BACKGROUND: There are many studies that have documented the increasing impact of stress and anxiety on an individual’s health and well-being. Everyone handles stress and anxiety differently with these conditions having varying physiological effects. To better recognize whether or not a person may need help in tackling these conditions, scholars have developed reliable validated instruments. Two prominent instruments that effectively assess stress and anxiety levels are the Perceived Stress (PSS) and Generalized Anxiety Disorder (GAD-7) scales. Furthermore, the literature has shed light onto the importance of the carotid intima-media thickness (c-IMT) measurement as a tool in evaluating the risk of cardiovascular disease. After all, heart disease has been reported as being the number one killer of Americans in recent years. The specific aims of this study were to determine if there was an association between perceived stress / generalized anxiety and c-IMT (static association), and also if higher levels of perceived stress / generalized anxiety result in a significant increase in c-IMT (changes over time). METHODS: Data was collected on about 700 participants comprised of employees from Emory University in Atlanta, Georgia. At baseline, six, twelve, and twenty-four months, the largest number of participants had completed and calculated their scores on the PSS and GAD-7 scales. At these same time points, participants had their IMT measured and recorded for the left and right common carotid arteries by a trained sonographer of the Emory Predictive Health Institute. Due to incomplete measurements and scores, only 228 participants were included for statistical analyses. This was still considered a suitable sample size given that this study only involved four measurement time points. Various statistical models were fitted for the data. All variables in the models were treated as categorical except for time which was continuous. Four separate models were built that included the variables perceived stress, age group, gender and time. In a similar manner, four models were built that included the variables generalized anxiety, age group, gender and time. AIC values, -2 log-likelihoods, partial correlations, p-values, and other relevant information were reported for these models. All statistical analyses were performed using the Statistical Analysis System (SAS), version 9.2. RESULTS: The mean c-IMT measurements for the Emory participants were higher than established normal ranges. A strong correlation existed between the PSS and GAD-7 two-year averages when treated as continuous variables (.7316, p <.0001). Likewise, a meaningful relationship existed when both scales were categorical (.4154, p < .0001). The analyses revealed that the left and right mean IMT measurements for the common carotid arteries modeled a linear trend with an unstructured covariance the best. The partial correlations for perceived stress and generalized anxiety revealed weak, but significant positive associations with the mean c-IMT measurement. Although the slope coefficients were not significant for perceived stress, an increase from below average to above average perceived stress level still resulted in an increase in mean c-IMT measurement. Conversely, mild generalized anxiety was found to be statistically significant in the regression model of the left mean c-IMT. This was after controlling for age group and gender. The p-value for mild generalized anxiety was 0.0258, and the slope coefficient was 0.04856. IMT measurements were consistently higher for males on both sides compared to females. They were also higher on the left side compared to the right. CONCLUSIONS: Failure to control anxiety could lead to c-IMT soaring to dangerous levels resulting in a myocardial infarction and/or cerebrovascular accident. Individuals should engage in healthy lifestyle practices that lower stress and anxiety levels to decrease the chances of cardiovascular disease. Based on this study’s findings, a person can certainly use their c-IMT readings, as well as their perceived stress and generalized anxiety scores, as indicators that lifestyle modifications may be needed.

Title from second page of PDF document. Includes bibliographical references (p. 103-109).

