Objectives: For characterizing the association between parenting and offspring social phobia (SP), contrasting maternal vs. paternal contributions, putative predictors of unfavorable parenting behaviors and its specificity for SP are warranted to delineate targeted prevention and intervention strategies. Methods: A population-based sample of 1053 adolescents was followed-up using the M-CIDI. Parenting was assessed via questionnaire in offspring passing the high risk period for SP-onset. Natal complications and childhood serious health problems as assessed by maternal reports were hypothesized to relate to unfavorable parenting. Results: The pattern of maternal overprotection, paternal rejection and lower emotional warmth was associated with SP, but not with other offspring anxiety disorders. Natal complications were related to overprotection and lower emotional warmth; trend-level associations emerged for serious health problems and unfavorable parenting. Conclusions: Paternal behavior appears particularly relevant for SP. The pattern of maternal overprotection, paternal rejection and lower emotional warmth was observed in SP only, suggesting that its detailed assessment provides a promising opportunity for targeted prevention and intervention in SP.

To determine whether children with selective mutism (SM) withhold speech to regulate their emotional arousal and decrease automatic distress, the current study examines the behavioral and physiological responses of children with SM in comparison to children with social phobia (SP) and children with no psychiatric disorder (TD) as they participate in two social situations. A single case design strategy is used to compare behavioral and physiological responses both within and across groups. Examining the temporal sequencing of behaviors and physiology provides a direct test of the utility of emotion regulation theory as it pertains to children with social phobia/selective mutism. The results indicate that children with SM show elevated arousal and emotional reactivity across all interaction segments relative to other children. Unique affective, behavioral and physiological responses occur between and within groups in relation to situational demands. The temporal sequencing of behavioral and physiological responses suggests that behavioral deficits may be related to underutilized and/or deficient physiological response systems and that not speaking represents a primitive avoidance strategy by children with SM to regulate extreme physiological arousal.

In der vorliegenden Arbeit erfolgte ein Vergleich einer Patientengruppe im Hinblick auf ihre Zahnbehandlungsangst und weiterer psychischer Parameter. In einer Vielzahl von Studien wurden bereits Patienten in Zahnarztpraxen / Zahnkliniken zu ihrem psychischen Befinden in der Situation der Zahnbehandlung befragt. Eine Studie im zahnärztlichen Setting setzt allerdings voraus, dass das Angstniveau dieser Personen es zulässt, sich einer Zahnbehandlung zu unterziehen. Insgesamt haben 102 Patienten aus dem Vogtland an der Studie zur Zahnbehandlungsangst teilgenommen, die die gleichen Fragebögen zur Beurteilung ihrer psychischen Situation ausfüllten. Im deutschsprachigen Raum befanden sich beide Praxen im Vogltlandkreis. Die Zahnbehandlungsangst wurde mit der Dental Anxiety Scale (DAS) gemessen sowie mit zwei Items zur Angst vor der Behandlung mittels der Amsterdam Properative Anxiety Scale (APAIS). Die beiden Instrumente korrelierten signifikant stark miteinander (Spearman: r = 0,67, p = 0,000). Das Durchschnittsalter aller Teilnehmer betrug 40,3 (SD 15,74) Jahre. Auffällig war, dass mit einem Wert von 58,8 % mehr weibliche Personen als männliche Patienten an der Studie teilgenommen haben. Das Bildungsniveau der Patientengruppe befand sich unter den deutschen Durchschnitt (Statistisches Bundesamt). Darüber hinaus bestand bei den Probanden kein signifikant schlechter Gesundheitszustand, welcher in Beziehung zu höherem Alter, dem Geschlecht oder dem Bildungsniveau gesetzt werden könnte. Darüber hinaus wiesen die Probanden anhand des GSI (BSI-18) eine allgemeine, signifikant höhere psychische Belastung auf. Auffällig war, dass die mittleren Werte in den Subskalen Depressivität, Somatisierung und Ängstlichkeit signifikant höher waren. Im Vergleich aller Skalen nach niedriger und