Although several efficacious treatments exist for social anxiety disorder (SAD), less research has been devoted to identifying specific mechanisms involved in the etiology of SAD using high-risk, longitudinal designs. Given the high prevalence and personal and societal burden associated with a diagnosis of SAD, research is needed to elucidate causal factors at play in the development of SAD to inform innovative prevention programs for at-risk individuals. Theoretical models and empirical research suggest that biased attention toward threat-relevant information is an important factor in the maintenance of SAD. However, relatively little is known about the role of attention bias to threat in the development of SAD, and evidence is inconclusive with regard to whether attention biases lead to increases in anxiety over time. Also, only one study has examined attentional control as a potential factor moderating this relationship despite long-held assertions that "control over cognitive processes" may be an important individual difference factor determining the strength of the relationship between attention bias and development of excessive anxiety. Finally, a few studies have shown that attention bias to threat predicts stress reactivity, but these studies have only been conducted in unselected samples rather than with individuals at risk for developing SAD. Thus, the aims of this study were to examine the moderating effects of risk for SAD and attentional control on the relationships between attention bias to threat and (1) psychological and biological social stress reactivity and (2) development of SAD. The primary aim of the study was to examine the aforementioned relationships using attention bias to threat as assessed using the modified probe detection task (MPDT). In an exploratory analysis, the relationships were examined using an index of attention disengagement bias assessed with the Posner spatial cueing task (PSCT). Attentional control was represented by four indices, analyzed in separate regression analyses given their weak bivariate associations (i.e., Antisaccade task reaction time and accuracy rate, Attention Network Test executive control score, and total score on the Attentional Control Scale). First-year college students at low or high risk for developing SAD completed assessments of attention bias, attentional control, and anxiety during their first month of college. Approximately four months later, they completed a social stressor task and the same self-report measures of social anxiety. At the end of their first year in college, they completed the self-report measures of social anxiety once more, as well as a diagnostic interview for SAD. Correlational analyses indicated that attention bias to threat on the MPDT was associated with concurrent self-reported social anxiety but did not prospectively predict psychological or biological social stress reactivity, self-reported social anxiety, or SAD diagnostic status at the end of the first year in college. Hierarchical regression analyses supported the hypothesized double moderation for concurrent social anxiety, such that high levels of attentional control weakened the association between attention bias toward threat and social anxiety, only among the individuals at high risk for SAD. However, analyses did not support this relationship in predicting prospective outcomes, and several unexpected patterns emerged in which interactions between attention bias and attentional control were observed to predict prospective outcomes, but only among individuals at low risk for developing SAD. Likewise, exploratory analyses using the PSCT index of attention bias revealed unexpected interactions between risk group, attention bias, and attentional control. Considered together, results of the current study highlight the importance of considering individual differences in attention bias and attentional control in the maintenance and development of SAD. / Psychology

The default mode network (DMN) is active in the absence of task demands and during self-referential thought. Considerable evidence suggests that the DMN is involved in normative aspects of social cognition, and as such, disruptions in the function of DMN would be expected in disorders characterized by alterations in social function. Consistent with this notion, work in autism spectrum disorder (ASD) and social anxiety disorder (SAD) has demonstrated altered activation of several core regions of the DMN relative to neurotypical controls. Despite emergent evidence for alterations within the same brain systems in SAD and ASD, as well as a behavioral continuum of social impairments, no study to date has examined what is unique and what is common to the brain systems within these disorders. Therefore, the primary aim of the current study is to precisely characterize the topology of neural connectivity within the DMN in SAD and ASD and neurotypical controls in order to test the following hypotheses through functional and structural connectivity analyses of the DMN. Our analyses demonstrate increased coavtivation of the dorsomedial prefrontal cortex in ASD and SAD compared to controls, as well as over and under connectivity in structural brain connectivity in ASD. These results may reflect general deficits in social function at rest, and disorder specific alterations in structural connectivity in ASD. / Master of Science

