Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype bears conceptual similarities with prior accounts of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar etiologic origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has systematically evaluated the common and potentially distinguishing factors within and between these conceptually similar but diagnostically distinct groups. For example, cognitive features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these distinguishing features to clarify the differential diagnosis remains unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to empirically establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or alternatively whether specific features of each disorder can be used to disambiguate them empirically. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success. / M.S. / Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype has conceptual similarities with descriptions of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has evaluated the common and potentially distinctive factors within and between these distinct groups. For example, features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these differentiating features to clarify the differential diagnosis is unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or whether specific features of each disorder can be used to differentiate them. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success.

Social Anxiety Disorder is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, the core, maladaptive cognition is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets remediation of intense and unfounded FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. The degree to which FNE and biased attention are related processes is unknown. This study sought to assess the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). In addition, this study examines differences in attention bias between a clinically confirmed group of youth SAD and healthy controls. A significant group difference in average latency to fixate on angry faces was found [F(1,65) = 31.94, p < .001, ηp2 = .33]. However, the pattern was not consistent across the other attention bias metrics (i.e., dot probe bias scores and first fixation direction percentage towards angry faces). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions and implications of these findings within the context of refinements to existing interventions are discussed. / Master of Science / Social Anxiety Disorder (SAD) is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, a main feature of the disorder is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. However, the degree to which FNE and biased attention are related processes has not been studied. This study examined the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). This study also examines differences in attention bias between a youth with SAD and healthy youth (no psychological diagnoses). Group differences were found for only one attention bias measure (i.e., youth with SAD were quicker to look at anger faces relative to non-anxious youth). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions of these findings are discussed.

The present study examined the social skills and social acceptance of children with SAD (n=20), children with GAD (n=18), and typically developing (TD) children (n=20). A multimodal assessment paradigm was employed to address three study objectives: (a) to determine whether social skills deficits are unique to children with SAD or extend to children with GAD, (b) to assess whether skills vary as a function of social context (in vivo peer interaction Wii Task versus hypothetical Social Vignette Task) and (c) to examine the relationship between anxiety diagnosis and social acceptance. Parent questionnaire data indicated that both youth with SAD and GAD experienced difficulties with assertiveness, whereas children with SAD experienced a broader range of social skills difficulties. Blinded observers’ ratings during the behavioral assessment social tasks indicated that compared to children with GAD and TD children, children with SAD have deficits in social behaviors and social knowledge across settings, including speech latency, a paucity of speech, few spontaneous comments, questions and exclamations, and ineffective social responses. In addition, vocal analysis revealed that children with SAD were characterized by anxious speech patterns. By comparison, children with GAD exhibited non-anxious speech patterns and did not differ significantly from TD youth on social behaviors, with the exception of fewer spontaneous comments and questions. Lastly, children with SAD were perceived as less likeable and less socially desirable by their peers than both children with GAD and TD children. Clinical implications of these findings are discussed

Background: Social anxiety disorder (SAnD) is a highly prevalent condition, characterised by an intense fear of social or performance situations where individuals worry about being negatively evaluated by others. An up to date systematic review of the effectiveness of cognitive behavioural therapies for SAnD is required to guide practice. Objectives: To assess the efficacy and acceptability of cognitive behavioural therapy (CBT) compared with treatment as usual/waiting list (TAU/WL) for individuals with SAnD. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, and international trial registers (ICTRP; ClinicalTrials.gov) in October 2011 and CINAHL in October 2012. We also searched reference lists of retrieved articles, and contacted trial authors for information on ongoing/completed trials. Selection criteria: Randomised and quasi-randomised controlled trials undertaken in out-patient settings, involving adults aged 18-75 years with a primary diagnosis of SAnD, assigned either to CBT or TAU/WL. Data collection and analysis Data on patients, interventions and outcomes were extracted by two review authors independently, and the Risk of bias in each study was assessed. The primary outcomes were social anxiety reduction (based on relative risk (RR) of clinical response and mean difference in symptom reduction), and treatment acceptability (based on RR of attrition). Results: Thirteen studies (715 participants) were included in the review, of which 11 studies (599 participants) contributed data to meta-analyses. Based on four studies, CBT was more effective than TAU/WL in achieving clinical response at post-treatment (RR 3.60, 95% CI 1.35 to 9.57), and on eleven studies (599 participants) it was more effective than TAU/WL in reducing symptoms of social anxiety. No significant difference was found between CBT and TAU/WL for attrition. No significant difference was demonstrated for social anxiety at follow-up and no studies examined follow-up data for clinical response or attrition. Authors' conclusions: The available evidence suggests that cognitive behavioural therapy might be effective in reducing anxiety symptoms for the short-term treatment of SAnD. However, the body of evidence comparing CBT with TAU/WL is small and heterogeneous.

