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.

Human beings are social creatures. Accordingly, fear of social situations can be severely disabling. Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation in social or performance situations. SAD has an early onset and often goes undetected an untreated. Descriptive studies on non‐clinical samples are required in order to find ways to prevent SAD and associated consequences. This thesis aimed at examining epidemiological variables of SAD in adolescence which is the critical period for onset of SAD. More exactly, issues of detection and prevalence, victimization and developmental course were addressed. Data was collected in four different community samples, using cross‐sectional and longitudinal designs. In the first study (n=169), psychometric evaluation of a screening questionnaire for use with adolescents was conducted. The second study (n=2128) investigated prevalence of SAD in students in grade 6‐8 (age 12‐14 years). In the third study (n=3211), the association between SAD and victimization in high‐school students (aged 17) was investigated. Finally, in the fourth study (n=350), longitudinal associations between social anxiety and depressive symptoms were investigated, with 4 waves of data from grade 7 to grade 11. Self‐reported SAD was found among 4.4% of students in grade 6‐8 and among 10.6% of high‐school students. Females reported SAD to a significantly higher degree than males in all age groups. Experiences of peer victimization, maltreatment and sexual victimization were significantly more common in those reporting SAD than in non‐cases. Social anxiety was stable over adolescence. Further, peer victimization in grade 7 predicted social anxiety that mediated subsequent depressive symptoms. In conclusion, self‐reported SAD is common in Swedish adolescents and especially in girls and older adolescents. Social anxiety is stable over adolescence and correlated with depressive symptoms over course. The high prevalence rates, stable course and mediation of depressive symptoms call for early detection and prevention of social anxiety. The relationship between victimization and SAD needs to be investigated further in controlled prospective studies on children and adolescents.

Le trouble anxieux généralisé (TAG) est un problème majeur de santé publique. Il est fréquemment sous ou mal diagnostiqué, notamment chez les personnes âgées. Il est souvent comorbide et source d’incapacité et présente un faible taux de rémission complète. Malgré des conséquences socio-économiques et sanitaires importantes, les recherches sur les déterminants du TAG en population générale âgée restent limitées. L'objectif de cette thèse était d’étudier les caractéristiques cliniques et étiologiques du TAG à partir de l'étude prospective ESPRIT, constituée de 2259 personnes âgées de 65 ans et plus et examinées à 6 reprises pendant 12 ans.La prévalence du TAG des 6 derniers mois était de 4,6 %, 14% des cas présentant une comorbidité avec une dépression majeure et 35% avec une phobie mais les facteurs associés sont différents. Au cours des 12 ans de suivi, 8,4% des participants ont présenté un TAG incident (10 pour 1000 personnes-années), qui était un premier épisode dans 80% des cas. Plusieurs facteurs prédictifs de TAG ont été identifiés à partir de modèles statistiques multivariés : le sexe féminin, la survenue d’événements de vie stressants récents ou anciens (pendant l’enfance), certaines maladies chroniques (troubles respiratoires, cognitifs, arythmie et insuffisance cardiaque, dyslipidémie, adiposité) et troubles psychiatriques (dépression majeure, phobie, antécédents de TAG). Certains variants génétiques des récepteurs adrénergiques augmentent le risque de TAG (mais pas de phobie) et peuvent moduler l'effet des événements stressants. Le TAG apparaît comme un trouble affectif multifactoriel lié au stress résultant de facteurs de risque proximaux et distaux et cliniquement distinct des autres troubles psychiatriques majeurs de la personne âgée.Ce travail apporte de nouvelles connaissances sur les déterminants du TAG avec des implications cliniques en termes de diagnostic et d’étiologie. Il pourrait permettre le développement de stratégies originales de prévention et d'intervention chez le sujet âgé, avec des conséquences majeures en santé publique. / Generalized anxiety disorder (GAD) is a major public health concern. It is frequently under-recognized or misdiagnosed, especially in the elderly. It is associated with high comorbidity and disability, and a low rate of full remission. Despite substantial socioeconomic and public health consequences, there has been little research to identify GAD determinants in general elderly populations. The aim of this thesis was to provide a deeper understanding of the clinical characteristics and risk factors for GAD in late life from the prospective ESPRIT study of 2259 community-dwelling French elderly (aged 65 years and over) examined six times over 12 years.The 6-month current prevalence of GAD was 4.6%, 14% of the cases were comorbid with major depression and 35% with phobia but the factors associated with these disorders differed. During the 12-year follow-up, 8.4% of the participants experienced incident GAD (10 per 1000 person-years) of which 80% were first episodes. Multivariate statistical models showed that the main predictors for late-life GAD were being female, reporting recent and childhood adverse life events, having chronic physical (respiratory disorders, arrhythmia and heart failure, cognitive impairment, dyslipidemia, and adiposity), and mental (major depression, phobia, and past GAD) disorders. Specific genetic variants of adrenergic receptors increase the risk of GAD (but not phobia) and moderate the effect of adverse life events. GAD can be characterized as a multifactorial stress-related affective disorder resulting from both proximal and distal risk factors, and is clinically distinct from other major psychiatric disorders in the elderly.This work provides new knowledge on GAD determinants with clinical implications for diagnosis and etiology. It could also contribute to developing novel preventative and intervention strategies in the elderly, with major potential consequences for overall health and daily functioning.