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Both human and animal studies indicate that early trauma can influence brain development and can lead to dysregulation and dysfunction. This includes cognitive deficits. The risk of childhood trauma (CHT) and resulting cognitive deficits are well established in Posttraumatic Stress Disorder (PTSD). This is not the case for Social Anxiety Disorder (SAD). The experience of CHT does not inevitably lead to later psychopathology, suggesting that resiliency factors may be at play. Indeed, research shows that resilience is protective against the development of PTSD although this has not been well studied in SAD, particularly in the context of childhood trauma and neurocognition. Methods: This exploratory study assessed for the possible contribution of CHT on cognitive functioning in adults with SAD. We assessed 44 individuals who formed part of a larger study on neurocognitive and neuroimaging correlates in a sample drawn from the Western Cape, South Africa. Using a neuropsychological test battery, memory, attention and executive functioning (EF) (underpinned by hippocampal, cingulate cortex and pre frontal-cortex function respectively) were assessed. CHT was assessed with the Childhood Trauma Questionnaire (CTQ). We compared neurocognitive and resilience (CD-RISC) variables across four groups (SAD with trauma, SAD without trauma, PTSD and healthy controls) using analysis of variance (ANOVA) statistics. Results: None of the groups differed significantly on cognitive variables, however, on average all outcomes were in the predicted direction. Separate analyses for the traumatised groups only showed a significant effect for EF and attention, suggesting an association between EF, attention and CHT. On a measure of resilience, healthy controls had significantly higher resilience scores than the other 3 groups. Unexpectedly, SAD and PTSD groups with CHT had higher resilience scores than the SAD group without CHT, suggesting that resilience moderates CHT. Lastly individuals with SAD and PTSD with CHT reported more emotional abuse and neglect than any other type of childhood trauma. Conclusion: This exploratory study is unique in its comparative assessment of the effects of CHT and resilience on discussed. / AFRIKAANSE OPSOMMING: Agtergrond: Beide mens- en dierestudies dui daarop dat vroeë trauma brein ontwikkeling kan beïnvloed en kan lei tot disfunksie. Dit sluit kognitiewe tekortkominge in. Die risiko van vroeë kinderjare trauma (KJT) en die gevolglike kognitiewe tekortkominge is goed gevestig in Posttraumatiese stresversteuring (PTSV). Dit is egter nie die geval in Sosiale angsversteuring (SAV) nie. Die ervaring van KJT lei nie noodwendig tot latere psigopatologie nie, wat daarop dui dat veerkragtigheidsfaktore 'n rol kan speel. Trouens, navorsing toon dat veerkragtigheid beskermend is teen die ontwikkeling van PTSV, maar dit is egter nie behoorlik nagevors in SAV nie - veral nie in die konteks van vroeë kinderjare en neurokognisie nie. Metodologie: Hierdie verkennende studie het die invloed van KJT op kognitiewe funksionering in 44 individue geëvalueer. Hierdie studie het deel gevorm van 'n groter studie oor neurokognitiewe- en neurobeeldingskorrelate in 'n steekproef wat gewerf is uit die Wes-Kaap, Suid-Afrika. ‘n Neurosielkundige toetsbattery was gebruik om geheue, aandag en uitvoerende funksionering (UF) (wat onderskeidelik deur die hippokampus, cingulate korteks en prefrontale korteks ondersteun word) te assesseer. KJT is beoordeel met die "Childhood Trauma Questionnaire" (CTQ). 'n Analise van variansie (ANOVA) was gebruik om die neurokognitiewe en veerkragtigheid (CD-RISC) veranderlikes oor vier groepe (SAV met trauma, SAV sonder trauma, PTSV en gesonde kontrole) te vergelyk. Resultate: Nie een van die groepe het beduidend verskil van mekaar op grond van kognitiewe veranderlikes nie, maar oor die algemeen was alle uitkomste in die voorspelde rigting. Afsonderlike analises op die getraumatiseerde groepe het 'n beduidende effek gehad vir UF en aandag, wat dui op 'n assosiasie tussen UF, aandag en KJT. Die gesonde kontrole het beduidende hoër veerkragtigheid tellings as die ander 3 groepe gehad. SAV en PTSV groepe met KJT het teen verwagtinge hoër veerkragtigheidstellings gehad as die SAV sonder KJT, wat daarop dui dat veerkragtigheid KJT modereer. Laastens, individue met SAV en PTSV met KJT het meer emosionele mishandeling en verwaarlosing gerapporteer as enige ander tipe kinderjare trauma. Bespreking: Hierdie verkennende studie is uniek in sy vergelykende evaluering van die invloed van KJT en veerkragtigheid op die neurokognisie in deelnemers met SAV en PTSV. Beperkings en aanbevelings vir toekomstige navorsing word bespreek.

