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This dissertation is divided into three parts. The first part aimed to investigate the cannabidiol anxiolytic effect in treatment-naïve individuals with social anxiety disorder through simulation of public speaking. Twenty-four never-treated social anxiety disorder subjects were allocated to receive 0 or 600 mg cannabidiol (CBD; n=12) in a double-blind randomized design. The same number of controls performed the simulation of a public speaking test without receiving any medication. Pretreatment with CBD significantly reduced anxiety, cognitive impairment, and discomfort in speech performance and significantly decreased alertness in their anticipatory speech. The placebo group displayed higher anxiety, cognitive impairment, discomfort, and alertness when compared with controls as assessed with the Visual Analogue Mood Scale (VAMS). The SSPS-N scores showed significant increases during testing of the placebo group that was almost abolished in the cannabidiol group. No significant differences were observed between the cannabidiol and control groups in SSPS-N scores or in cognitive impairment, discomfort, and alertness factors of the VAMS. The second part evaluated healthy subjects\' x y during a public speaking test following a high rimonabant oral dose, to understand better the possible pharmacological approaches for anxiety disorder treatment. Twenty four participants were randomly allocated to receive 0 or 90 mg rimonabant (n=12) in a double-blind design. No significant adverse effects were reported in either group. Participants who received rimonabant showed increased anxiety levels compared to placebo during anticipatory speech and performance measurements. Rimonabant treatment did not affect sedation, cognitive impairment, discomfort, blood pressure, heart rate, self-statements during public speaking, or bodily symptoms scales. Increased anxiety may reflect lower endocannabinoid activity in CB1 receptors and CB1 p \' possible role in modulation of anxiety and anxiety disorders. The third part aimed to monitor cannabinoid blood concentrations during sustained abstinence from chronic daily cannabis smoking. Thirty male chronic daily cannabis smokers resided on a secure clinical research unit for up to 33 days, with blood collected once daily. ?9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) whole blood concentrations were quantified by two-dimensional gas chromatography-mass spectrometry. Twenty-seven of 30 participants were THC-positive on admission, with a median (range) concentration 1.4 ng/mL (0.3-6.3). THC decreased gradually with only 1 of 11 participants negative at 26 days; 2 of 5 participants remained THC-positive (0.3 ng/mL) for 30 days. 5.0% f p p h TH >=1 0 g/ L f 12 y M 11-OH-THC w 1 1 g/ L w h >=1 0 g/ L 24h THCCOOH detection rates were 96.7 on admission, decreasing slowly to 95.7 and 85.7% on days 8 and 22, respectively; four of 5 participants remained THCCOOH positive (0.6-2.7 ng/mL) after 30 days and one remained positive on discharge at 33 days. THC was quantified in some participants for 30 days, albeit in low concentrations, due to the large cannabinoid body burden from