hoher Ängstlichkeit lag der mittlere Wert der gesamten Gruppe von GSI bei 8,17 (SD 8,08) mit einer hohen Signifikanz von p = 0,003, einer Somatisierung mit 2,08 (SD 2,82) p = 0,030, einer Depressivität von 1,64 (2,30) p = 0,010 sowie Ängstlichkeit von 4,45 (3,97) p = 0,001. Der mittlere Wert der DAS lag bei 21,78 (SD 2,66). Die Mittelwerte der APAIS (Angst vor der Behandlung) befanden sich bei 6,43 (SD 2,14). Die Patientengruppen unterschieden sich somit weder im Allgemeinen (BSI-18) noch im Speziellen auf das die Zahnbehandlung bezogene Angstniveau (DAS, APAIS) signifikant voneinander. Dennoch bestanden Unterschiede in den mittleren Werten für die mundgesundheits-bezogene Lebensqualität (OHIP) der Probanden, da sich diese signifikant voneinander unterschieden. Auch in Hinblick auf Einschränkungen der mundgesundheitsbezogenen Lebensqualität (OHIP) war in der Gruppe der hoch Ängstlichen ein starker Zusammenhang zum Angstniveau wahrnehmbar. Hinsichtlich des zahnmedizinischen Vorsorgeverhaltens hatten die Patienten auch einen signifikant schlechteren Vorsorgeindex vorzuweisen. Es ließ sich zudem feststellen, dass bei den meisten Patienten seit dem letzten Zahnarztbesuch signifikant mehr Zeit vergangen war. Patienten, die anhand der DAS Kategorisierung ein erhöhtes Angstniveau aufwiesen, ließen sich demnach auch seltener Zahnstein entfernen und eine professionelle Zahnreinigung durchführen. In der Zahnarztpraxis gaben Patienten mit einem erhöhten DAS-Angstniveau hingegen an, seltener zum Zahnarzt zu gehen als Patienten mit niedrigerer Angstausprägung. Das Angstniveau (DAS) der Patienten war schließlich auch im hohen Maß von der Art des Zahnarztbesuches abhängig. Je invasiver die Behandlung, desto mehr Angst hatten die Patienten vor dem Zahnarztbesuch. Auch die allgemeine psychische Belastung (BSI-18) war bei Patienten, die sich für eine Prophylaxebehandlung in der Zahnarztpraxis befanden, signifikant geringer. Die These, dass Personen, nachdem sie über das zahnmedizinische Setting befragt wurden, ein höheres Angstniveau aufzuweisen haben und auch den Zahnarztbesuch unter Umständen meiden, konnte in der vorliegenden Studie bestätigt werden. Deshalb ist es wichtig, dass sich Zahnärzte/Zahnärztinnen für das Thema „Zahnbehandlungsangst“ sensibilisieren, um Patienten mit erhöhtem Angstniveau entsprechend begegnen zu können.:1 Einleitung 1.1 Allgemeine Definitionen und Ausführungen zum Thema Angst 1.2 Zahnbehandlungsangst und Angststörungen 1.3 Zahnbehandlungsangst und andere psychische Störungen 1.4 Zahnbehandlungsangst, Mundgesundheit und somatische Störungen 1.5 Prävalenz 1.6 Ätiologie 1.7 Diagnostik 1.7.1 ICD-10 Kriterien der spezifischen Phobie (F40.2) 1.8 Zahnärztliche Screeninginstrumente zur Erhebung von Zahnbehandlungsangst 1.8.1 Screeninginstrumente (Fragebögen) 1.9 Statement 1.10 Therapie 1.11 Rückfallprophylaxe 2 Fragestellungen 3 Material und Methoden 3.1 Studiendesign 3.1.1Fragebogen 3.2 Beschreibung der Instrumente 3.2.1 Patientendokumentationsbogen 3.2.2 Gesundheitszustand 3.2.3 DAS - Dental Anxiety Scale nach Corah (1969) 3.2.4 Dental Fear Survey (DFS) 3.2.5 Amsterdam Preoperative Anxiety and Information Scale (APAIS) 3.2.6 BSI-18 (Brief Symptom Inventory 18) 3.2.7 The Oral Health Impact Profile (OHIP-5) 3.2.8 Mundgesundheit 3.2.9 L-1 – Kurzskala Lebenszufriedenheit – 1 3.2.10Skala Optimismus- Pessimismus-2 (SOP-2) 3.2.11OSS-3 – Oslo-3-Items Social Support Scale 3.3 Durchführung 3.4 Statistische Auswertung 4 Ergebnisse 4.1 Beschreibung des Patientenkollektivs 4.1.1 Soziodemografie 4.1.2 Zahnbehandlungsangst des Patientenkollektivs 4.1.3 Psychisches Befinden des Patientenkollektivs 4.2 Vorsorgeverhalten und Stellung der Mundgesundheit 4.2.1 Zusammenhang zwischen Zahnbehandlungsangst und anderen verwendeten Instrumenten 5 Diskussion 5.1 Patientenkollektiv 5.1.1 Soziodemographie der Gesamtgruppe 5.2 Soziodemographie - Vergleich der beiden Patientengruppen 5.2.1 Psychisches Befinden – Geschlechts-, Alters- und Bildungsspezifische Unterschiede 5.2.2 Vorsorgeverhalten und Einstellung zur Mundgesundheit – Vergleich der beiden Patientengruppen 5.2.3 Zahnbehandlungsangst im Zusammenhang mit anderen verwendeten Instrumenten 5.3 Kritische Betrachtung 5.4 Ausblick 5.4.1 Implikationen für die Forschung 5.4.2 Implikationen für die Praxis 6 Zusammenfassung Summary Literaturverzeichnis I Tabellenverzeichnis XVII Abbildungsverzeichnis XIX Abkürzungen XX Anhang XXI Danksagung XXIX Erklärungen XXX