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O Transtorno de Ansiedade Social (TAS) tem sido considerado um grave problema de saúde mental pela sua alta prevalência em pessoas jovens e pelas incapacidades decorrentes no desempenho e interações sociais. É fundamental que se disponha de instrumentos validados e abrangentes que avaliem tanto os recursos e déficits comportamentais quanto os prejuízos sociais e funcionais destas pessoas. Objetivou-se, neste trabalho, verificar as associações entre as manifestações comportamentais e clínicas do TAS por meio de dois estudos, um psicométrico e outro empírico, visando: (a) aferir as propriedades psicométricas do Inventário de Habilidades Sociais (IHS-Del-Prette), enquanto medida do repertório comportamental de habilidades sociais, em relação à avaliação das manifestações clínicas próprias do TAS, medidas pelo Inventário da Fobia Social (SPIN); e (b) comparar e caracterizar o repertório de habilidades sociais apresentado por universitários brasileiros portadores de TAS e não portadores frente a uma situação experimental estruturada, o Teste de Simulação de Falar em Público (TSFP). Do estudo psicométrico, participaram 1006 universitários, na faixa etária entre 17 e 35 anos, de ambos os gêneros, provindos de duas instituições de ensino superior. Posteriormente, 86 participantes foram randomicamente selecionados desta amostra inicial e agrupados como casos e não-casos de TAS a partir de avaliação clínica sistemática por meio da Entrevista Clínica Estruturada para o DSM-IV. Do delineamento empírico, participaram 26 universitários, sendo 13 com diagnóstico de TAS e 13 não portadores de transtornos psiquiátricos. Quanto aos resultados, o IHS apresentou boa consistência interna para o escore total, reforçando a sua validade de construto. Observou-se boa validade concorrente entre o IHS e o SPIN, com um coeficiente altamente significativo de correlação negativa entre eles, indicando que quanto mais elaborado for o repertório de habilidades sociais de um indivíduo, menor é a sua probabilidade de satisfazer os critérios de rastreamento de indicadores para o TAS. O IHS demonstrou distinguir significativamente indivíduos com e sem TAS, atestando sua validade discriminativa e preditiva para esse diagnóstico, evidenciando-se assim a sua validade clínica e a possibilidade do seu uso em estudos empíricos que testem a eficácia terapêutica de programas de intervenção. No TSFP, os grupos caso e não-caso de TAS não demonstraram diferenças significativas, em termos de freqüência, para a maioria dos marcadores comportamentais de ansiedade avaliados. Um número maior de sujeitos do grupo não-caso foi avaliado como apresentando um nível de habilidades sociais apropriadas para falar em público, que variou de moderado a alto, em comparação ao grupo caso. Ao longo do TSFP, a freqüência de emissão dos marcadores comportamentais de ansiedade pelos sujeitos de ambos os grupos manteve-se estável. Os grupos diferiram significativamente na maioria dos itens indicativos da habilidade de falar em público do IHS e quanto ao escore geral desta habilidade. A análise dos resultados do estudo empírico aponta para a necessidade de novos estudos com amostras clínicas de indivíduos com TAS dos subtipos generalizado e circunscrito, e não-clínica, com maior número de sujeitos, previamente avaliados quanto ao medo de falar em público, e também para a possibilidade de uso do TSFP em programas de Treinamento em Habilidades Sociais. / Social Anxiety Disorder (SAD) has been considered a serious mental health problem for its high prevalence in young people and for the resulting disabilities in the performance and social interactions. It stands out, thus, as being fundamental to have comprehensive and validated instruments which evaluate both the resources and the social and functional impairments of these people. In this work, we aimed at verifying the associations between the behavioral and clinical manifestations of SAD by means of two studies, a psychometric study and an empirical one, in order to: (a) check the psychometric properties of the Social Skills Inventory (HIS-Del-Prette), as a measure of the social skills behavioral repertoire in relation to the evaluation of the typical clinical manifestations of SAD, measured by the Social Phobia Inventory (SPIN); (b) compare and characterize the social skills repertoire shown by Brazilian undergraduates with and without SAD in a structured experimental situation, the Simulated Public Speaking Test (SPST). A total of 1006 undergraduates of both genders participated in the psychometric study, with ages between 17 and 35, from two universities. Subsequently, 86 participants were randomly selected from this initial sample and grouped as SAD case and non-case from the systematic clinical evaluation. In the empirical outline, 26 undergraduates participated, 13 with a SAD diagnosis and 13 without the disorder. According to the results, IHS showed good internal consistency for the total score, reinforcing its construct validity. Good concurrent validity was demonstrated between IHS and SPIN, with a highly significant negative correlation coefficient between them, indicating that the more elaborate the social skills repertoire of an individual is, the smaller the probability that he or she will meet the screening criteria for the indicators of SAD. IHS proved to significantly distinguish individuals with and without SAD, attesting thus, discriminative and predictive validity for this diagnosis, showing its clinical validity for the diagnosis of this disorder and yet the possibility of using it in empirical studies testing the therapeutical efficacy in programs of intervention. In the SPST, the case and non-case groups of SAD did not show significant differences in terms of frequency for most of the social anxiety markers, except in relation to facial movements of discomfort, and the class of non-verbal markers, in which the non-case group presented higher values. A higher number of individuals from this group were evaluated as showing a level of appropriate social skills for speaking in public which varied from moderate to high, in comparison with the other group. Throughout SPST, the frequency of emission of anxiety behavioral markers by the participants of both groups was stable. The groups differed significantly in most items of IHS indicative of abilities to speak in public, as well as in the general score of this ability. The analysis of the results of the empirical study points to the necessity of new studies with clinical samples of individuals with SAD of the generalized and circumscribed subtypes and non-clinical, with a larger number of participants, previously evaluated as to the fear of speaking in public, and also to the possibility of using SPST in Social Skills Training.