extended exposure / Esta tese é dividida em três partes. A primeira parte consiste em investigar o efeito ansiolítico do canabidiol na ansiedade social através do teste de simulação de falar em público. Vinte e quatro sujeitos com ansiedade social, nunca tratados, receberam placebo ou canabidiol (CBD) 600 mg (n=12) em um estudo randomizado e duplo-cego. O mesmo número de indivíduos saudáveis realizaram o teste de simulação de falar em público sem receber medicação. A administração do CBD reduziu significativamente a ansiedade, sedação física e outros sentimentos e atitudes durante a fase de estresse, e diminui o nível de alerta na fase pré-estresse. O grupo placebo apresentou níveis elevado de ansiedade, sedação física, outros sentimentos e atitudes, e alerta comparado com o grupo controle. A pontuação do SSPS-N evidenciou aumento significativo durante o teste no grupo placebo, enquanto que o CBD reduziu estes níveis. Não houve diferenças significativas entre os grupos CBD e controle na SSPS-N e nos fatores sedação física, outros sentimentos e atitudes e alerta, da Visual Analogue Mood Scale (VAMS). A segunda parte do estudo avaliou a ansiedade em indivíduos saudáveis que receberam alta dose oral de rimonabanto e submetidos ao teste de simulação de falar em público, para melhor entendimento do possível mecanismo farmacológico para tratamento de transtornos de ansiedade. Vinte e quatro sujeitos saudáveis receberam placebo ou rimonabanto 90 mg (n=12) em um randomizado e duplo-cego. Não foi observado efeitos adversos significativo em ambos grupos. O grupo rimonabanto apresentou maiores níveis de ansiedade na fase pré-estresse e durante o estresse. Não houve diferença significativa quanto aos demais fatores avaliados entre os grupos. O aumento na ansiedade após administração do rimonabanto pode-se ao fato de haver diminuição no sistema endocanabinóide nos receptores CB1 e a possível modulação na ansiedade clínica e patológica. A terceira parte objetivou quantificar canabinóides no sangue total em usuários crônicos de cannabis durante abstinência supervisionada. Trinta usuários crônicos de cannabis, do sexo masculino, permaneceram no centro de pesquisa por até 33 dias, com coleta de sangue uma vez ao dia. ?9-tetrahidrocanabinol (THC), 11-hidróxi-THC (11-OH-THC) e 11-nor-9-carbóxi-THC (THCCOOH) foram quantificados no sangue por meio da cromatografia gasosa-espectrometria de massa bidimensional. Vinte e sete de 30 usuários foram positivos para THC no ingresso do estudo, com concentração mediana (variação) de 1.4 ng/mL (0.3-6.3). Níveis de THC diminuíram gradativamente com somente 1 de 11 participantes negativo no dia 26; 2 de 5 indivíduos permaneceram positivos para THC (0.3 g/ L p 30 5 0% j TH >=1 0 g/ L p 12 ç mediana de 11-OH-TH f 1 1 g/ L g >=1 0 g/ L pó 24h. A taxa de detecção de THCCOOH foi 96.7% no ingresso, diminuindo gradativamente para 95.7 e 85.7% nos dias 8 e 22, respectivamente; 4 de 5 sujeitos permaneceram positivo para THCCOOH (0.6-2.7 ng/mL) após 30 dias e um permaneceu positivo no 33º dia. Foi detectado THC em alguns indivíduos por 30 dias, porém em baixas concentrações, devido a extensa eliminação do canabinóide em decorrência da exposição crônica

