Purpose: There is accumulating evidence that treatment preference may significantly impact treatment compliance and satisfaction in individuals with psychological disorders. Very few studies have examined treatment preferences in clients with social anxiety disorder (SAD). Moreover, little is known if treatment preference for a conventional therapy such as cognitive behavioural therapy versus mindfulness-based interventions, influence outcomes. The primary objective of the current study was to determine whether treatment expectancy and preferences for a mindfulness intervention adapted for SAD (MBI-SAD), cognitive behavior group therapy (CBGT), or no preference, would influence treatment compliance and treatment satisfaction. Method: The sample included 97 participants who met the DSM-5 criteria for SAD. After selecting a treatment preference, participants were randomly assigned to a treatment group. Analyses of variance, chi-square, and logistic regressions were conducted to determine if being matched to one’s preferred treatment influenced outcomes, and if those with no preference differed from those who indicated a preference. Hierarchical multiple regression was used to determine if participants’ perceptions of credibility and expectations and match to treatment influenced compliance and satisfaction. Results: There was some support that treatment preference and match to treatment influenced compliance and satisfaction, however the majority of the analyses revealed no impact of treatment preferences. CBGT met expectations more often than did MBI-SAD when participants were matched to their preferred treatment. When participants were matched to their preferred treatment or had no preference, they were more compliant with homework than those who were not matched. Those with no preference had lower attendance than both the matched and not matched groups. Perceived credibility and expectancy were higher for those who were matched to their preferred group, however this did not have an impact on compliance and satisfaction. The remainder of the analyses did not find a relationship between treatment preference or match to treatment on compliance or satisfaction.

Purpose: There is growing interest in the clinical application of mindfulness meditation. However, little is known about the extent to which clients prefer mindfulness-based interventions (MBI) over conventional psychological therapies. The present study examined predictors of treatment preference and credibility in individuals with social anxiety disorder (SAD) who participated in a randomized trial of a mindfulness intervention adapted for SAD (MBI-SAD) versus a conventional psychological therapy (cognitive behavior group therapy; CBGT). Method: The sample included 97 adults who met DSM-5 criteria for SAD. Binary logistic and multiple linear regressions were conducted to examine baseline sociodemographic and clinical predictors of treatment preference for the MBI-SAD and perception of treatment credibility. Analysis of variance was used to compare levels of trait mindfulness across treatment preference groups. Results: The majority of participants (49%) reported a preference for the MBI-SAD. Ratings of treatment credibility were comparable for the two interventions. Employment status significantly predicted preference for CBGT versus the MBI-SAD, whereas younger age predicted preference for CBGT. Higher household income, a history of psychotherapy, elevated scores on clinician ratings of depression and social anxiety, and lower scores on self-report depression predicted no treatment preference. Higher household income predicted greater perceived credibility of treatment. Trait mindfulness did not differ across the treatment preference groups or predict treatment credibility. Discussion: Mindfulness meditation appears to be an acceptable and credible treatment for SAD. However, few baseline demographic and clinical characteristics predicted preference for the MBI-SAD. Additional research is needed to explore factors that shape preference and beliefs about mind-body interventions.

Contemporary cognitive theories argue that socially anxious individuals adopt self-protective behavioural strategies under conditions of perceived social threat in order to prevent or diminish the likelihood of negative social outcomes. When performed in an anxiety-provoking but otherwise innocuous situation, however, safety behaviours are posited to facilitate biased processing of threat-relevant information, disrupt behavioural performance, elicit negative social responses, and ultimately prevent disconfirmation of fear-relevant beliefs. This dissertation project was designed to evaluate the effects of safety behaviour reduction strategies on a number of the core processes relevant to the persistence of pathological social fear. Two studies were conducted to address the following issues: Do safety behaviour reduction strategies influence socially anxious individuals’ (1) self- and social-judgments, (2) social performance, (3) the interpersonal reactions of oneself and others, and (4) appraisals of future social events. In study 1, in vivo safety behaviours were manipulated in a sample of 50 socially anxious students during a laboratory social interaction. Participants were randomly assigned to either a safety behaviour reduction (SB, n = 25) or exposure alone (control, n = 25) condition, and subsequently took part in two conversations with a trained experimental assistant. Results revealed that participants in the SB group displayed more accurate self-judgments of anxiety-related behaviour, improved social performance, and evoked more positive partner reactions. Study 2 was designed to replicate and extend the findings of study 1 in a sample of 80 patients seeking treatment for social anxiety disorder (SAD). Following a baseline conversation, participants were randomly assigned to the graduated exposure (GE, n = 40) or safety behaviour reduction condition (SB, n = 40). Consistent with the findings of study 1, the SB group displayed more accurate self-judgments about visible displays of anxiety, more effective social behaviour, and were better liked by their interaction partner relative to GE participants. Moreover, relative to controls, participants in the SB group made less negative judgments about the likelihood of previously identified feared outcomes pertaining to future social events. Implications of the present findings for elucidating the role of safety behaviours in the maintenance of SAD, and its treatment outcome will be considered.

