Behavioral treatment of childhood social phobia.

Sixty-seven children (ages 8 and 12) with social phobia were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for social phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with social phobia and the durability of treatment effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia: A comparison of behavior therapy and atenolol.

72 social phobics were randomly assigned to behavioral (flooding) or drug treatment with atenolol or placebo. Treatment was administered over a 3-mo period of time, and duration of treatment effects was determined at a 6-mo follow-up assessment. Multiple measures of outcome were used, including self-report, clinician ratings (including assessment by independent evaluators), behavioral assessment, and performance on composite indexes. The results indicated that flooding consistently was superior to placebo, whereas atenolol was not. Flooding also was superior to atenolol on behavioral measures and composite indexes. Those Ss who improved during treatment maintained gains at the 6-mo follow-up regardless of whether they received flooding or atenolol. The variability of outcome on different measures in social phobia research is discussed, and the need for broad-based treatment strategies to address the pervasive deficits associated with social phobia is noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial.

A new cognitive therapy (CT) program was compared with an established behavioral treatment. Sixty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for social phobia were randomly assigned to CT, exposure plus applied relaxation (EXP = AR), or wait-list (WAIT). CT and EXP = AR were superior to WAIT on all measures. On measures of social phobia, CT led to greater improvement than did EXP = AR. Percentages of patients who no longer met diagnostic criteria for social phobia at posttreatment-wait were as follows: 84% in CT, 42% in EXP = AR, and 0% in WAIT. At the 1-year follow-up, differences in outcome persisted. In addition, patients in EXP = AR were more likely to have sought additional treatment. Therapist effects were small and nonsignificant. CT appears to be superior to EXP = AR in the treatment of social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial.

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking self-reported childhood behavioral inhibition to adolescent social phobia

OBJECTIVE: Behavioral inhibition in children has been hypothesized to be a risk factor for the later development of social phobia. However, this hypothesis has yet to be demonstrated in a prospective study. The purpose of the study presented here is to test whether behavioral inhibition in childhood constitutes a risk factor for social phobia during adolescence. METHOD: The sample consisted of 2,242 high school students assessed over a 4-year period. Assessments included self-report questionnaires, structured clinical interviews, and measurements of heart rate. Cox proportional hazards models were used to evaluate risk. RESULTS: Social avoidance, a component of behavioral inhibition, predicted onset of social phobia during high school. However, social avoidance was not related to depression in adolescence. Another component of behavioral inhibition, fearfulness, increased the risk for both social phobia and depression. Among subjects who were both socially avoidant and fearful, 22.3% developed social phobia--a risk more than four times greater than that for subjects with neither feature of behavioral inhibition. CONCLUSION: This prospective study demonstrates that behavioral inhibition in childhood increases the risk of social phobia in adolescence.     

Social skills, social outcomes, and cognitive features of childhood social phobia.

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7–14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The legend and myth of school phobia.

Many phrases are well-known for describing behavior problems in children and adolescents, but perhaps the one most overused and least understood is "school phobia." Although variously defined, school phobia has referred generally to children and adolescents avoidant of school due to overwhelming fearfulness. Given the construct's debatable discriminant validity, however, a critique of its clinical utility seems appropriate. The authors outline the historical development of school phobia, including the transition from viewing the problem as a syndrome to a symptom of general school refusal behavior. A review of the research evidence supports the contention that school phobia violates 2 contemporary criteria for a phobia, i.e., excessiveness and specificity. Given the questionable validity of the construct, recommendations are made regarding future classification, assessment, and treatment methods for youngsters with school refusal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Update on and Advances in Assessment and Cognitive-Behavioral Treatment of Anxiety Disorders in Children and Adolescents.

Most child psychologists would agree that treating anxiety disorders in children is extremely challenging at times but also rewarding. This article provides an updated look at assessment strategies and promising psychosocial treatment techniques for children with 3 common anxiety disorders: separation anxiety disorder, social phobia, and generalized anxiety disorder. The need for comprehensive diagnostic evaluations is highlighted through information on the wide range of assessment procedures and instruments available to practicing psychologists interested in treating anxious youth. In addition, a treatment approach shown to be empirically efficacious for treating anxious children, cognitive-behavioral therapy, is described. We provide practical examples of assessment and treatment techniques for clinical practice. Tables are included that can serve as useful quick references for the 3 areas covered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention training in individuals with generalized social phobia: A randomized controlled trial.