O Transtorno de Ansiedade Social (TAS) caracteriza-se pelo medo acentuado e persistente de situações sociais ou de desempenho, mostrando-se associado a prejuízos funcionais . Objetiva-se avaliar a associação do TAS a prejuízos funcionais nas atividades cotidianas, por meio da validação de duas escalas de auto e de hetero-avaliação, aplicadas a universitários brasileiros. Realizou-se dois estudos, um de comparação entre grupos TAS e Não TAS e outro de estudos de casos. Procedeu-se à tradução e adaptação da Escala de Liebowitz para auto-avaliação dos prejuízos funcionais (ELAPF) e da Escala de Liebowitz para hetero-avaliação dos prejuízos funcionais (ELHPF). Participaram do estudo de comparação entre grupos 173 universitários (TAS = 84 e Não TAS = 89), de ambos os sexos, com idade entre 17 e 35 anos. Procedeu-se a aplicação da Entrevista clínica semi-estruturada para o DSM-IV, para a confirmação diagnóstica e dos instrumentos: ELAPF, ELHPF, Questionário de Saúde Geral -12 (QSG-12), Inventário de Fobia Social (SPIN). Para os estudos de casos, selecionou-se três participantes do grupo TAS e procedeu-se a uma entrevista semi-estruturada sobre o impacto do transtorno nas atividades cotidianas, nos relacionamentos e na saúde geral. Os dados das escalas foram codificados e os grupos comparados por teste estatísticos não paramétricos (p 0,05) e para os estudos de casos foram integrados e analisados qualitativamente os dados das escalas e da entrevista,. Os grupos não apresentaram diferenças significativas quanto as variáveis demográficas. O grupo TAS apresentou no QSG-12 mais dificuldades quanto ao bem estar geral, e na ELAPF e na ELHPF apresentou, com significância estatística, mais dificuldades nas últimas semanas e no curso da vida. Observou-se para o grupo TAS: a) para a ELHPF, consistência interna de 0,68 no curso da vida e 0,67 nas duas últimas semanas, o coeficiente de correlação Kappa entre os avaliadores, variou de 0,75 a 0,93, caracterizando nível de concordância satisfatória e na análise dos componentes principais extrairam-se dois fatores para os dois parâmetros temporais; a validade concorrente realizada com o SPIN, mostrou valores que variaram entre 0,11 e 0,33 para o parâmetro no curso da vida e 0,17 a 0,39 nas duas últimas semanas, e b) para a ELAPF, a consistência interna foi de 0,85 para o parâmetro no curso da vida e 0,83 nas duas últimas semanas e na análise dos componentes principais extrairam-se três fatores, para o parâmetro temporal no curso da vida e dois fatores no parâmetro nas duas últimas semanas; a validade concorrente realizada em relação ao SPIN, mostrou valores no curso da vida de -0,14 a 0,25 e nas duas últimas semanas, a correlação variou de 0 a 0,38. Os estudos de casos evidenciaram que os prejuízos funcionais associados ao TAS têm impacto negativo para os relacionamentos, as atividades cotidianas, o bem estar e a percepção de saúde. As escalas , mostraram-se válidas para a avaliação dos prejuízos funcionais associados ao TAS, o que contribui para as práticas de saúde mental, em especial as de terapia ocupacional, que tem como foco as intervenções voltadas para a vida cotidiana. / Social Anxiety Disorder (SAD) is characterized by marked and persistent fear of social or performance situations and is associated with functional impairment. The objective of the present study was to assess the association of SAD with functional impairment in daily activities by means of the validation of two scales (auto and hetero-evaluation) applied to Brazilian university students. Two studies were conducted, one of them comparing SAD and Non SAD groups and the other consisting of cases studies. The Liebowitz Disability Self Rating Scale (LDSRS) and the Disability Profile /Clinician- Rated (DP) were translated and adapted. A total of 173 university students (SAD = 84 and Non-SAD = 89) of both genders, aged 17 to 35 years participated in the study of group comparison. A semi-structured clinical interview for DSM-IV was applied for confirmation of the diagnosis and the following instruments