The present dissertation consists of three empirical studies on social anxiety disorder (SAD) in a sample of Swedish children and adolescents. Based on findings made in a large behavior treatment study, the thesis contributes to the field of research on childhood SAD by investigating a factor that maintains the disorder, ways to measure and screen for diagnosis, and the treatment of the disorder. Study I investigated whether giving an educational course to the parents of socially anxious children would lead to a better outcome of a behavior-treatment study consisting of individual and group treatment components such as exposure in-vivo and social skills training, compared to a condition where only children were treated and the parents received no educational course.  Another purpose of Study I was to investigate what influence, if any, co-morbidity has on treatment outcome. The results showed that there was no significant difference between the two treatment groups on any of the primary or secondary outcome measures. Further, the comorbid disorders did not impair the SAD treatment but was rather associated with further improvement, and despite the sole focus on SAD, there was significant improvement in the comorbid disorders. Study II tested the psychometric properties of the Social Phobia and Anxiety Inventory for Children in a sample of children with SAD. The results indicated that the instrument is a both valid and reliable measure. Further, a three-factor solution represented the three areas of SAD commonly found in adult studies, i.e. fear of performance, observation, and interaction situations. Study III explored threat perception and interpretation bias by means of an ambiguous stories task. The results showed that children with SAD deviated significantly from a non-anxious control peer group with regard to their interpretations. Post treatment the threat perception bias was altered in a normal direction, and one year after treatment termination, the SAD sample ratings were comparable to those of the non-anxious children. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Manuscript.</p>

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Separation anxiety disorder (SAD) is the most common and impairing childhood anxiety disorder. Left untreated, SAD is associated with heightened risk for the development of additional internalizing disorders as well as impairments in educational attainment and social functioning. Numerous clinical trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of childhood anxiety disorders, including SAD. However, additional research is needed to enhance the compatibility (e.g., fit of the treatment to the patient population) and ultimate uptake of evidence-based interventions for anxious youth. The current research evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for school-aged girls with SAD provided within the novel context of a one-week camp-like setting. This alternative treatment format was predicated on evidence supporting the need for treatments that allow for creative and developmentally-sensitive applications of intervention components, incorporate a child's social context, target relevant parenting variables, and provide additional models for treatment delivery. Twenty-nine female children aged 7 to 12 with a principal or co-principal diagnosis of SAD were randomized to an immediate treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized-controlled trial. Measures were administered at pretreatment/ pre-waitlist, post-treatment/post-waitlist, and six weeks following treatment to assess changes in symptom reports, functional outcomes, and overall program satisfaction. Analyses of covariance were conducted to assess effects of treatment condition and repeated measures analyses of variance were conducted to evaluate change over the three data collection time points. Relative to waitlist, children in the immediate treatment group evidenced significant reductions in SAD severity by clinician report on a diagnostic interview measure. Moreover, treatment gains strengthened over time. Contrary to hypotheses, children receiving the intervention did not display significantly greater improvements relative to waitlist on parent-rated fear and avoidance scores or on parent or child self-report measures. Potential explanations for non-significant findings are discussed. Overall, the intervention's positive therapeutic response on SAD diagnostic status and severity suggests one possible delivery model for surmounting difficulties faced in the dissemination of standard, weekly treatments for this condition. / 2031-01-02

