Children with Social Anxiety Disorder (SAD) characterized by persistent shyness and anxiety in social or performance situation, exhibit social skills deficits. These deficits include difficulty initiating conversations, maintaining eye contact, and taking turns when speaking, which in turn leads to impairments in their daily interactions and development of peer relationships (Greco, 2005; Miers, 2010). Although there are many subjective assessments for treatment outcomes for children with SAD, in order to become more thorough and effective when assessing treatment outcomes, more objective measures of actual behaviors are needed. This study uses digital vocal analysis to examine vocal parameters associated with anxiety such as pitch and volume in children with SAD pre and post treatment. Measuring vocal parameters during role-play behavioral assessment tasks allowed us to examine whether the software was capable of detecting differences in vocal characteristics that are consistent with the clinical presentation of the disorder. Children with SAD showed differences in vocal characteristics pre to post treatment, in regards to pitch, pitch variability, volume, and volume variability. There were significant changes in volume pre to post treatment, however the changes in pitch, pitch variability, and volume variability were not significant. These results suggest that post SET-C treatment, certain vocal characteristics, (one of the social skills deficits exhibited by children with SAD) improved. Implications of the findings are discussed.

Thesis (Ph.D.)--Boston University / Although meta-analytic studies support the efficacy of cognitive-behavioral therapy for social anxiety disorder, a proportion of patients drop out of treatment or fail to benefit. Research to date has explored patient- and treatment-specific predictors of poor treatment response, including comorbid depression, but has not evaluated variables related to the patient's social environment. Expressed emotion (EE), an index of critical, hostile, and overprotective attitudes expressed by a significant other toward an individual with a psychiatric or medical condition, has been found to predict psychiatric relapse and poor treatment outcome in a wide range of disorders. Because EE and a closely related construct, perceived criticism, have been shown to predict treatment outcome and course in anxiety and mood disorders, it was expected that EE and perceived criticism would also predict treatment outcome in social anxiety disorder. Forty patients undergoing 12-session group cognitive-behavioral therapy for social anxiety disorder completed questionnaires about their symptoms of social anxiety and depression, and levels of perceived criticism, before and after treatment. Each participant designated one significant other who was then assessed for EE using the Camberwell Family Interview, a semi-structured interview method. Results indicate that higher initial severity of social anxiety and lower levels of perceived criticism predicted treatment dropout. There was also a trend for participants with a significant other rated as high in emotional overinvolvement, one of the EE-subscales, to show less change on a composite measure of anxiety symptoms. Comorbid depression and critical EE were associated with pretreatment severity of social anxiety but not outcome. These findings add to an increasing body of literature showing that the manifestation of significant others' EE, and EE's effect on clinical outcome, can vary as a function of the identified patient's diagnosis. For socially anxious individuals, perceiving criticism in the social environment may provide an important impetus for seeking and adhering to treatment, whereas significant others' overprotective behavior may negatively impact their ability to benefit from treatment. Further research replicating these findings, clarifYing the mechanisms and developing supplemental interventions, are important future directions.

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Bakgrund: Generaliserat ångestsyndrom (GAD) är en vanlig diagnos med negativa konsekvenser såväl på individ- som samhällsnivå. För att som fysioterapeuter kunna fånga upp den här typen av patienter och då ha god kunskap om olika träningsformer som tillförlitlig behandling ansågs det fördelaktigt att undersöka det vetenskapliga underlaget för styrketräning som behandlingsmetod. Syfte: Syftet med denna litteraturstudie var att undersöka det vetenskapliga underlaget för effekten av styrketräning, i jämförelse med annan eller ingen intervention, som behandlingsmetod för att minska oros- och ångestsymtom hos vuxna mellan 18-64 år med GAD. Metod: En litteraturstudie av randomiserade kontrollerade studier där populationen var vuxna mellan 18-64 år med GAD. Sökningar genomfördes i databaserna PubMed, Cochrane, PEDro och Psycinfo. Fyra studier inkluderades och granskades sedan med PEDro. Den sammanvägda tillförlitligheten av resultatet av tre studier bedömdes med hjälp av GRADEstud. Resultat: Det vetenskapliga underlaget för styrketräning som behandling för personer med GAD är för begränsat för att kunna dra några starka slutsatser. Alla inkluderade studier visade dock på reducering av oros- och ångestsymtom, som båda är kännetecknande symtom för GAD. Konklusion: Det sammanvägda resultatet indikerar på att styrketräning skulle kunna vara en alternativ behandlingsmetod för denna patientgrupp. Mer forskning behövs dock för att kunna utvärdera effekten av styrketräning som behandling för personer med GAD. / Background: Generalized anxiety disorder (GAD) is a common diagnosis with negative consequences both on an individual and societal level. In order for physiotherapists to be able to catch these patients and then have good knowledge of different forms of exercise as reliable treatment, it was considered beneficial to investigate the scientific basis for resistance exercise training as a treatment method. Objective: The aim of this literature review was to investigate the scientific basis for the effect of resistance exercise training, in comparison with other or no intervention, as a treatment method to reduce worry and anxiety symptoms in adults aged 18-64 with GAD. Method: A literature review of randomized controlled trials where the population was adults between 18-64 years old with GAD. Searches were conducted in the databases PubMed, Cochrane, PEDro and Psycinfo. Four studies were included and reviewed with PEDro. The combined reliability of the results of three studies was assessed using GRADEstud. Results: The scientific basis for resistance exercise training as a treatment for people with GAD is too limited to be able to draw any strong conclusions. However, all included studies showed a reduction in worry and anxiety symptoms, both of which are characteristic symptoms of GAD. Conclusion: The combined results indicate that strength training could be an alternative treatment method for this patient group. However, more research is needed to be able to evaluate the effect of strength training as a treatment for people with GAD.