Social anxiety disorder is the third most common mental disorder with the lifetime prevalence rate of 13.3% in the US population. Typically, it causes significant impairment in a wide range of functioning and follows a chronic, unremitting course if untreated. Over the past two decades, there has been a dramatic increase in clinical research aimed at examining underlying mechanisms maintaining social anxiety. One line of research has investigated attentional biases in social anxiety, using various cognitive experiment paradigms, including the emotional Stroop and the modified dotprobe tasks. However, overall findings are equivocal about the nature of attentional biases in social anxiety and several methodological problems limit the interpretability of the data. The present study examined attentional biases associated with social anxiety using a new research paradigm in the field of anxiety disorders: the inattentional blindness paradigm. This paradigm presents a social cue in the absence of the subjects’ expectation while they are engaged in a cognitively demanding task, thereby enabling the more purely attentional aspect of information processing to be examined reducing the influence of potential response biases or effortful strategies. Two independent experiments were conducted using nonclinical student samples consisting of individuals high in social anxiety (HSAs) versus individuals low in social anxiety (LSAs) based on the static and sustained inattentional blindness tasks. Overall, results revealed that HSAs were more likely to detect or identify a socially-threatening cue, relative to LSAs; whereas LSAs were more likely to detect or identify a non-threatening social cue, relative to HSAs. These findings were observed only in the presence of a bogus-speech manipulation. These data suggest the promising utility of the inattentional blindness paradigm in investigating attentional biases in social anxiety and perhaps other psychopathological conditions. Theoretical and clinical implications are discussed. / text

Major Depression (MD) and Generalized Anxiety Disorder (GAD) are psychiatric disorders that arise from dysfunction of the core human capacities for emotion. Sapience is inextricably bound up with the potential for feelings of regret, worry and concern. When these emotions lead to clinically significant impairment or distress, they may result in one or both of the disorders of MD and GAD. The occurrence of MD and GAD in the same person, known as comorbidity, is remarkably high; substantially higher than would be expected by chance. MD and GAD have been studied since the mid-20th century, resulting in a substantial body of literature. The personality trait of neuroticism is also known to correlate highly with these disorders. This project was designed to compare the etiological structure of MD and GAD using a range of psychosocial and genetic methods in three datasets, while also assessing the correlated trait of neuroticism. Results are used to inform theoretical formulation of an approximate model of comorbidity for the two disorders. Psychosocial findings suggest that MD and GAD have similar relationships with most risk factors, and that neuroticism displays results consistent with it composing a portion of the liability to MD and GAD. Efforts to detect specific genetic loci involved in the etiology of MD and GAD are modestly successful. Two genome-wide significant variants were found for MD (one already identified in the literature); two for GAD, and one for neuroticism. There were also a number of significant genomic regions for each outcome. The use of aggregate genetic methods to estimate heritability based on genotypes was less successful. Estimation was only successful in one sample of the three, and produced modest estimates of heritability (0.2-0.25) for MD and comorbid MD+GAD. Genetic correlation was estimated to be very high between neuroticism and MD. Models of comorbidity are evaluated in light of these results, and a model comprising multiple liability distributions, one shared entirely by MD and GAD, and two additional correlated ones for the two disorders, with reciprocal phenotypic causation, is deemed most consistent with observed evidence.

Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.

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

Acid-sensing ion channel 1A (ASIC1A) is abundant in the nucleus accumbens (NAc), a region known for its role in addiction. Because ASIC1A has been previously suggested to promote associative learning, we hypothesized that disrupting ASIC1A in the NAc would reduce drug-associated learning and memory. However, contrary to this hypothesis, we found that disrupting ASIC1A in the NAc increased cocaine-conditioned place preference, suggesting an unexpected role for ASIC1A in addiction-related behavior. Investigating the underlying mechanisms, we identified a novel postsynaptic current during neurotransmission mediated by ASIC1A and ASIC2 and thus well-positioned to regulate synapse structure and function. Consistent with this possibility, disrupting ASIC1A altered dendritic spine density and glutamate receptor function, and increased cocaine-evoked plasticity in AMPA-to-NMDA ratio, all resembling changes previously associated with cocaine-induced behavior. Together, these data suggest ASIC1A inhibits plasticity underlying addiction-related behavior, and raise the possibility of therapies for drug addiction by targeting ASIC-dependent neurotransmission. The amygdala plays critical roles in the learning and expression of fear-related behavior. Previous studies have implicated the amygdala in CO2-evoked fear-like behavior in mice; however, a more recent study demonstrated that humans lacking the amygdala bilaterally experience fear and panic with CO2-inhalation. Because all subjects lacking the amygdala had panic attacks after inhaling CO2 compared to only 25% of controls, this data suggests the amygdala may play an inhibitory role in CO2-evoked panic. To assess the role of the amygdala in CO2-evoked behaviors in mice, we lesioned the amygdala and optogenetically stimulated different amygdalar nuclei. We found that large unilateral and bilateral amygdala lesions caused the emergence of escape-like jumping behavior in mice exposed to CO2 and a relative deficit in CO2-evoked freezing. This jumping behavior depended on the dorsal periaqueductal gray, a brain area previously associated with panic attacks. Additionally, the putative CO2 chemosensor ASIC1A and ASIC2 are not necessary for CO2-evoked jumping, and may even play an inhibitory role in this behavior. Optogenetic manipulation of the amygdala revealed that stimulation of the basolateral amygdala enhanced jumping behavior and inhibited freezing behavior. This may be due to the basolateral amygdala's ability to inhibit the main output center of the amygdala, the central nucleus. Together, these results suggest that different amygdalar nuclei differentially modulate CO2-evoked behavior by regulating the switch between mobile and immobile defense responses. Additionally, they provide additional evidence that amygdalar dysfunction may contribute to panic disorder.

