analysis was used to assess the URICA's factor structure. The relationship between URICA scores and self-reported drug use was also assessed. Comparison of the URICA and the categorical measure using discriminant function analysis indicated limited convergence between the 2 measures and suggests that they may assess different aspects of readiness to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the social validity of behavioral interventions: A review of treatment acceptability measures.

Increased attention to the construct of social validity in school psychology research and practice has resulted in a focus on treatment acceptability, the extent to which interventions are considered appropriate, effective, and fair. Questionnaires represent the typical measurement approach to treatment acceptability. This article reviews treatment acceptability measures and practices that have been developed and used to assess the social validity of behavioral interventions. A comparative framework was developed and applied to provide a systematic critique of 9 treatment acceptability measures along such dimensions as content and purpose of the instrument, psychometric properties, scoring procedures and interpretation, and use of the measure in research in practice. No one instrument was selected to be the most comprehensive and it is argued that treatment acceptability assessment practices need to move beyond the traditional questionnaire format. Alternatives to rating scales are presented and directions for future research regarding the measurement of treatment acceptability are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory.

The development, reliability, and discriminative ability of a new instrument to assess social phobia are presented. The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived instrument incorporating responses from the cognitive, somatic, and behavioral dimensions of social fear. The SPAI high test–retest reliability and good internal consistency. The instrument appears to be sensitive to the entire continuum of socially anxious concerns and is capable of differentiating social phobics from normal controls as well as from other anxiety patients. The utility of this instrument for improved assessment of social phobia and anxiety and its use as an aid for treatment planning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blushing and physiological arousability in social phobia.

Blushing is the most prominent symptom of social phobia, and fear perception of visible anxiety symptoms is an important component of cognitive behavioral models of social phobia. However, it is not clear how physiological and psychological aspects of blushing and other somatic symptoms are linked in this disorder. The authors tested whether social situations trigger different facial blood volume changes (blushing) between social phobic persons with and without primary complaint of blushing and control participants. Thirty social phobic persons, 15 of whom were especially concerned about blushing, and 14 control participants were assessed while watching an embarrassing videotape, holding a conversation, and giving a talk. Only when watching the video did social phobic persons blush more than controls blushed. Social phobic persons who complained of blushing did not blush more intensely than social phobic persons without blushing complaints but had higher heart rates, possibly reflecting higher arousability of this subgroup. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change.

Objective: To assess the validity of the stages of change (SOC) algorithm for current smokers. Design: This study was a mail-based, cross-sectional survey study of 242 adult smokers. Main Outcome Measures: The main outcome measures were the SOC algorithm and a variety of alternative questionnaire items measuring motivation to quit smoking. Results and Conclusion: The results revealed that the SOC algorithm systematically underestimated motivation to quit smoking relative to a variety of other measures. Further, the stages of change do not appear to be qualitatively distinct categories. More than half the precontemplators were contemplating cessation, and many precontemplators intended to quit. Most contemplators were not merely contemplating cessation but rather were trying to quit currently. In summary, there is a divergence between the concepts underlying the SOC-precontemplation, contemplation, and preparation-and the operational definitions of these concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of gender differences in social phobia

The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations.     

The validity and reliability of the Violence Risk Scale-Sexual Offender version: Assessing sex offender risk and evaluating therapeutic change.

The Violence Risk Scale-Sexual Offender version (VRS-SO) is a rating scale designed to assess risk and predict sexual recidivism, to measure and link treatment changes to sexual recidivism, and to inform the delivery of sexual offender treatment. The VRS-SO comprises 7 static and 17 dynamic items empirically or conceptually linked to sexual recidivism. Dynamic items with higher ratings identify treatment targets linked to sexual offending. A modified stages of change model assesses the offender's treatment readiness and change. File-based VRS-SO ratings were completed on 321 sex offenders followed up an average of 10 years postrelease. VRS-SO scores predicted sexual and nonsexual violent recidivism postrelease and demonstrated acceptable interrater reliability and concurrent validity. A factor analysis of the dynamic items generated 3 factors labeled Sexual Deviance, Criminality, and Treatment Responsivity, all of which predicted sexual recidivism and were differentially associated with different sex offender types. The dynamic items together made incremental contributions to sexual recidivism prediction after static risk was controlled for. Positive changes in the dynamic items, measured at pre- and posttreatment, were significantly related to reductions in sexual recidivism after risk and follow-up time were controlled for, suggesting that dynamic items are indeed dynamic or changeable in nature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paroxetine in the treatment of generalized social phobia: open-label treatment and double-blind placebo-controlled discontinuation

Sixty-nine patients with traumatic knee hemarthrosis were evaluated an average of 3 days after trauma by high field (1.5T) magnetic resonance imaging (MRI) using sagittal T1, T2-weighted and coronal 3D-gradient echo images. All knees were arthroscopically examined shortly afterwards. The diagnostic validity of MRI for intraarticular pathology was determined using arthroscopy as golden standard. All patients had pathological findings on arthroscopy. The injuries were sports-related in 77% of the cases. MRI was highly sensitive (86%) and specific (92%) for diagnosis of anterior cruciate ligament tears. Diagnosis of medial meniscal tears showed a 74% sensitivity and 66% specificity. MRI detected lateral meniscal tears in 50% with an 84% specificity. As such, MRI missed 10 significant meniscus ruptures requiring surgical treatment. The sensitivity for partial or total medial collateral ligament tears was 56%, the specificity 93%. Rupture of the medial retinaculum in cases with patellar dislocation or significant damage of articular cartilage were only detected by MRI in a few cases (27% and 20% sensitivity, respectively). MRIs low diagnostic validity for intraarticular pathology with hemarthrosis may be attributed to the shifting paramagnetic properties of the blood remains and catabolic processes in meniscal and chondral tissues during the hemoglobin degradation process. Accordingly, MRI, with the technique used, could neither replace arthroscopy in the diagnosis and screening of acute knee injuries, nor select patients with need for immediate arthroscopic meniscal surgery.