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

Predicting who will benefit from what in the treatment of psychiatric disorders is incremental to future development of psychological treatments. In the current study functional magnetic resonance imaging (fMRI) data from participants with social anxiety disorder (SAD) was used to elucidate whether neural responses to negative evaluation could predict treatment response in SAD. Nine weeks prior to Internet- delivered Cognitive Behaviour Therapy (ICBT) onset, participants viewed negative social stimuli directed either at themselves or an significant other during fMRI scanning. Regression analyses including the differential activations for other-referential criticism in contrast to self-referential criticism in the posterior mid cingulate cortex (pMCC) and the lingual gyrus (LG) predicted 34% of treatment change as measured by residual gain scores on the Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) in our sample. The final regression model, combining these measures with behavioural measures, which by themselves explained 27% of the variance, resulted in a model explaining 50% of the variance regarding treatment response. This lends additional support to the notion that further elucidating the neurobiological underpinnings of core processes in SAD, as well as the neural correlates of treatment response to CBT, would be of great value in predicting treatment outcome.

The number of children in classrooms is constantly increasing, causing shy children to become more invisible in the classroom. Thompson&Rudolph (2000: 542) indicate that shyness and withdrawal are attempts to avoid participation in one’s surroundings. The researcher is of the opinion that if shyness is not adequately addressed during middle childhood, it can continue to limit the potential of shy people. Shyness is not generally considered as problematic behaviour for children in their middle childhood. Shyness inhibits children to express themselves. They rarely participate in class and usually hold an irrational negative view of themselves. There is a need for shy children to be able to express themselves, in order to gain optimally from the school setting. Play therapy is based on developmental principles and thus provides, through play, developmentally appropriate means of expression and communication (Landreth&Bratton, 1999:5). Group therapy complements the normal developmental tasks that further children’s capacities for social interaction and intimacy. The researcher conducted intervention research. Many facets of intervention research are both qualitative and quantitative in nature, depending on the distinctive elements of the particular research project (De Vos, 2002a:368). Due to both the qualitative and quantitative nature of intervention research, the researcher employed Creswell’s dominant-less-dominant model in order to accommodate both research approaches. The goal of this study was to explore the impact of group play therapy on the social skills of shy children in their middle childhood. The researcher conducted a one-group pretest-posttest design in order to measure “shyness” as well as social skills before and after intervention. Seeing that the quantitative paradigm answered the research question of this research project, it was utilized as the dominant approach. Through comparing the pre-test and post-test scores, the researcher realized that group play therapy has a positive impact on the social skills of shy children. The unstructured observation provided the researcher with a better insight into the phenomena of shyness, and represented the qualitative approach. By combining the two research approaches, the researcher was able to achieve the outlined goal and objectives of this study. Further research into effective implementation of group play therapy to address shyness in the middle childhood years is recommended. / Dissertation (MSD (Play Therapy))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted

La presente investigación buscó analizar la relación entre la Ansiedad por COVID-19 y el Apoyo Social Percibido, en una muestra de trabajadores en modalidad remota de Lima Metropolitana, y Callao. Participaron en el estudio 205 adultos, entre 20 y 60 años. Se utilizaron la Coronavirus Anxiety Scale (CAS), traducida por Caycho-Rodríguez et al. (2020) y la adaptación peruana del Cuestionario MOS (Cruz, 2009). Se encontró una relación pequeña e inversa entre la ansiedad por COVID-19 y el apoyo social percibido, además de diferencias significativas en ambas variables, según género, grupo de edad y estado civil. / The present research aimed to describe the relationship between COVID-19 Anxiety and Perceived Social Support in remote workers in Lima Metropolitana and Callao. The study was carried out in 205 adults, ranging in age from 20 to 60 years. The Spanish translation of the Coronavirus Anxiety Scale (CAS) made by Caycho-Rodríguez et al. (2020) and the Peruvian adaptation of the MOS Social Support Survey (Cruz, 2009) were used. A small and negative correlation was found between COVID-19 Anxiety and Perceived Social Support. In addition, significant differences were found regarding gender, age group and marital status. / Tesis