were applied: LDSRS, DP, General Health Questionnaire-12 (GHQ-12), and Social Phobia Inventory (SPIN). Three participants of the SAD group were selected for the case studies and submitted to a semi-structured interview about the impact of the disorder on daily activities, relationships, and general health. The scale data were coded and the groups were compared by a non-parametric test (p 0.05), and for the case studies the scale and interview data were integrated and analyzed qualitatively. The groups did not differ significantly in terms of demographic variables. For the SAD group, application of the GHQ-12 revealed more difficulties regarding general well-being, and application of the LDSRS and DP revealed significantly more lifetime difficulties and difficulties in the last weeks. The following observations were made for the SAD group: a) for the DP, the internal consistency was 0.68 during the life course and 0.67 during the last two weeks; the Kappa correlation coefficient for the two raters ranged from 0.75 to 0.93, characterizing a satisfactory level of concordance, and two factors for the two temporal parameters were extracted in the analysis of the principal components; concurrent validity performed with the SPIN showed values ranging from 0.11 to 0.33 for the lifetime parameter and from 0.17 to 0.39 for the last two weeks, and b) for the LDSRS, the internal consistency was 0.85 for the lifetime parameter and 0.83 for the last two weeks; concurrent validity performed with the SPIN showed lifetime values ranging from 0.14 to 0.25 and values ranging from 0 to 0.38 in the last two weeks. The case studies demonstrated that the functional impairment associated with SAD has a negative impact on relationships, daily activities, well-being, and health perception. The scales proved to be valid for the assessment of the functional impairment associated with SAD, a fact that contributes to mental health practices, especially those of occupational therapy, that focus on interventions in daily life.

O Transtorno de Ansiedade Social (TAS) caracteriza-se pelo medo acentuado e persistente de situações sociais ou de desempenho, mostrando-se associado a prejuízos funcionais . Objetiva-se avaliar a associação do TAS a prejuízos funcionais nas atividades cotidianas, por meio da validação de duas escalas de auto e de hetero-avaliação, aplicadas a universitários brasileiros. Realizou-se dois estudos, um de comparação entre grupos TAS e Não TAS e outro de estudos de casos. Procedeu-se à tradução e adaptação da Escala de Liebowitz para auto-avaliação dos prejuízos funcionais (ELAPF) e da Escala de Liebowitz para hetero-avaliação dos prejuízos funcionais (ELHPF). Participaram do estudo de comparação entre grupos 173 universitários (TAS = 84 e Não TAS = 89), de ambos os sexos, com idade entre 17 e 35 anos. Procedeu-se a aplicação da Entrevista clínica semi-estruturada para o DSM-IV, para a confirmação diagnóstica e dos instrumentos: ELAPF, ELHPF, Questionário de Saúde Geral -12 (QSG-12), Inventário de Fobia Social (SPIN). Para os estudos de casos, selecionou-se três participantes do grupo TAS e procedeu-se a uma entrevista semi-estruturada sobre o impacto do transtorno nas atividades cotidianas, nos relacionamentos e na saúde geral. Os dados das escalas foram codificados e os grupos comparados por teste estatísticos não paramétricos (p 0,05) e para os estudos de casos foram integrados e analisados qualitativamente os dados das escalas e da entrevista,. Os grupos não apresentaram diferenças significativas quanto as variáveis demográficas. O grupo TAS apresentou no QSG-12 mais dificuldades quanto ao bem estar geral, e na ELAPF e na ELHPF apresentou, com significância estatística, mais dificuldades nas últimas semanas e no curso da vida. Observou-se para o grupo TAS: a) para a ELHPF, consistência interna de 0,68 no curso da vida e 0,67 nas duas últimas semanas, o coeficiente de correlação Kappa entre os avaliadores, variou de 0,75 a 0,93, caracterizando nível de concordância satisfatória e na análise dos