Change-talk (CT), or self-arguments for change, has been associated with favorable patient outcomes, while counter change-talk (CCT), or self-arguments against change, has been associated with poorer outcomes. Most studies on change language have focused on the prediction of distal posttreatment outcomes, while the prediction of more proximal outcomes has remained largely untested. Addressing this gap, we examined early treatment CT and CCT as predictors of worry change trajectories, “hazard” of clinically significant response, and time to response (i.e., outcome efficiency) in CBT and CBT integrated with MI (MI-CBT) for generalized anxiety disorder (GAD). We also explored whether treatment type moderated these associations. Data derived from a randomized controlled trial comparing CBT (n = 43) and MI-CBT (n = 42) for GAD. Independent observers reliably coded CT/CCT during session 1. Patients rated their worry after every session. Multilevel modeling revealed that, across both treatments, more CT associated with lower midtreatment worry level (p = .03), whereas more CCT associated with a slower rate of worry reduction at midtreatment (p = .04). However, treatment moderated the associations between CT and both midtreatment worry level (p = .004) and rate of change (p = .03). In CBT, patients with higher vs. lower CT had less worry and a faster rate of worry reduction; in MI-CBT, CT was unrelated to midtreatment worry level and the rate of worry change. Treatment did not moderate the CCT-worry relations. Survival analyses revealed that, across both treatments, more CT associated with a greater hazard of response (p = .004) and approached a faster time to response (p = .05), and more CCT associated with a lower hazard of response (p = .002) and approached a slower time to response (p = .06). Patient motivational language predicts proximal outcomes, and may be useful in differential treatment selection.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

No description available.

Det transdiagnostiska begreppet ’konstruktiv självhävdelse’ (assertiveness på engelska) definieras som handlande som är förenligt med respekt för både egna och andras rättigheter, exempelvis att uttrycka behov, sätta gränser och dela tankar och känslor. Bristande självhävdelse är förknippat med klinisk och subklinisk psykisk ohälsa, till exempel stress, relationssvårigheter, emotionell instabilitet, generaliserat ångestsyndrom, social ångest och depression. Studiens syfte är att undersöka effekten på konstruktiv självhävdelse av ett internet-behandlingsprogram med kognitivbeteendeterapeutisk inriktning, Respekt i kvadrat. Via annonsering i sociala medier rekryterades 205 deltagare med självupplevda besvär (88 % kvinnor, medelålder 42 år), vilka randomiserades till grupperna självhjälp (n = 67), behandlarstöd (n = 70) och väntelista (n = 68). Konstruktiv och aggressiv självhävdelse mättes med Adaptive and Aggressive Assertiveness Scales. Behandlingsbetingelserna förbättrades avsevärt jämfört med väntelista på skalan för konstruktiv självhävdelse. Effektstyrkorna (ES) mellan grupper var stora, ES = 0,9 för behandlarstöd–väntelista och ES = 1,0 för självhjälp–väntelista; effekterna var stora redan vid mittenmätningen. Inomgruppseffekterna mellan för- och eftermätning var också stora, ES = 1,0 för båda behandlingsbetingelserna. Grupperna behandlarstöd och självhjälp hade signifikant ökning av andelen kliniskt signifikant förbättrade individer för konstruktiv självhävdelse jämfört med väntelista (17 % respektive 18 % mot 1,5 %). Mellangruppseffekten självhjälp–behandlarstöd vid eftermätningen var inte signifikant. Resultaten visar att Respekt i kvadrat är effektivt och att behandlarstöd inte påverkar effekten. Forskning med ett mer representativt stickprov samt validerade skattningsskalor krävs för att avgöra om resultaten kan generaliseras till populationen i stort.

Aus der Einleitung: "In den vergangenen 15 Jahren sind in verschiedenen Ländern der Welt größere epidemiologische Studien zur Häufigkeit psychischer Störungen in der Allgemeinbevölkerung durchgeführt worden, die auch eine grobe Abschätzung der Häufigkeit Sozialer Phobien erlauben. Ein Überblick über diese Studien ergibt allerdings auf den ersten Blick ein recht verwirrendes Bild, da die Prävalenzabschätzungen der verschiedenen Studien eine scheinbar widersprüchliche Befundlage erkennen lassen. Ältere - vor Einführung expliziter diagnostischer Kriterien für Soziale Phobi durchgeführte Studien aus den 60er und frühen 70er Jahren - schätzten die Prävalenz dieses Krankheitsbildes auf lediglich 1% (1). [...]"