Background: Anxiety in the workplace is a special problem as workplaces are especially prone to provoke anxiety: There are social hierarchies, rivalries between colleagues, sanctioning through superiors, danger of accidents, failure, and worries of job security. Workplace phobia is a phobic anxiety reaction with symptoms of panic occurring when thinking of or approaching the workplace, and with clear tendency of avoidance. Objectives: What characterizes workplace-related anxieties and workplace phobia as domain-specific mental disorders in contrast to conventional anxiety disorders? Method: 230 patients from an inpatient psychosomatic rehabilitation center were interviewed with the (semi-)structured Mini-Work-Anxiety-Interview and the Mini International Neuropsychiatric Interview, concerning workplace-related anxieties and conventional mental disorders. Additionally, the patients filled in the self-rating questionnaires Job-Anxiety-Scale (JAS) and the Symptom Checklist (SCL-90-R)measuring job-related and general psychosomatic symptom load. Results: Workplace-related anxieties occurred together with conventional anxiety disorders in 35% of the patients, but also alone in others (23%). Workplace phobia could be found in 17% of the interviewed, any diagnosis of workplace-related anxiety was stated in 58%. Workplace phobic patients had significantly higher scores in job-anxiety than patients without workplace phobia. Patients with workplace phobia were significantly longer on sick leave in the past 12 months (23,5 weeks) than patients without workplace phobia (13,4 weeks). Different qualities of workplace-related anxieties lead with different frequencies to work participation disorders. Conclusion: Workplace phobia cannot be described by only assessing the general level of psychosomatic symptom load and conventional mental disorders. Workplace-related anxieties and workplace phobia have an own clinical value which is mainly defined by specific workplace-related symptom load and work-participation disorders. They require special therapeutic attention and treatment instead of a “sick leave” certification by the general health physician. Workplace phobia should be named with a proper diagnosis according to ICD-10 chapter V, F 40.8: “workplace phobia”. / Hintergrund: Angst am Arbeitsplatz ist ein spezielles Phänomen, da Arbeitsplätze ihrer Natur nach angstauslösende Charakteristika aufweisen: Vorgesetzte die sanktionieren, Rangkämpfe mit Kollegen, reale Unfallgefahren, Scheitern und Leistungsversagen, Unklarheit um plötzliche Veränderungen, Arbeitsplatzunsicherheit. Arbeitsplatzphobie ist eine phobische Angstreaktion mit Panikerleben beim Gedanken an oder bei Annäherung an den Arbeitsplatz. Fragestellung: Was charakterisiert arbeitsplatzbezogene Ängste und Arbeitsplatzphobie als lebensbereichsspezifische Angsterkrankungen in Abgrenzung zu klassischen Angsterkrankungen? Methode: 230 Patienten einer stationären psychosomatischen Rehabilitation wurden im halbstrukturierten Interview (Mini-Arbeits-Angst-Interview, Mini International Neuropsychiatric Interview) hinsichtlich arbeitsplatzbezogener Ängste und klassischer psychischer Erkrankungen befragt. Selbsteinschätzungsurteile wurden hinsichtlich des Schweregrads der arbeitsbezogenen (Job-Angst-Skala, JAS) und allgemeinen psychosomatischen (Symptom-Checkliste, SCL-90-R) Symptombelastung erhoben. Ergebnisse: 58% der befragten Patienten litten an mindestens einer arbeitsplatzbezogenen Angstvariante. Arbeitsplatzbezogene Ängste kamen bei 35% der Befragten zusammen mit einer klassischen Angsterkrankung vor, bei 23% jedoch als allein stehende Angsterkrankung. 17% der Befragten erfüllten die Kriterien einer Arbeitsplatzphobie. Arbeitsplatzphobie-Patienten hatten signifikant höhere Job-Angst-Werte als Patienten ohne Arbeitsplatzphobie, und sie waren signifikant länger arbeitsunfähig in den letzten 12 Monaten (23,5 Wochen versus 13,4 Wochen). Schlussfolgerung: Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie haben eine spezielle klinische Wertigkeit, die sich anhand arbeitsbezogener Partizipationsstörungen und spezifischer arbeitsbezogener Symptombelastung beschreiben lässt. Arbeitsplatzphobie erfordert besondere therapeutische Herangehensweisen anstelle von angsterhaltender da Vermeidungsverhalten fördernder „Krankschreibung“. Arbeitsplatzphobie sollte als Diagnose benannt werden entsprechend ICD-10 Kapitel V, F 40.8: “Arbeitsplatzphobie”.