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

O transtorno de ansiedade social (TAS) ou fobia social se caracteriza por ansiedade e medo excessivos em relação à situação social. Os indivíduos diagnosticados com TAS evitam às situações sociais temidas ou as suportam com imenso medo ou ansiedade. Além disso, sentem uma forte sensação de insuficiência e de inadequação diante do outro, também têm um medo excessivo do julgamento alheio, por supor que ele seja sempre desfavorável. Estudos epidemiológicos indicam que o TAS tem grande impacto funcional negativo, tanto social quanto educacional e ocupacional. Os fóbicos sociais, normalmente, recorrem ao saber médico que tende a apresentar uma resposta clara e objetiva: trata-se de um transtorno neurobiológico que deve ser tratado via medicação. A psicanálise se contrapõe às pretensões da ciência de reduzir o ser humano ao corpo biológico e à sedação indiscriminada do sofrimento psíquico através de psicofármacos. Diante disso, o objetivo deste trabalho é abordar o TAS sob a perspectiva da psicanálise. Esse trabalho se baseia em um modelo de pesquisa qualitativa em psicanálise, que permite compreender os fenômenos em sua complexidade. Segundo Freud, a fobia é um meio encontrado pelo indivíduo para se livrar da angústia, que é produzida pelo ego frente à ameaça de castração. O que ocorre na fobia, no fundo, é a substituição de um perigo interno, pulsional, por um externo, perceptivo. Através do conceito de narcisismo, Freud pôde concluir que os sentimentos de inferioridade e de insuficiência, bem presentes no TAS, são decorrentes da impossibilidade de satisfação narcísica através do ideal do ego e da dificuldade de obter satisfação da libido objetal. Já o conceito de superego lhe permitiu compreender que o neurótico atribui ao outro o olhar vigilante do superego, assim como seus julgamentos e suas censuras. Por isso, o fóbico social teme tanto o olhar alheio e tem a sensação clara de estar sendo observado pelo outro. Esse quadro foi denominado por Freud de delírio de observação, o qual revela o quanto a realidade psíquica é composta por fantasias que para o indivíduo adquire o mesmo estatuto de realidade da percepção. A partir dessas considerações, o transtorno de ansiedade social seria, para a psicanálise, uma tentativa do indivíduo de solucionar seu conflito psíquico. Diante da relevância deste quadro, a psicanálise, por meio de sua teoria e de sua prática clínica, pode contribuir para o alívio desse sofrimento humano / The social anxiety disorder (SAD) or social phobia is characterized by an excessive anxiety and fear towards the social situation. The individuals that are diagnosed with SAD avoid the feared social situations or they endure it with an immense fear and anxiety. Moreover, they feel a strong sensation of insufficiency and inadequacy towards others, they also have a great amount of fear of being judged, for supposing that they will always be negatively evaluated. Epidemiological researchs indicate that SAD has a great negative functional impact, in the social, educational and occupational areas. The social phobics usually look for a physician, who generally have a clear and objective answer: it is a neurobiological disorder that must be treated with medication. The psychoanalysis opposes the science´s pretension of reducing the human being to the biological body and to the indiscriminated use of medication to mitigate the psychic suffering. Therefore, the purpose of this thesis is to understand how the psychoanalysis perceives the SAD. This study is based on a qualitative psychoanalysis research, which allows the understanding of the phenomena in its complexity. According to Freud, the phobia is a way that the individual finds to get rid of the anguish that is produced by the ego when dealing with the castration threat. What truly occurs in the phobia is the substitution of an internal, pulsional, fear for an external, perceptive, one. Through the concept of narcisism, Freud could conclude that the feelings of inferiority and insuficiency, widely present on SAD, are consequences of the impossible narcissistic satisfaction through the ideal of the ego and the difficulty of obtaining the objectal libido satisfaction. And the concept of superego allowed him to understand that the neurotics attribute to the other the scrutiny eye of the superego, as well as its judgments and censure. Therefore, the social phobic fears the scrutiny from others and has the clear sensation of being observed by others. Freud has called these symptons observational delirium, which reveals how much of the psychic reality is composed by fantasys, that acquires the same status of the perception´s reality for the individual. From these considerations, the social anxiety disorder would be, for psychoanalysis, an attempt of the individual to solve his psychic conflict. Given the importance of this matter, psychoanalysis, through its theory and clinical practice, may contribute to the mitigation of this human suffering

Despite evidence supporting a robust relation between common factors- aspects of the therapeutic setting that are common across all types of treatment- and treatment response, little is known about the mechanisms by which these common factors effect change. Two of the most well-researched common factors include the client’s expectations about the effectiveness of treatment (termed outcome expectancy), and the quality of the therapeutic relationship (termed working alliance). Using archival data, the present study tests the hypothesis that the relation between outcome expectancy and symptom reduction is mediated by the alliance following treatment for social anxiety disorder. Data were collected in a sample of 65 individuals who received cognitive behavioral therapy for social phobia with public speaking fears. Mediation analyses were conducted using Andrew Hayes’ Process Macro (Hayes, 2013). None of the mediation analyses were significant. These findings suggest that the mechanisms of common factor variables may vary by disorder.

