Made available in DSpace on 2016-08-03T16:34:28Z (GMT). No. of bitstreams: 1 MariaSilviaAndrietta.pdf: 378221 bytes, checksum: 3918149ecd540dbb786f658e988f1d3a (MD5) Previous issue date: 2013-08-28 / The social anxiety disorder (SAD) can be described as fear or discomfort in situations where a person believes that their performance is being evaluated by others and when the person fears to behave in a humiliating or embarrassing way. An essential element of this type of symptom is the judgment that these individuals make about the opinions of others. This judgment is closely related to the concept of empathy or the capacity to put yourself in the place of another individual and deduce, even in a distorted way, what this person is thinking or feeling. This project investigated the relationship between empathic capacity and levels of social anxiety in normal subjects. Two questionnaires were applied: Liebowitz Social Anxiety Scale and Interpersonal Reactivity Idex (IRI). Significant correlations were observed among both scales scores, suggesting that the expression of social anxiety demand some empathic capacity. These results justify further investigations on how both phenomena can be associated in terms of neuropsychological mechanisms. / O transtorno de ansiedade social (TAS) pode ser descrito como o medo ou desconforto em situações nas quais o indivíduo acredita que seu desempenho esteja sendo avaliado por outros e onde tema comportar-se de forma humilhante ou embaraçosa. Este medo é acompanhado de sintomas autonômicos como suor, taquicardia e tremores e pode induzir a esquiva de tais situações. Um dos elementos essenciais deste tipo de sintoma é o julgamento que o indivíduo faz a cerca da opinião de outras pessoas. Uma das hipóteses envolvidas neste estudo é a de que este fenômeno patológico envolva mecanismos associados à empatia na medida em que envolve a atitude de colocar-se no lugar de outra pessoa e inferir, mesmo que de maneira distorcida, o que esta pessoa está pensando ou sentindo. Este projeto visa investigar a relevância da capacidade empática de pessoas com altos níveis de ansiedade social na gênese de seus sintomas. Para isso, serão aplicados dois questionários em voluntários adultos: A Escala de Ansiedade de Liebowitz e a Escala Multidimensional de Reatividade Interpessoal de Davis (EMRI), e serão estudadas as possíveis correlações entre a Ansiedade Social e a Empatia. A hipótese a ser testada é a de que indivíduo com altos níveis de ansiedade social teria uma atividade espelho mais acentuada e, com isso, um maior índice de empatia. Espera-se que este tipo de estudo possa contribuir para um melhor entendimento a respeito da fisiopatologia da ansiedade social e, consequentemente, contribuir para o desenvolvimento de formas de psicoterapia comportamentais mais eficazes para este tipo de problema clínico.

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

Evidence suggests that both the BIS and the BAS play a role in the individual differences seen in social anxiety disorder; however, findings concerning the role of the BAS have been mixed. To date, the role of RST subsystems underlying social anxiety has been measured with outdated scales. This study addressed this issue by using a measure purpose-built for the revised RST. The current study was able to replicate past findings that the BAS is differentially related to social interaction anxiety and social observation anxiety (Kimbrel et al., 2010; Kimbrel et al., 2012). While using a newer measure based on the revised RST; however, results indicated that BAS sensitivity related to both subdimensions of social anxiety. In addition, findings indicate that the RST systems remain good predictors of social anxiety symptoms even after accounting for the influence of levels of positive and negative affect. Implications and future directions are discussed.

New technology provides the possibility of delivering exposure therapy for socially anxious individuals through virtual environments. This study investigated whether emotional responses and empathy can be experienced for virtual characters (avatars) and whether the evaluations differ depending on level of social anxiety. Six scenes depicting avatars interacting were created through the consumer story scripting software Plotagon and then replicated with real humans. 102 participants viewed the scenes and appraised their emotional response and level of empathy. Results revealed the avatars varied in ability to elicit positive emotions, yet were equally successful in the negative conditions. An association was found between high social anxiety and a more negative emotional response of the scenes with humans but not with avatars. In conclusion it was found possible to feel emotions and empathy for virtual characters in a manner somewhat similarly to that for humans.