Introducción: Existe un número reducido de estudios que han explorado la asociación entre síntomas de ansiedad social y síntomas de uso excesivo de internet. Objetivo: Determinar la relación entre la presencia de síntomas de ansiedad social y síntomas de dependencia al internet en estudiantes universitarios de segundo a quinto año de la carrera de medicina humana en el año 2018 en una universidad privada de Lima, Perú. Métodos: Se realizó un estudio transversal analítico con una población de 600 estudiantes de 2do a 5to año de medicina de 18 años a más en una universidad privada en el año 2018 en Lima, Perú. El desenlace (síntomas de uso excesivo de internet) fue medido con el Test de Young y categorizado en ausencia de síntomas, síntomas leves y síntomas moderados- severos, mientras que para la exposición (síntomas de ansiedad social) se utilizó la escala de SIAS y fue categorizada en presencia o ausencia de síntomas. Para el análisis multivariado se empleó el modelo de regresión logística multinomial; con ello se calculó el OR crudo y ajustado con un intervalo de confianza de 95%. Resultados: El 57.6% del total de estudiantes fueron mujeres y la mediana de edad para ambos géneros fue de 21 años con un rango intercuartílico entre 20 a 22 años. Se encontró que el 51.2% de los participantes presentaron síntomas de uso excesivo de internet, 27.8% corresponden a síntomas leves y 23.4% a síntomas moderados/ severos. 20.5% de los estudiantes presentaron síntomas de ansiedad social. Se encontró asociación entre síntomas de ansiedad social y los síntomas de uso excesivo de internet (p<0.001). Discusión y Conclusiones: Los estudiantes con síntomas de ansiedad social tuvieron más probabilidad de presentar síntomas de uso excesivo de internet. Se recomienda realizar estudios longitudinales para verificar la persistencia de los resultados durante el tiempo. / Introduction: There are only a few studies that have explored the association between symptoms of social anxiety and symptoms of excessive use of internet. Objetive: To determine the relationship between the presence of symptoms of social anxiety and symptoms of internet dependence in university students from the second to fifth year of the human medicine career in 2018 at a private university in Lima, Peru. Methods: An analytical cross-sectional study was conducted with a population of 600 medical students 18 years old or older from 2nd to 5th year at a private university in the year 2018 in Lima, Peru. The outcome (symptoms of excessive use of the Internet) was measured with Young's Internet Addiction Test and was classified in three categories: absence of symptoms, mild symptoms and moderate to severe symptoms, whilst the exposure (symptoms of social anxiety) was measured with SIAS scale and was categorized in two: presence or absence of symptoms. For multivariate analysis, the multinomial logistic regression model was employed; the crude OR as well as the adjusted OR were calculated and a confidence interval of 95% was used. Results: 57.6% of total students were women and median age for both genders was 21 years with an interquartile range of 20 to 22 years. It was found that 51.2% of participants had symptoms of excessive use of internet; 27.8% corresponded to mild symptoms and 23.4% to moderate to severe symptoms. 20.5% of the students had symptoms of social anxiety. We found a strong association between symptoms of social anxiety and the symptoms of excessive use of Internet (p<0.001). Discussion and Conclusions: Students with symptoms of social anxiety were more likely to have symptoms of excessive use of internet. Nevertheless, longitudinal studies are recommended in order to verify the persistence of the results over time. / Tesis

Social anxiety disorder, also known as social phobia, is one of the most prevalent anxiety disorders, affecting 7-13% of subjects in the community at some time in their lives. Despite being eminently treatable, it remains largely under-recognised and, therefore, undertreated. The disorder is characterized by a fear of scrutiny by others, with sufferers experiencing excessive anxiety in social and performance situations. This excessive anxiety usually leads to avoidance behaviour that can severely affect normal daily living. With onset commonly occurring during childhood or adolescence, social anxiety disorder may disrupt normal patterns of development of social and personal relationships, often having a long-term impact on emotional stability in social or working life. If left untreated, the course of social anxiety disorder is frequently complicated with comorbid conditions, particularly major depression or substance abuse. This review assesses the size of the clinical problem by evaluating current and lifetime prevalence estimates, age of onset, risk factors and evolution of the clinical course; thereby providing the rationale for early recognition and prompt treatment.

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIAX/ M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-tooffspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.

This study examined the association of social anxiety, loneliness, and problematic Internet use (PIU) with the online solicitation of minors. Within a convenience sample of adult Internet users from Germany, Finland, and Sweden (N = 2,828), we compared the responses of participants who had not interacted sexually with strangers online (n = 2,049) with participants who sexually interacted with unknown adults online (n = 642), and both groups with adults who sexually solicited unknown minors online (n = 137). Online sexual interaction with adults was associated with higher levels of social anxiety, loneliness, and PIU compared with not sexually interacting with strangers online. Sexually soliciting minors online was associated with higher levels of social anxiety, loneliness, and PIU compared with sexually interacting with adults and not sexually interacting with strangers at all. Interestingly, compared with those with adult contacts, loneliness was specifically pronounced for participants who solicited children, whereas social anxiety and PIU were pronounced for participants soliciting adolescents. These findings suggest that social anxiety, loneliness, and PIU may be among the motivators for using the Internet to solicit individuals of different age groups for sexual purposes. These factors emerged as specifically relevant for adults who sexually solicited minors and who reported greater impairments compared with adults who sexually interacted with adults. These characteristics may thus be important to consider for assessment and treatment procedures for individuals soliciting minors online.