Social anxiety disorder is the fourth most prevalent mental disorder in the US. Over the past several decades, psychotherapeutic, specifically cognitive behavioral, and pharmacologic approaches have been found efficacious for social anxiety disorder. A number of meta-analyses have been conducted since 1995 examining the efficacy of cognitive behavioral therapy (CBT) and/or pharmacotherapy for social anxiety disorder. Though there have been numerous trials in the past decade, no meta-analysis examining both psychotherapy and pharmacotherapy for social anxiety disorder has been published since 2001. For the present study, a comprehensive literature search produced 93 publications featuring 94 controlled trials (N = 11,503), which were included in the final analyses. We found a moderate to large effect size for all active treatments compared to control conditions. Significant heterogeneity among treatment effects was evident, largely accounted for by true variation between effects, versus standard error. Examination of potential study characteristic moderators indicated that treatment type (CBT, medication, combination), analysis type (intent-to-treat vs. completer), funding source, type of screening interview, type of treatment clinic (academic or private), version of diagnostic criteria, type of social anxiety sample (generalized social anxiety disorder only vs. mixed sample of generalized and specific social anxiety disorder) and type of inclusion/exclusion criteria related to other anxiety disorders were significant moderators. Publication type, inclusion/exclusion criteria related to depression and substance abuse/dependence, and full sample comorbidity with another disorder were not. Treatment type was no longer a significant moderator once control condition was accounted for. In psychotherapy trials, self-exposure (as compared to all other types of CBT) and psychotherapist training were significant moderators, whereas variables corresponding to treatment modality and delivery were not. Medication class and specific drug type were significant moderators for pharmacotherapy studies comparing an active treatment to a control condition. Head-to-head comparisons, which included trials comparing active treatments, indicated no differences between psychotherapy, medication, and the combination of the two. Further, social anxiety treatment had moderate to large effects on depression and quality of life. / Psychology

The purpose of this research was to explore HIV/AIDS stigma in the workplace, with a special focus on the stigmatised. The sample consisted of 10 HIV/AIDS positive employees. A qualitative interview schedule was designed. The interview guide was used to facilitate one-on-one interviews with each participant. An analysis of the data revealed that the majority of the participants were shunned by family, friends and partners. Others were too ashamed or afraid to reveal their positive status. The majority of the participants did not feel comfortable revealing their positive status to their line managers and to their co-workers. All participants felt that others viewed people living with HIV/AIDS as dirty and unclean and many had been exposed to stigmatising behaviours towards them due to their HIV/AIDS positive status. As a coping mechanism, most participants noted that they would walk away if stigmatised against. Recommendations were made to address HIV/AIDS stigma in the workplace. / Industrial & Organisational Psychology / M. A. (Industrial and Organisation Psychology)

published_or_final_version / Social Work / Master / Master of Social Work