componentes principais extrairam-se dois fatores para os dois parâmetros temporais; a validade concorrente realizada com o SPIN, mostrou valores que variaram entre 0,11 e 0,33 para o parâmetro no curso da vida e 0,17 a 0,39 nas duas últimas semanas, e b) para a ELAPF, a consistência interna foi de 0,85 para o parâmetro no curso da vida e 0,83 nas duas últimas semanas e na análise dos componentes principais extrairam-se três fatores, para o parâmetro temporal no curso da vida e dois fatores no parâmetro nas duas últimas semanas; a validade concorrente realizada em relação ao SPIN, mostrou valores no curso da vida de -0,14 a 0,25 e nas duas últimas semanas, a correlação variou de 0 a 0,38. Os estudos de casos evidenciaram que os prejuízos funcionais associados ao TAS têm impacto negativo para os relacionamentos, as atividades cotidianas, o bem estar e a percepção de saúde. As escalas , mostraram-se válidas para a avaliação dos prejuízos funcionais associados ao TAS, o que contribui para as práticas de saúde mental, em especial as de terapia ocupacional, que tem como foco as intervenções voltadas para a vida cotidiana. / Social Anxiety Disorder (SAD) is characterized by marked and persistent fear of social or performance situations and is associated with functional impairment. The objective of the present study was to assess the association of SAD with functional impairment in daily activities by means of the validation of two scales (auto and hetero-evaluation) applied to Brazilian university students. Two studies were conducted, one of them comparing SAD and Non SAD groups and the other consisting of cases studies. The Liebowitz Disability Self Rating Scale (LDSRS) and the Disability Profile /Clinician- Rated (DP) were translated and adapted. A total of 173 university students (SAD = 84 and Non-SAD = 89) of both genders, aged 17 to 35 years participated in the study of group comparison. A semi-structured clinical interview for DSM-IV was applied for confirmation of the diagnosis and the following instruments were applied: LDSRS, DP, General Health Questionnaire-12 (GHQ-12), and Social Phobia Inventory (SPIN). Three participants of the SAD group were selected for the case studies and submitted to a semi-structured interview about the impact of the disorder on daily activities, relationships, and general health. The scale data were coded and the groups were compared by a non-parametric test (p 0.05), and for the case studies the scale and interview data were integrated and analyzed qualitatively. The groups did not differ significantly in terms of demographic variables. For the SAD group, application of the GHQ-12 revealed more difficulties regarding general well-being, and application of the LDSRS and DP revealed significantly more lifetime difficulties and difficulties in the last weeks. The following observations were made for the SAD group: a) for the DP, the internal consistency was 0.68 during the life course and 0.67 during the last two weeks; the Kappa correlation coefficient for the two raters ranged from 0.75 to 0.93, characterizing a satisfactory level of concordance, and two factors for the two temporal parameters were extracted in the analysis of the principal components; concurrent validity performed with the SPIN showed values ranging from 0.11 to 0.33 for the lifetime parameter and from 0.17 to 0.39 for the last two weeks, and b) for the LDSRS, the internal consistency was 0.85 for the lifetime parameter and 0.83 for the last two weeks; concurrent validity performed with the SPIN showed lifetime values ranging from 0.14 to 0.25 and values ranging from 0 to 0.38 in the last two weeks. The case studies demonstrated that the functional impairment associated with SAD has a negative impact on relationships, daily activities, well-being, and health perception. The scales proved to be valid for the assessment of the functional impairment associated with SAD, a fact that contributes to mental health practices, especially those of occupational therapy, that focus on interventions in daily life.