The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or neutral emotional expression cued different locations on the computer screen. In the attention modification program (AMP), participants responded to a probe that always followed neutral faces when paired with a threatening face, thereby directing attention away from threat. In the attention control condition (ACC), the probe appeared with equal frequency in the position of the threatening and neutral faces. Results revealed that the AMP facilitated attention disengagement from threat from pre- to postassessment and reduced clinician- and self-reported symptoms of social anxiety relative to the ACC. The percentage of participants no longer meeting Diagnostic and Statistical Manual (4th ed.) criteria for GSP at postassessment was 50% in the AMP and 14% in the ACC. Symptom reduction in the AMP group was maintained during 4-month follow-up assessment. These results suggest that computerized attention training procedures may be beneficial for treating social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study.

This article reports results from a universal preventive program aimed at (a) reducing social anxiety and (b) preventing the development of syndromal social anxiety among a population-based sample of older children and young adolescents during a 1-year period. Pupils (N = 1,748) from 2 counties were cluster randomized to either an intervention or a control condition. In the intervention condition, the Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)—which educates pupils, parents/guardians, teachers/school staff, and county health workers—was administered. The results indicate that NUPP-SA had a significant specific intervention effect for reducing social anxiety in the total sample as well as among the syndromal subjects. Further, significantly fewer subjects from the intervention county developed syndromal social anxiety during the 1-year period, thus showing a prevention effect. The results demonstrate the value of an intervention specifically aimed at reducing social anxiety and preventing the development of syndromal social anxiety among young people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of behavior modification with conduct problem children.

Evaluated a behavioral intervention program for conduct problem children with both behavioral and academic difficulties in elementary school. 16 Ss were each assigned to either a treatment or a "no-contact" control group. A standardized 20-hr treatment program involving the child, parents, and the teacher was provided by clinical psychologists. Both observational recordings and teacher ratings of social and academic behavior demonstrated that significantly greater behavioral improvement had occurred for treated than for control children. However, at a 9-mo follow-up, the control group had improved sufficiently that these differences were no longer significant. Although no differences existed between treated and untreated children in achievement test performance (California Achievement Test) or grades at termination, follow-up revealed that the treated Ss had significantly better achievement scores and grades 9 mo after termination. Ratings of therapists by teachers and parents were uniformly positive, and there were no dropouts during the 3-4 mo course of treatment. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Social phobia in youth: The diagnostic utility of feared social situations.

The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n = 50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n = 49), and youth without an anxiety disorder (n = 41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anxious solitude and peer exclusion predict social helplessness, upset affect, and vagal regulation in response to behavioral rejection by a friend.

It was hypothesized that combined individual child vulnerability (anxious solitude) and interpersonal stress (peer exclusion) would predict the strongest responses to experimentally manipulated behavioral peer rejection. Results indicated that in a sample of 3rd graders (N = 160, 59% girls), anxious solitary excluded children displayed more behavioral manifestations of social helplessness before and after behavioral rejection, reported more feelings of rejection in anticipation of and reaction to behavioral rejection, and were observably more upset during behavioral rejection than were normative children. Moreover, affective responses to behavioral rejection mediated the relation between anxious solitary excluded status and behavioral manifestations of social helplessness. Furthermore, anxious solitary excluded children versus anxious solitary children demonstrated excessive suppression of vagal tone and more sustained acceleration in heart rate during the experiment. Results also indicated that affective, social–cognitive, and regulatory processes directly contributed to children’s responses to behavioral rejection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent psychological and social predictors of young adult smoking acquisition and cessation: A 10-year longitudinal study.