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Traditionnellement, le construit de la phobie sociale a été défini selon une vision intrapersonnelle, en tant que trouble de l’anxiété. Une autre conception se propose de la définir d’un point de vue interpersonnel, comme un pattern global d’autoprotection. L’objectif principal de cette thèse est de tester des hypothèses tirées du modèle interpersonnel de la phobie sociale. Deux études, présentées sous forme d’articles, ont permis d’examiner si des patterns spécifiques d’autoprotection, tels que l’impuissance et la soumission, caractérisent le mode de fonctionnement des phobiques sociaux. Les études ont également évalué si l’autoprotection et l’anxiété sont interreliées. Pour la première étude, les patterns interpersonnels de 132 phobiques sociaux, évalués à l’aide d’une mesure dérivée du Circumplex interpersonnel, ont été comparés à ceux de 85 individus célibataires ayant une dysfonction sexuelle et 105 sujets normaux. La relation entre les patterns d’autoprotection, l’anxiété sociale, la détresse générale et le fonctionnement social a également été examinée chez les phobiques sociaux. La seconde étude a permis d’examiner l’évolution des patterns d’autoprotection ainsi que de l’anxiété sociale, de la détresse générale et du fonctionnement social, chez 85 phobiques sociaux à quatre moments : avant et après un traitement d’approche interpersonnelle, ainsi qu’aux relances de six mois et d’un an. L’étude a également comparé les participants en rémission et ceux satisfaisant les critères de la phobie sociale un an suivant la fin du traitement. Les résultats suggèrent que les patterns d’impuissance et de soumission sont caractéristiques de la phobie sociale. Plus précisément, ces patterns décrivent davantage les comportements des phobiques sociaux plutôt que ceux des groupes de comparaison. De plus, une réduction significative de l’autoprotection a été notée au post-traitement et maintenue jusqu’au suivi d’un an, surtout chez les participants en rémission.En outre, une relation entre l’autoprotection, l’anxiété sociale et la détresse générale a été mise en évidence chez les phobiques sociaux. Une amélioration de l’anxiété, de la détresse subjective et du fonctionnement social cohérente avec la dissolution des patterns d’autoprotection a également été obtenue au post-traitement. En conclusion, les résultats des deux études appuient une conception interpersonnelle de la phobie sociale. / Traditionally, the construct of social phobia has been viewed intra-personally, as a disorder of anxiety. In recent years, an alternative interpersonal account of the concept has been proposed, whereby social phobia is characterized as an overall self-protective pattern of specific fearfully self-protective patterns of interpersonal behaviour. The main objective of this dissertation was to test hypotheses drawn from this interpersonal approach. Two studies, presented in the form of research articles, were devised to examine whether specific self-protective interpersonal patterns of powerlessness and submissiveness are characteristic of the overall socially phobic pattern. The studies also examined whether self-protectiveness is interrelated with anxiousness. The first study compared the interpersonal patterns, assessed using an Interpersonal Circumplex measure, of 132 socially phobic individuals to those of 85 single sexually dysfunctional and 105 normal control participants. The relationship between self-protective patterns and social anxiety, general distress, and social functioning were also examined in the socially phobic group. The second study examined the evolution of self-protectiveness, as well as social anxiety, general distress, and social functioning, in 85 socially phobic individuals at four time-points: Prior to being treated by an interpersonal approach, post-treatment, as well as at a six-month and one-year follow-up. Remitted and non-remitted participants at the one-year follow-up were also compared. Results support the hypothesis that social phobia is characterized by self-protective patterns of powerlessness and submissiveness. Specifically, these interpersonal patterns were found to characterize the socially phobic group to a larger extent than either of the two contrast groups. They were also shown to improve meaningfully after treatment, especially in participants who achieved remission one year later.In addition, a relationship between the self-protective patterns and increased levels of social anxiety and subjective distress was found in the socially phobic group. Results also showed an improvement in anxiety, general distress, and social functioning consistent with the shrinking in self-protectiveness after treatment. In conclusion, the findings are consistent with predictions drawn from an interpersonal approach and provide support for this alternative conceptualization of social phobia.