Research indicates that without healthy and close relationships, well-being and functioning suffer. Despite this knowledge, quality of relationships has not been emphasized in the mental health literature, especially as related to social anxiety disorder (SAD) where social support needs may be higher. The aim of this study was to examine how those with SAD compared to those with another anxiety disorder (generalized anxiety disorder; GAD), a mood disorder (major depressive disorder; MDD) and those with no recent history of disorder, on measures of quality of relationships with family, friends and partners, as well as on intimacy and role functioning. Data were drawn from the National Comorbidity Survey Replication (NCS-R; Kessler et al., 2004), a large, U.S. nationally-representative epidemiological data set. Logistic regressions were used to examine the quality of relationships for those with SAD as compared to GAD, MDD and no disorder. The associations among relationship quality and high versus low severity of SAD were also examined. It was found that those with SAD were less likely to report high family and friend support than were those with no disorder, but more likely to report high marital support than those with GAD or MDD. Those with SAD were more likely to report high family stress than those with no disorder, but no more likely to report relationship stress than were the other clinical groups. With respect to severity of SAD, those with high SAD severity were more likely to report high friendship stress than those with low SAD severity. In examining role impairment, those with SAD were less likely to report social impairment than those with GAD or MDD, and less likely to report close relationship impairment than those with MDD. Those with high SAD severity reported higher impairment across social and close relationship functioning compared to those with low severity. This study redresses many of the limitations in the current literature, and the results inform future research efforts on treatment practices and prevention.

Magister Psychologiae - MPsych / The propensity to blush is typical of many individuals with social anxiety disorder (SAD). SAD is also associated with significant disability or functional impairment. The relationship between SAD, blushing and functional impairment is still not completely understood however. This study has focused on the association between the propensity to blush and reported level of functional impairment due to SAD. Data from thirty-eight (n=38) individuals with SAD, were collected via a larger study conducted at the MRC Anxiety and Stress Disorders Unit. Assessment tools include the Structured Clinical Interview for Axis I disorders – Patient Version (SCID -I/P), Social Phobia Inventory (SPIN) and the Blushing Propensity Scale. Demographic and clinical data were gathered and reported on. Spearman rank order correlations were used to determine relationships between variables, including blushing propensity, disability and symptom severity. Results were reported on and then discussed using the social attention theory. Limitations and recommendations were proposed in the final and concluding chapter. This study, as part of a larger study at the MRC Research Unit on Anxiety and Stress Disorders, has been approved by the Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch

Social anxiety disorder (SAD) is characterized by fear and avoidance of social interactions and situations in which an individual is being the focus of attention. This current thesis aims to examine the efficacy of pharmacological treatment, particularly selective serotonin reuptake inhibitors (SSRIs) in individuals with a generalized social anxiety disorder (gSAD) in comparison with placebo (no active medication). In this systematic review, Scopus and Web of Science were searched for relevant research regarding the efficacy of the SSRI medication (paroxetine, sertraline, fluvoxamine and escitalopram) in comparison with placebo. Sixteen articles were included in this analysis. Results demonstrated that SSRI medication has greater efficacy in comparison with placebo both in short- and long-term time, prevent relapse in the long-term treatment of SAD and had a beneficial effect on different areas of individuals life's such as work, performance, romantic relationships etc.

Social anxiety disorder (SAD) interferes with everyday life. It can, for instance, hinder careers, relationships, and leisure time. It is a common anxiety disorder that was neglected for decades. SAD individuals crave and fear social interactions simultaneously, leading to isolation in our highly social world. Therefore, research surrounding these kinds of disorders is essential. This systematic review has focused on the neural aspects and differences between SAD and healthy controls surrounding amygdala activation and connectivity. Functional magnetic resonance imaging (fMRI) studies conducted using social and emotional tasks were included. Findings include increased amygdala activation to fearful faces and words and a positive correlation between amygdala activation and symptom severity. Further, deficits in emotion regulation and a finding of gradual habituation have been found in SAD compared to healthy controls. Some limitations to this research are the small sample sizes used in the included articles and the use of both SAD and individuals with generalized SAD. The study is essential to assess future questions and directions regarding diagnosis, treatment, and understanding of SAD.

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.

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.