Social anxiety disorder (SAD) is one of the most common anxiety disorders and understanding its symptoms and risk factors is vital for developing treatments and prevention strategies. Atypical physiological responses have been observed in anxious individuals and their consequences present a human and economic burden. This dissertation includes two studies that explore the subjective and physiological responses to an acute stress in the context of treatment and risk factors for SAD. The goal of the first study was to examine whether cognitive behavioural group therapy (CBGT) and a mindfulness-based stress reduction (MBSR) program differentially influenced the subjective and physiological response to a speech task. Participants in the treatment groups performed two speech tasks, before and after treatment, while a healthy control group completed it only once. Results indicated significant differences for the subjective, but not the physiological measures of stress. Patients with SAD reported higher subjective anxiety than the healthy control group and these scores were significantly reduced following treatment. Greater improvements were noted in the CBGT group; nonetheless, the study did indicate promising results for MBSR. The second study aimed to explore the effects of behavioural inhibition (BI), parental bonding variables and their interaction on the subjective and physiological responses to a similar speech task in healthy children. BI was related to subjective anxiety in a predictive manner, but was generally unrelated to the physiological measures. Parental bonding variables were not related to any of the stress responses and no interaction between BI and parental bonding was observed. These studies contribute to the literature by demonstrating treatment differences and their subjective and physiological consequences on stress reactions and exploring the extent to which risk factors for SAD affect the stress response in healthy children.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T14:23:24Z No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-28T14:25:16Z (GMT) No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) / Made available in DSpace on 2016-01-28T14:25:16Z (GMT). No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) Previous issue date: 2014-01-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Transtorno de Ansiedade Social (TAS) é uma patologia muito comum nos dias atuais, figurando como o principal transtorno de ansiedade e uma das doenças mentais mais prevalentes na população mundial. É caracterizada por medo ou ansiedade excessiva e constante diante de situações sociais, que podem ser de desempenho, de interação ou de observação, em que o indivíduo apresenta temor em ser avaliado negativamente por outras pessoas, podendo ser exposto a humilhações e ao escrutínio. O objetivo do trabalho foi o desenvolvimento de um instrumento de rastreio dos sintomas do TAS, capaz de identificar os sujeitos com maior probabilidade de desenvolvimento da doença. O estudo dividiu-se em duas fases: primeiro tivemos a construção do instrumento, e segundo, a aplicação do mesmo em 297 pessoas. Foram aplicados um questionário sócio-demográfico, a Escala de Ansiedade Social de Liebowitz, o Mini Inventário de Fobia Social e a escala desenvolvida pelos autores. Os resultados preliminares mostraram excelentes índices de consistência interna e a análise fatorial foi considerada satisfatória. Houve associação entre a pontuação da escala e alguns indicadores sócio-demográficos, de acordo com a literatura científica da área. / The Social Anxiety Disorder (SAD) is a very common condition presently, appearing as the primary anxiety disorder and one of the most prevalent mental diseases worldwide. It is characterized by constant and excessive fear or anxiety about social situations, which can be of performance, interaction or observation, in which a person has fear of being negatively evaluated by others, and may be exposed to humiliation and scrutiny. The objective of this work is the development of a screening instrument of the symptoms of SAD, which is able to identify as well subjects with greater likelihood of developing the disease. The study was divided into two phases: the first refers to the construction of the instrument and the second consists on the application of the test to 297 subjects. One socio-demographic questionnaire, the Liebowitz Social Anxiety Scale, the Mini Social Phobia Inventory and the scale developed by the authors. Preliminary results showed excellent internal consistency and factor analysis was considered satisfactory. There was an association between the scale score and some socio-demographic indicators, according to scientific literature in the area.

O Transtorno de Ansiedade Social (TAS) tem sido considerado um grave problema de saúde mental pela sua alta prevalência em pessoas jovens e pelas incapacidades decorrentes no desempenho e interações sociais. É fundamental que se disponha de instrumentos validados e abrangentes que avaliem tanto os recursos e déficits comportamentais quanto os prejuízos sociais e funcionais destas pessoas. Objetivou-se, neste trabalho, verificar as associações entre as manifestações comportamentais e clínicas do TAS por meio de dois estudos, um psicométrico e outro empírico, visando: (a) aferir as propriedades psicométricas do Inventário de Habilidades Sociais (IHS-Del-Prette), enquanto medida do repertório comportamental de habilidades sociais, em relação à avaliação das manifestações clínicas próprias do TAS, medidas pelo Inventário da Fobia Social (SPIN); e (b) comparar e caracterizar o repertório de habilidades sociais apresentado por universitários brasileiros portadores de TAS e não portadores frente a uma