Objetivo: Construir um programa de Exposição à Realidade Virtual para tratar Fobia Social, avaliá-lo e aperfeiçoá-lo por meio de uma análise quantitativa e qualitativa. Método: Finalizaram o tratamento 21 sujeitos (11 homens e 10 mulheres) entre 18 e 63 anos diagnosticados pelo Manual Diagnóstico Estatístico de Transtornos Mentais 4a edição- texto revisado (DSM -IV- TR) para fobia social. Foram excluídos os sujeitos com depressão grave, com risco de suicídio, transtornos psicóticos e abuso de substância. Principais medidas de avaliação quantitativa: Escala de Ansiedade Social de Liebowitz - LSAS; Escala de Impressão Clínica Global - CGI; Escala para Incapacitação de Sheehan; Escala de Adequação Social - EAS; e Questionário de Pensamentos Automáticos - ATQ 30. Avaliação qualitativa: Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social. Procedimento: as Escalas e os Instrumentos foram aplicados no pré-tratamento, no pós-tratamento e no seguimento após seis meses de tratamento. O Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social foi aplicado no pós-tratamento. O tratamento consistiu em até 12 sessões de 50 minutos cada de exposição à Realidade Virtual. Resultados: Observou-se redução significativa no escore pós-tratamento que se manteve no seguimento, nas escalas que avaliaram ansiedade, fobia e disfunções cognitivas (LSAS, ATQ e EAS). Na CGI, houve redução na gravidade da doença após o tratamento e isto se manteve no seguimento. Os pacientes apresentaram melhora do transtorno que também se manteve no período do seguimento. A Escala de Incapacitação de Sheehan mostrou melhora significativa da vida profissional, social e familiar. O número médio de sessões para a diminuição da ansiedade social foi de 7. Conclusão: O tratamento utilizado neste estudo teve boa aceitação, boa adesão, auxilia na diminuição da ansiedade social como também no enfrentamento das situações temidas. Estudos controlados ulteriores deverão ser realizados para verificar se ratificam estes resultados preliminares / Objectives: To build a Virtual Reality Exposure software for the treatment of Social Phobia, to evaluate and improve it based on quantitative and qualitative analysis. Method: The treatment was completed by 21 subjects (11 men and 10 women) aged between 18 and 63, diagnosed with social phobia by the Diagnostic Statistical Manual of Mental Disorders 4th edition - revised text (DSM - IV-TR). Subjects were excluded on account of deep depression, suicide risk, psychotic disorders or substance abuse. The main measurement instruments for quantitative evaluation were: Liebowitz Social Anxiety Scale - LSAS, Clinical Global Impression Scale - CGI, Sheehan Disability Scale, Social Adjustment Scale - SAS, Automatic Thoughts Questionnaire - ATQ 30. Qualitative evaluation: Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety. Procedure: The Scales and Instruments were applied in the pre-treatment and post-treatment phases and in the follow-up assessment six months after treatment. The Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety was applied in the post-treatment phase. The treatment consisted of twelve 50-minute sessions of exposure to Virtual Reality. Results: A significant decrease in the score in scales that measure anxiety, phobia and cognitive dysfunctions (LSAS, ATQ and SAS) was observed after treatment and it was maintained on follow-up. Patients have shown improvement of the disorder that was also preserved on follow-up. The Sheehan Disability Scale has shown significant improvement in professional, social and family life. The average number of sessions to achieve a reduction of social anxiety was seven. Conclusion: The treatment used in this study has been well received; patients have shown adherence to it and it has helped them to reduce their social anxiety and deal with situations they feared. Further controlled trials should be undertaken to endorse these preliminary results