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

abstract: The purpose of this thesis study was to evaluate the nature of social anxiety in clinic-referred African American children versus their Caucasian counterparts. In particular, social anxiety symptom endorsement along the Social Phobia and Anxiety Inventory Scale for Children (SPAI-C; Beidel, Turner, & Morris, 1995) was examined in a sample of 107 African American and 364 Caucasian children (ages 7- to 17-years old) referred for anxiety. To evaluate symptom endorsement, simple descriptive analyses were conducted whereas measurement invariance tests were examined using confirmatory factor analyses. For the most commonly endorsed items, African American and Caucasian children shared seven of the top 10 most commonly identified social anxiety symptoms. Similar social fears across ethnicity focused on "assertiveness in situations perceived to be difficult" and ""speaking to large groups of peers they do not know." Findings also showed that African American children were more likely to report symptoms of "shaking when in social situations" than Caucasian children, and Caucasian children were more likely to report symptoms of "embarrassment when in front of adults" compared to African American children, but this was also on the basis of two items. When it came to the five factors of the SPAI-C, results showed measurement invariance across African American and Caucasian children. Overall, there were more similarities than differences between African American and Caucasian children in social anxiety symptoms based on the SPAI-C. Findings from this thesis study shed light on how to best accurately identify social anxiety among African American children compared to Caucasians, a contribution that can potentially impact assessment, treatment planning, and program response evaluation. / Dissertation/Thesis / M.A. Psychology 2013

Introdução O transtorno de ansiedade social (TAS) é um transtorno muito prevalente e incapacitante em crianças e adolescentes. Esse estudo foi delineado para avaliar a eficácia e a tolerabilidade de um inibidor seletivo da recaptação de serotonina altamente potente, o escitalopram, no tratamento do TAS em crianças e adolescentes. Métodos Vinte pacientes ambulatoriais com um diagnóstico principal de TAS foram tratados com escitalopram em um ensaio clínico aberto por 12 semanas. A medida de desfecho primária foi a mudança basal em comparação à final na Clinical Global Impression – Improvement Scale (CGI-I). As medidas de desfecho secundárias foram a CGI – Severity scale (CGI-S), a Social Phobia and Anxiety Inventory for Children (SPAI-C), a Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, e a The Youth Quality of Life Instument- Research Version (Y-QOL-R). Resultados Na escala CGI-I, 13 dos 20 pacientes (65%) tiveram um escore ≤ 2, correspondendo a uma resposta ao tratamento. Todas as medidas sintomáticas e de qualidade de vida mostraram melhoras significativas da avaliação basal à semana 12, com grandes tamanhos de efeito, variando de 0.9 a 1.9 (todos p < 0.01). O escitalopram foi geralmente bem tolerado. Conclusões Esses resultados sugerem que o escitalopram pode ser um tratamento eficaz e seguro no tratamento do TAS pediátrico. Futuros ensaios clínicos randomizados, placebo-controlados, fazem-se necessários. / Introduction Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Methods Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to endpoint in Clinical Global Impression – Improvement scale (CGI-I). Secondary efficacy measures included the CGI – Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED) – Child and Parent version, and The Youth Quality of Life Instument-Research Version (Y-QOL-R). Results On the CGI-I scale, 13 of 20 patients (65%) had a score ≤ 2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week-12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.01). Escitalopram was generally well-tolerated. Conclusion These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future placebo-controlled randomized clinical trials are warranted.

