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At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Manuscript.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

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

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of “Adam,” a Caucasian male referred to a prison-based sex offender treatment program. Adam’s social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam’s individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

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Although social anxiety disorder is most often diagnosed during adolescence, few investigations have examined the clinical presentation of this disorder exclusively in adolescents. Prior studies have demonstrated that some clinical features of SAD in adolescents are unique relative to younger children with the condition. Furthermore, the extant literature on daily functional impairment in this population is limited. In this investigation, multiple areas of functioning were examined in adolescents with SAD (n = 16) and normal control adolescents (n = 14): specific social skills, subjective distress and physiological reactivity during one speech performance task and one social interaction task; alcohol use and expectancies; subjective and objective quality of sleep; and daily distressing social activities. No differences were observed in sleep actigraphy, self-reported sleep difficulties, alcohol use, or alcohol expectancies. Adolescents with SAD reported greater distress during both analogue tasks relative to NC adolescents. During the speech task, adolescents with SAD exhibited significantly greater speech latency (4.42 seconds vs. 1.75 seconds) and spoke significantly less (83.09 seconds vs. 167.75 seconds) than NC adolescents. Additionally, SAD participants manifested greater skin conductance during the speech task. During the social interaction, adolescents with SAD asked significantly fewer questions (2.20 vs. 7.07) and required significantly more confederate prompts (2.33 vs. 1.14) to stimulate interaction. Finally, adolescents with SAD reported more frequent anxiety-provoking situations in their daily lives and greater avoidance of these situations, including answering questions in class, assertive communication, and interacting with a group. iv The findings are discussed with respect to the current understanding of alcohol use, quality of sleep, and social functioning in adolescents with SAD.

Objective: Two significant challenges for the dissemination of social skills training programs are (a) the need to provide sufficient practice opportunities to assure skill consolidation and (b) the need to assure skill generalization (i.e., use of the skills outside the clinic setting). In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This investigation describes the development of an interactive skills-oriented virtual school environment and evaluated its utility for the treatment of social anxiety disorder in preadolescent children (Study 1). This environment included both in-clinic and at-home solutions. In addition, a pilot replication/extension study further examined preliminary treatment efficacy between children who received a standard multi-component treatment and children who received the modified treatment with social skills practice in a virtual environment (Study 2). Method: Eleven children with a primary diagnosis of social anxiety disorder between 7 to 12 years old participated in the initial feasibility trial (Study 1). Five additional children participated in the replication/extension study (Study 2). To investigate preliminary treatment efficacy, clinical outcome measures for the Study 2 sample were compared to a comparison sample who received the standard treatment. Results: Overall, the virtual environment program was viewed as acceptable, feasible, and credible treatment components to children, parents, and clinicians alike but modifications would likely improve the current version. Additionally, although preliminary, children who received the modified treatment with virtual environment practice demonstrated significant improvement at post-treatment on clinician ratings but not parent or self-reported measures. Conclusion: Virtual environments are feasible, acceptable, and credible treatment components for clinical use. Future investigations will determine if the addition of this dose-controlled and iv intensive social skills practice results in treatment outcome equivalent to traditional cognitivebehavioral programs.

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Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and one that is particularly disruptive of social relationships. Socially anxious individuals often have trouble forming and maintaining intimate relationships, as evidenced by a high divorce rate and low relationship satisfaction within existing relationships. However, little is known about the specific reasons why relationships involving socially anxious individuals suffer. Initial research suggests that such relationships may be characterized by lower levels of emotional intimacy and difficulties managing and resolving conflict. The current study aimed to detect specific problems socially anxious individuals have communicating with their partners during conflict and support-seeking conversations. Male (n = 50) and female (n = 57) undergraduates ("actors") and their intimate partners ("partners") completed two videotaped conversations in our laboratory. One conversation featured a topic of conflict within the relationship, whereas the other focused on a personal problem experienced by the actor. Outcomes of interest included level of engagement and expressiveness of the actor, presence of positive (e.g., humor) and negative (e.g., withdrawal) communication behavior by the actor, feelings of satisfaction and closeness of both partners, and emotions experienced by both partners. We hypothesized that social anxiety would be associated with lower levels of engagement and expressiveness overall, but especially during conflict. Further, we hypothesized that those higher on social anxiety would demonstrate more negative communication behavior (such as expressing hostility toward their partners) during conflict. Results provided some evidence that socially anxious individuals were less engaged and expressive when speaking with their partners. However, there was no evidence that they used more negative communication behaviors. Our hypothesis that social anxiety would be associated with greater difficulty during conflict had minimal support; rather, conversations in which the actor elicited support appeared to be the most difficult for socially anxious individuals, particularly when emotional experience was considered. Clinical implications and ideas for further research are explored. / Psychology