Diferentes ensaios clínicos randomizados demonstram que a Terapia Cognitivo-Comportamental (TCC) é muito efetiva no tratamento do Transtorno de Ansiedade Social (TAS). Entretanto, uma quantidade significativa de pacientes não apresentam melhora após a finalização da intervenção com TCC. Tal dado indica a necessidade de desenvolver novas estratégias de tratamento para o TAS. A Terapia Cognitiva Processual (TCP) é uma nova abordagem dentro do campo da TCC que tem como principal objetivo auxiliar os pacientes a identificar e modificar suas crenças centrais disfuncionais, sendo o Processo uma das principais técnicas utilizadas. Algumas pesquisas têm demonstrado a efetividade do Processo no tratamento do TAS e de outros transtornos psiquiátricos. Entretanto, novas pesquisas são necessárias para avaliação não somente de tal técnica, mas de todo o protocolo de intervenção da TCP. Esta pesquisa objetivou avaliar se participantes que receberam uma intervenção individual em TCP apresentam diferenças em relação a sintomas de ansiedade social, medo da avaliação negativa, esquiva e desconforto social, ansiedade, depressão, sofrimento psíquico, distorções cognitivas e viés atencional. Este é um ensaio clínico randomizado que comparou um grupo que recebeu intervenção em TCP e um grupo lista de espera no tratamento do TAS. O estudo apresenta três grupos de pesquisa: o TCP (n =18), o lista de espera (n =21) e o saudável (n =19). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCP e lista de espera. Foram realizadas avaliações no pré e pós-teste através de diferentes escalas de auto-relato e do teste de Stroop emocional. Adicionalmente, o grupo TCP respondeu tais escalas a cada quatro sessões. O tratamento foi realizado em 16 sessões com duração de 1h30min cada utilizando a TCP no formato individual. Houve uma redução significativa nos sintomas de ansiedade social, ansiedade, depressão, esquiva e desconforto social, e sofrimento psíquico no grupo TCP ao longo do tratamento (p < 0,05). Tais reduções foram associadas a tamanhos de efeito grandes. Não foram observadas mudanças em nenhum dos instrumentos utilizados no grupo lista de espera (p > 0,05). Houve ainda uma significativa redução no medo da avaliação negativa após a utilização do Processo no grupo tratado, além de uma redução em distorções cognitivas (p < 0,05). Não foram observadas diferenças no pré e pós-teste em relação ao viés atencional nos três grupos da pesquisa (p > 0,05). Este estudo sugere que a TCP pode ser uma nova abordagem clínica efetiva no tratamento do TAS associado à diferentes comorbidades, haja vista que houve uma redução em sintomas de ansiedade social e sintomas comórbidos / Different randomized clinical trials show that Cognitive Behavioral Therapy (CBT) is highly effective in the treatment of Social Anxiety Disorder (SAD). However, a large number of patients do not show improvement after receiving CBT. This indicates that it is important to develop new treatments for SAD. Trial-Based Cognitive Therapy (TBCT) is a new approach within the field of CBT area. It aims to help patients to identify and to modify their dysfunctional core beliefs. One of the main TBCT techniques proposed by TBCT is the Trial. Some research studies have demonstrated the effectiveness of Trial in the treatment of SAD, and other disorders. However, further investigation is needed to firmly establish the efficacy not just for the Trial technique, but also the TBCT approach as a treatment for SAD and other disorders. This research aims to evaluate wheter SAD participants receiving TBCT individual-sessions differ from a SAD waiting list group condition regarding symptoms of social anxiety, fear of negative evaluation, social avoidance and distress, anxiety, depression, mental suffering, and attentional bias. This is a randomized clinical trial comparing TBCT and a Waitlist control condition for the treatment of SAD. The study has three groups: TBCT (n =18), Wailist (n =21), and healthy group (n =19). An independent researcher to study distributed randomly the participants with SAD between TBCT or Waitlist condition. Assessments were made at pre and post-test using several self-report scales, and the emotional Stroop test in the three groups. Additionaly, the TBCT group answered these scales each four sessions. The treatment was delivered in sixteen 1.5 hour sessions using the individual TBCT format. There were reductions in social anxiety, anxiety, depression, social avoidance and distress, and mental suffering symptoms at TBCT group (p < 0.05), but not in the Waitlist group (p > 0.05). Those reductions were associated with a large effect size. There was a significant reduction at fear of negative evaluation after Trial use, and reductions at cognitive distortions throughout the treatment as well (p < 0.05). There were no differences among the three groups regarding attentional bias at pre-test nor at post-test (p > 0.05). This study suggests that TBCT may be a new effective clinical approach to treat SAD associated with high rates of comorbidity, as there were significant reductions in the comorbid symptoms