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

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-09-14T17:23:28Z No. of bitstreams: 1 francescastephantavares.pdf: 4616479 bytes, checksum: e0c4d57f55d2f6ec14037ab0926aab1c (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-09-26T20:18:02Z (GMT) No. of bitstreams: 1 francescastephantavares.pdf: 4616479 bytes, checksum: e0c4d57f55d2f6ec14037ab0926aab1c (MD5) / Made available in DSpace on 2016-09-26T20:18:02Z (GMT). No. of bitstreams: 1 francescastephantavares.pdf: 4616479 bytes, checksum: e0c4d57f55d2f6ec14037ab0926aab1c (MD5) Previous issue date: 2011-11-04 / O presente trabalho estudou a interrelação entre episódios de Bullying na infância e adolescência e Ansiedade Social\Fobia Social na idade adulta. O Bullying é um tipo específico de violência entre pares descrito como um abuso de poder continuado ao longo do tempo, com a intenção clara de afligir, intimidar e agredir outra pessoa no convívio permanente em locais coletivos, ocorrendo, preferencial, mas não exclusivamente, nas escolas. Bullying pode então ser considerado como um fator de forte interferência negativa para o desenvolvimento. A Ansiedade Social\Fobia Social é caracterizada como um quadro patológico no qual uma pessoa teme a convivência social por estar preocupada em ser humilhada e constrangida. A dificuldade em situações sociais durante a infância e adolescência pode influenciar no desenvolvimento de habilidades sociais necessárias para posterior funcionamento acadêmico, social e profissional. É necessário um maior entendimento entre dificuldades de socialização na infância e adolescência, e o desenvolvimento de Fobia social na idade adulta. Com o objetivo de analisar a relação que os participantes estabelecem entre as experiências de Bullying na infância e adolescência e os sintomas atuais de Ansiedade Social, foram realizadas entrevistas semiestruturadas com pacientes fóbico sociais do Programa de Transtornos de Ansiedade da Secretaria Municipal de Saúde do Município de Juiz de Fora. Foram realizadas trinta entrevistas, duas com cada um dos quinze participantes da pesquisa. Como resultados podemos destacar o número importante dos participantes pesquisados que tiveram experiências significativas de vitimização escolar. Grande parte dos participantes foi alvo de apelidos durante todo o período escolar, e também sofreram experiências de isolamento ou exclusão. Essas experiências em sua maioria ocorreram em sala de aula, e os participantes não contaram para ninguém os episódios sofridos. Os relatos de perseguição na escola, humilhação, insegurança e exclusão também foram exemplificados em situações de convivência familiar e no trabalho. / This study examined the interrelationship between episodes of bullying in childhood and adolescence and Social Anxiety \ Social Phobia in adulthood. Bullying is a specific type of peer violence described as an abuse of power continued over time, with the clear intention of distressing, intimidating and assaulting another person in the permanent coexistence of local collectives, occurring preferred, but not exclusively, on schools. Bullying can then be considered as a strong negative interference factor for development. The Social Anxiety \ Social Phobia is characterized as a pathological picture in which a person fears the social life to be worried about being humiliated and embarrassed. The difficulty in social situations during childhood and adolescence may influence the development of social skills needed for later academic functioning, social and professional. A greater understanding of difficulties of socialization in childhood and adolescence and the development of social phobia in adulthood is needed. In order to analyze the relationship established between the participants experiences of bullying in childhood and adolescence and current symptoms of social anxiety, semi-structured interviews were conducted with social phobic patients in the Anxiety Disorders Program of the Juiz de Fora Municipal Health Secretary. As a result we can highlight the large number of survey participants who had significant experiences of school victimization. Most of the participants was target of nicknames throughout the school year, and also suffered experiences of isolation or exclusion. These experiences mostly occurred in the classroom, and participants did not tell nobody suffered episodes. The reports of harassment in school, humiliation, insecurity and exclusion were also exemplified in situations of family and work.

Despite evidence supporting a robust relation between common factors- aspects of the therapeutic setting that are common across all types of treatment- and treatment response, little is known about the mechanisms by which these common factors effect change. Two of the most well-researched common factors include the client’s expectations about the effectiveness of treatment (termed outcome expectancy), and the quality of the therapeutic relationship (termed working alliance). Using archival data, the present study tests the hypothesis that the relation between outcome expectancy and symptom reduction is mediated by the alliance following treatment for social anxiety disorder. Data were collected in a sample of 65 individuals who received cognitive behavioral therapy for social phobia with public speaking fears. Mediation analyses were conducted using Andrew Hayes’ Process Macro (Hayes, 2013). None of the mediation analyses were significant. These findings suggest that the mechanisms of common factor variables may vary by disorder.