Objective: A 10-year follow-up study to test the extent to which theory-based adolescent psychological and social factors directly predict and moderate the prediction of young adult smoking acquisition and cessation. Design: A prospective community-based sample. A total of 2,970 adolescents participated in the large Washington State Hutchinson Smoking Prevention Project (HSPP) longitudinal cohort. As predictors, psychological factors (i.e., parentnoncompliance, friendcompliance, rebelliousness, achievement motivation, and thrill seeking) and social environmental factors (i.e., parent's and friend's smoking) were measured when adolescents were 17–18 years old. Main Outcome Measures: As main outcome measures, smoking acquisition and cessation were assessed both at ages 18 and 28. Results: Psychological and social factors predicted 3% to 7% probability (p     

Cognitive Therapy Versus Fluoxetine in Generalized Social Phobia: A Randomized Placebo-Controlled Trial.

Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for generalized social phobia were assigned to cognitive therapy (CT), fluoxetine plus self-exposure (FLU + SE), or placebo plus self-exposure (PLA + SE). At posttreatment (16 weeks), the medication blind was broken. CT and FLU + SE patients then entered a 3-month booster phase. Assessments were at pretreatment, midtreatment, posttreatment, end of booster phase, and 12-month follow-up. Significant improvements were observed on most measures in all 3 treatments. On measures of social phobia, CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment. FLU + SE and PLA + SE did not differ. CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up. On general mood measures, there were few differences between the treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric CNS consultation model in a medical setting

This prospective follow-up study reports the outcome of children and adolescents discharged from short-term inpatient treatment based on teacher evaluations with Rutter's Questionnaire. There was a significant reduction in deviant behaviour between pretreatment and 5-month follow-up assessment but not between 5-month and 1-year follow-up. However, relatively few children fell within the normal range of non-clinically referred children. The child's more impaired general functioning, more frequent individual behaviour symptoms, antisociality and disengaged family interaction were associated with less favourable outcome. Pure affective or anxiety disorder predicted functioning within normal range and improvement in behaviour problems at follow-up. Treatment variables were not found to be associated with the outcome.     

Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time

Examined 9-month follow-up data obtained from children and adolescents with sickle cell disease (SCD) and their parents participating in a longitudinal study of pain coping strategies. Of 87 subjects completing the baseline assessment of pain coping strategies, 70 (80%) of their parents completed a structured pain interview assessing their child's health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for age and pain frequency revealed that baseline Coping Attempts were associated with higher levels of school, household, and social activity during painful episodes. Baseline Passive Adherence was associated with more frequent health care contacts during the subsequent 9 months. Increases in Negative Thinking over time were associated with further increases in health care contacts during the follow-up period. Comparing pain coping strategies assessed at baseline to pain coping strategies measured at follow-up revealed that pain coping strategies were relatively stable over time for younger children but changed more for adolescents.     

Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia

The aim of this work was to test the contribution of cognitive therapy to exposure in vivo in the group treatment of generalized social phobia. Seventy-one severely disabled social phobics, selected according to DSM-III-R criteria, were assigned at random to: (a) self-exposure in vivo, (b) self-exposure in vivo with cognitive therapy, or (c) a waiting-list control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-ups) was used. Additionally, half of the patients in both therapeutic groups were given self-help manuals for managing anxiety. Most patients that were treated (64%) showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic models. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of adding cognitive therapy or a self-help manual to exposure alone. Finally, several topics that may contribute to future research in this field are discussed.     

Reliability and validity of the Social Phobia and Anxiety Inventory for adolescents.

Although social anxiety is known to be common among adolescents, there are no self-report measures with demonstrated reliability and validity for this population. The Social Phobia and Anxiety Inventory (SPAI) is a measure of social anxiety developed for adults. The purpose of this study was to determine the reliability and validity of the SPAI for adolescents. The sample consisted of 223 adolescents (aged 12–18 yrs) from both clinical and community sources. Confirmatory factor analysis established the validity of the 2 separate factors of Social Phobia and Agoraphobia. Reliability estimates by Cronbach alpha were acceptable for the SPAI subscales and total. The SPAI demonstrated good construct validity, showing statistically significant relationships with independent measures of social phobia and other anxiety variables. The results demonstrate that the SPAI is a reliable and valid measure of social phobia for adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)