situação experimental estruturada, o Teste de Simulação de Falar em Público (TSFP). Do estudo psicométrico, participaram 1006 universitários, na faixa etária entre 17 e 35 anos, de ambos os gêneros, provindos de duas instituições de ensino superior. Posteriormente, 86 participantes foram randomicamente selecionados desta amostra inicial e agrupados como casos e não-casos de TAS a partir de avaliação clínica sistemática por meio da Entrevista Clínica Estruturada para o DSM-IV. Do delineamento empírico, participaram 26 universitários, sendo 13 com diagnóstico de TAS e 13 não portadores de transtornos psiquiátricos. Quanto aos resultados, o IHS apresentou boa consistência interna para o escore total, reforçando a sua validade de construto. Observou-se boa validade concorrente entre o IHS e o SPIN, com um coeficiente altamente significativo de correlação negativa entre eles, indicando que quanto mais elaborado for o repertório de habilidades sociais de um indivíduo, menor é a sua probabilidade de satisfazer os critérios de rastreamento de indicadores para o TAS. O IHS demonstrou distinguir significativamente indivíduos com e sem TAS, atestando sua validade discriminativa e preditiva para esse diagnóstico, evidenciando-se assim a sua validade clínica e a possibilidade do seu uso em estudos empíricos que testem a eficácia terapêutica de programas de intervenção. No TSFP, os grupos caso e não-caso de TAS não demonstraram diferenças significativas, em termos de freqüência, para a maioria dos marcadores comportamentais de ansiedade avaliados. Um número maior de sujeitos do grupo não-caso foi avaliado como apresentando um nível de habilidades sociais apropriadas para falar em público, que variou de moderado a alto, em comparação ao grupo caso. Ao longo do TSFP, a freqüência de emissão dos marcadores comportamentais de ansiedade pelos sujeitos de ambos os grupos manteve-se estável. Os grupos diferiram significativamente na maioria dos itens indicativos da habilidade de falar em público do IHS e quanto ao escore geral desta habilidade. A análise dos resultados do estudo empírico aponta para a necessidade de novos estudos com amostras clínicas de indivíduos com TAS dos subtipos generalizado e circunscrito, e não-clínica, com maior número de sujeitos, previamente avaliados quanto ao medo de falar em público, e também para a possibilidade de uso do TSFP em programas de Treinamento em Habilidades Sociais. / Social Anxiety Disorder (SAD) has been considered a serious mental health problem for its high prevalence in young people and for the resulting disabilities in the performance and social interactions. It stands out, thus, as being fundamental to have comprehensive and validated instruments which evaluate both the resources and the social and functional impairments of these people. In this work, we aimed at verifying the associations between the behavioral and clinical manifestations of SAD by means of two studies, a psychometric study and an empirical one, in order to: (a) check the psychometric properties of the Social Skills Inventory (HIS-Del-Prette), as a measure of the social skills behavioral repertoire in relation to the evaluation of the typical clinical manifestations of SAD, measured by the Social Phobia Inventory (SPIN); (b) compare and characterize the social skills repertoire shown by Brazilian undergraduates with and without SAD in a structured experimental situation, the Simulated Public Speaking Test (SPST). A total of 1006 undergraduates of both genders participated in the psychometric study, with ages between 17 and 35, from two universities. Subsequently, 86 participants were randomly selected from this initial sample and grouped as SAD case and non-case from the systematic clinical evaluation. In the empirical outline, 26 undergraduates participated, 13 with a SAD diagnosis and 13 without the disorder. According to the results, IHS showed good internal consistency for the total score, reinforcing its construct validity. Good concurrent validity was demonstrated between IHS and SPIN, with a highly significant negative correlation coefficient between them, indicating that the more elaborate the social skills repertoire of an individual is, the smaller the probability that he or she will meet the screening criteria for the indicators of SAD. IHS proved to significantly distinguish individuals with and without SAD, attesting thus, discriminative and predictive validity for this diagnosis, showing its clinical validity for the diagnosis of this disorder and yet the possibility of using it in empirical studies testing the therapeutical efficacy in programs of intervention. In the SPST, the case and non-case groups of SAD did not show significant differences in terms of frequency for most of the social anxiety markers, except in relation to facial movements of discomfort, and the class of non-verbal markers, in which the non-case group presented higher values. A higher number of individuals from this group were evaluated as showing a level of appropriate social skills for speaking in public which varied from moderate to high, in comparison with the other group. Throughout SPST, the frequency of emission of anxiety behavioral markers by the participants of both groups was stable. The groups differed significantly in most items of IHS indicative of abilities to speak in public, as well as in the general score of this ability. The analysis of the results of the empirical study points to the necessity of new studies with clinical samples of individuals with SAD of the generalized and circumscribed subtypes and non-clinical, with a larger number of participants, previously evaluated as to the fear of speaking in public, and also to the possibility of using SPST in Social Skills Training.