Abstract The primary aim of the current study was to examine social anxiety symptoms in high-functioning children and adolescents, ages eight to 17 years old with autism (HFA) or Asperger syndrome (AS). The second aim was to study emotion recognition skills in children and adolescents with HFA/AS. In addition, two internationally used social anxiety questionnaires (The Social Phobia and Anxiety Inventory for Children and; The Social Anxiety Scale for Children -revised) were translated into Finnish, and psychometric analyses were performed in order assess the research and clinical utility of these measures as novel tools for the study of child social anxiety in Finland. Results suggest that adolescents, in particular, with HFA/AS experience a greater number of social anxiety symptoms and have increased rates of clinically relevant social anxiety disorder (SAD) than do their control counterparts. Parents reported higher levels of anxiety symptoms in their children with HFA/AS regardless of the child’s age; however, individuals with HFA/AS self-reported anxiety symptoms increased later in their development (i.e., adolescence). In addition, overall facial emotion recognition increased with age in the HFA/AS group. Despite this, the HFA/AS group did not reach the higher ability level attained by the typically developing adolescents regardless of age. Specifically, when the facial emotion expressed a combination of both surprise and fear, participants with HFA/AS labelled the facial expression as “fear” statistically significantly more often than did controls. Moreover, control participants interpreted faces which blended sadness and neutral emotions as neutral more often than HFA/AS participants. Results suggest that social anxiety is clinically important to assess in children and adolescents with HFA/AS. Clinical interventions which enhance emotion recognition skills and reduce social anxiety symptoms in individuals with HFA/AS may be warranted. / Tiivistelmä Tutkimuksen päätarkoituksena oli selvittää sosiaalista ahdistuneisuutta 8–17-vuotiailla hyvätasoisilla lapsilla ja nuorilla, joilla on autismi (HFA) tai Aspergerin oireyhtymä (AS). Tutkimuksen toinen tarkoitus oli selvittää, miten HFA- ja AS-lapset ja nuoret kykenevät tunnistamaan tunteita kasvonilmeistä. Tutkimus arvioi myös kahden kansainvälisesti tunnetun, sosiaalista ahdistuneisuutta mittaavan kyselylomakkeen (The Social Phobia and Anxiety Inventory for Children ja The Social Anxiety Scale for Children -revised) toimivuutta suomalaisessa väestössä. Tavoitteena oli antaa uusia työvälineitä suomalaiselle lastenpsykiatrialle tutkimus- ja kliiniseen työhön. Tutkimustulokset osoittivat HFA- ja AS-nuorten kokevan muita nuoria useammin sosiaalista ahdistuneisuutta. Vanhemmat havaitsevat HFA- ja AS-lastensa sosiaalisen ahdistuneisuuden oireet lapsen iästä riippumatta, kun lapset itse kertoivat oireistaan vasta nuoruusiässä. Tutkimus osoitti myös, että HFA:ta tai AS:ää sairastavien kyky tunnistaa tunteita paranee iän myötä. Se ei kuitenkaan saavuta tavalliseen tapaan kehittyvien lasten taitotasoa nuoruusikään mennessä. HFA- ja AS-lapset ja nuoret tulkitsevat ikätovereitaan useammin kasvojen ilmeen peloksi silloin, kun kasvojenilme on sekoitus pelko-yllättyneisyyttä. Tavalliseen tapaan kehittyneet lapset ja nuoret tulkitsevat kasvojenilmeen useammin neutraaliksi kuin HFA tai AS diagnoosin saaneet, jos kasvojenilme on sekoitus surullinen-neutraalia. Tutkimustulosten perusteella tulee HFA:ta tai AS:ää sairastavia lapsia ja nuoria hoidettaessa ottaa huomioon sosiaalinen ahdistuneisuus. Heille tulisi nykyistä useammin tarjota tilaisuus myös kuntouttaa kykyä tunnistaa toisten ihmisten tunteita.

Social anxiety disorder has several impairments (including attention bias in ratings of facial expressions). Character strengths has been seen to increase well-being and functioning among healthy individuals. With this in mind, three aims were stated; Is there a relation between SAD and VIA, can this relation be explained by confounding’s and does ratings of faces tell anything about the relation? Data were collected through a survey from 41 participants (13 men) with a mean age of 30 years. Correlation and regression models were performed to see if these constructs were related. The findings showed that character strengths and social anxiety were correlated, and that the regression model did not predict SAD. The regression model for Via were significant with all confounding variables. Ratings of facial expression were not related to any variables. Further studies need to look more into this correlation to see the underpinnings of these constructs.

Magister Psychologiae - MPsych / Increased rates of alcohol abuse and childhood trauma have been reported in previous studies of anxiety disorders, and social anxiety disorder (SAD) in particular. Yet the exact nature of this relationship remains unclear. This study aimed to assess whether SAD is a risk factor for later development of alcohol use disorders (AUD) and to investigate the association of childhood trauma with the prospective SAD-AUD comorbidity in adults with SAD. Data from fifty seven adult participants (N=57) with a primary diagnosis of SAD (mean age 36.7; 60% male) completed the self-rated Childhood Trauma Questionnaire (CTQ) as well as the Liebowitz Social Anxiety Scale (LSAS), a measure of SAD symptom severity. Alcohol abuse and dependence information were assessed with the Structured Clinical Interview for Axis I Disorders-Patient Version (SCID-I/P). Data from sixty two adult age and gender match controls were used as a comparison group. A Cognitive Behavioural Model and the Social Learning Model are the theoretical frameworks utilised in the conceptualisation of this research. The data is quantitative in nature and will be statistically analysed using descriptive statistics, logistic regression and ANOVA using the Statistical Package for the Social Sciences (SPSS) version 17.0. Informed consent was obtained in writing from all participants. The findings of the study were that 73.7% of the SAD sample met severity criteria for at least one type of childhood abuse or neglect as measured by the CTQ subscales using previously established thresholds. Physical neglect was found to be significantly associated with increased SAD symptom severity.17.5% of the SAD sample had a comorbid lifetime alcohol use disorder (AUD) and of those 80% reported experiencing childhood trauma. In conclusion there was a high rate of childhood trauma in individuals with SAD and there is a strong association between childhood trauma and comorbid AUDs in those with SAD.Thus screening for childhood trauma in SAD individuals is clinically prudent.