This study investigated the possible relationship between bilingualism and social anxiety disorder. Past research has indicated developmental delays in language as increasing risk for other psychological difficulties. With the pressure to learn two languages, possibly in the drastically different environments of home, school, and/or work, individuals may be vulnerable to becoming socially anxious in conjunction with language use. This study examined a series of factors surrounding linguistic development and reports of social anxiety. Participants were divided into 4 groups: Socially Anxious (SA; n = 43) monolinguals, Non-Socially Anxious (Non-SA; n = 81) monolinguals, SA bilinguals (n = 30), and Non-SA bilinguals (n = 43). Measures of social anxiety, linguistic ability, and demographic information were collected and compared. The results of this study showed no direct link between bilingualism and SAD. However results raised other questions as there was an overrepresentation of SA bilinguals having accents when compared with Non-SA bilingual individuals.

This study examined whether schemas formed during training (graduate coursework, clinical supervision, etc.) are responsible for the tendency of clinicians to experience higher rates of false recall for clinical case details when compared to novices. Participants in this study were recruited from a general psychology class to limit preexisting knowledge of psychological disorders. Half of the participants were trained to recognize features of Generalized Anxiety Disorder with the purpose of forming a schema for that disorder, whereas the other half were not. Participants’ memory for the diagnostic and non-diagnostic details within a hypothetical case vignette was tested using a free recall prompt followed by a yes/no recognition test. Trained participants falsely recognized the diagnostic detail ‘restlessness’ and falsely recalled the diagnostic detail ‘uncontrollable worry’ at a significantly higher rate than controls, suggesting that the training successfully formed a schema for GAD symptoms.

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Social Anxiety Disorder (SAD) is characterized by excessive concern or fear of negative evaluation in one or more social situations and ranks as one of the most common psychiatric disorders. SAD has also been characterized by significant deficits in social motivation and a lack of reactivity to pleasurable stimuli (i.e., positive affect; [PA]), particularly within social contexts. Recent neuroimaging work has shifted towards examining positively-valenced motivational systems in SAD focused on reward responses to social and nonsocial stimuli. These studies have revealed aberrant reward processing during social reward tasks in individuals with SAD. However, not all individuals with SAD exhibit reward circuitry dysfunction. Therefore, the current study aimed to examine if functional patterns of connectivity in the brain underlie heterogeneity in PA differences in individuals with SAD. Results revealed several functional connectivity strength differences between SAD and control groups within reward regions. Additionally, associations between regions of interest (ROIs)-couplings (i.e., OFC and insula, OFC and subgenual cingulate, insula and cingulate, and cingulate and subgenual cingulate) and diminished PA were present in individuals with SAD, but not controls. Lastly, results demonstrated that individuals with SAD had higher variability in their reward connectivity strength presentations and reports of PA as compared to controls. These results hold significance for the development of interventions for SAD that focus on the enhancement of PA to bolster social reward responsivity. / M.S. / Social Anxiety Disorder (SAD) is a common disorder where individuals experience persistent excessive fear of one or more social situations. Individuals with SAD also tend to show lower social motivation and a lack of reactivity to pleasurable activities/events (referred to broadly as positive affect; [PA]), particularly within social situations. Current work has focused on areas within the brain that are responsible for reward responses, and have indicated that individuals with SAD show different types of reward processing during social reward situations. However, not all individuals with SAD show these same patterns. Therefore, the current study aimed to examine if connections between reward regions in the brain underlie differences in PA differences in individuals with SAD. Results showed several differences between SAD and control groups within reward regions of the brain. Additionally, specific associations between brain regions of interest and low PA were present in individuals with SAD, but not controls. Lastly, results demonstrated that individuals with SAD had higher variability in their connections between reward regions and reports of PA as compared to controls. These results can help inform the development of treatments for SAD that focus on the improving PA in an attempt to increase responsiveness to social rewards.