Background. To examine the role of parental psychopathology and family environment for the risk of social anxiety disorder (SAD) in offspring from childhood to early adulthood, covering an observational period of 10 years. Method. A community sample of 1,395 adolescents (aged 14 to 17 years at baseline) was prospectively followed-up over the core high risk period for SAD onset. DSM-IV offspring and parental psychopathology was assessed using the Munich-Composite International Diagnostic Interview; direct diagnostic interviews in parents were supplemented by family history reports from offspring. Parental rearing was assessed by the Questionnaire of Recalled Rearing Behavior in offspring, family functioning by the McMaster Family Assessment Device in parents. Results. Parental SAD was associated with the offspring’s risk to develop SAD (OR = 3.3, 95%CI: 1.4-8.0). Additionally, other parental anxiety disorders (OR = 2.9, 95%CI: 1.4-6.1), depression (OR = 2.6, 95%CI: 1.2-5.4) and alcohol use disorders (OR = 2.8, 95%CI: 1.3-6.1) were associated with offspring SAD. Offspring’s reports of parental overprotection, rejection and lack of emotional warmth, but not parental reports of family functioning were associated with offspring SAD. Analyses of interaction of parental psychopathology and parental rearing indicated combined effects on the risk for offspring SAD. Conclusions. These findings extend previous results in showing that both parental psychopathology and parental rearing are consistently associated with the risk for offspring SAD. As independent and interactive effects of parental psychopathology and parental rearing may have already manifested in early adolescence, these factors appear crucial and promising for targeted prevention programs.

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Anxiety disorders are among the most commonly diagnosed class of mental illness in the United States, and often involve abnormally high levels of stress and social fear. Despite high lifetime prevalence rates, social anxiety disorder (SAD) has remarkably low diagnosis and treatment rates. Furthermore, while individuals with other specific psychiatric disorders tend to exhibit significant neuropsychological deficits, neuropsychological functioning in individuals with SAD remains largely untested. A majority of the few existing studies concerning neuropsychological performance in SAD samples focus on specific functions, and their limited results are highly mixed. The primary objective of this investigation was to provide a more thorough, broad assessment of both auditory and visual working memory as related to psychometrically-defined social anxiety disorder. In addition, this study aimed to help clarify as to whether such deficits are related to the construct of social anxiety, or whether any potential deficits are better explained by generalized state and/or trait (in-the-moment) anxiety. The implications of a deficit in the visual and/or auditory working memory domains are multifaceted. For example, such a deficit may lead to the inability to detect visual cues in social situations. The inability to process these social cues has the potential to exacerbate some SAD- related symptoms, such as fear of humiliation and judgment. Twenty-nine college students completed both phases of this study, including an assessment of state and trait anxiety as well as social phobia and a four-part working memory battery. An analysis of the Phase II data indicates that individual scores on the four measures of both visual and auditory working memory did not relate to trait and/or state anxiety or psychometrically-defined social anxiety.; Thus, it appears that social, generalized trait, and generalized state anxiety do not relate to a neuropsychological deficit in either type of working memory in this sample population. However, we did find a statistical trend suggesting that as social anxiety increased, there was a relative decrease in visual vs. auditory working memory. This statistical trend remained after covarying for state and trait anxiety respectively. Therefore, future research in this area should examine the discrepancy in performance between the auditory and visual working memory domains as it relates to both diagnosed social phobia and psychometrically-defined social anxiety.

No description available.

As interações entre o sistema nervoso central e os sistemas imune e endócrino são o objeto de estudo da psiconeuroimunologia. Protocolos de indução de estresse têm sido amplamente utilizados como métodos confiáveis de investigação da relação entre transtornos psiquiátricos, aspectos psicológicos, traços de personalidade, ansiedade e a resposta imune. O procedimento de simulação de falar em público (SFP) é um protocolo experimental validado que reconhecidamente é capaz de ativar o eixo hipotálamo-hipófise-adrenal (HPA) e produzir respostas de estresse em sujeitos humanos. Esse método foi utilizado para: 1) Comparar a reatividade imunológica de indivíduos com diagnóstico de fobia social com a de indivíduos sem qualquer diagnóstico psiquiátrico; 2) Investigar se ocorrem alterações imunes subseqüentes à exposição a um estressor agudo induzido em laboratório e 3) identificar e correlacionar parâmetros imunológicos com traços de personalidade, humor, níveis de ansiedade e medidas fisiológicas. Os traços de personalidade foram investigados por meio dos seguintes instrumentos: Inventário de Temperamento e Caráter (TCI), Escala de Afeto Positivo e Negativo (PANAS), Inventário de Ansiedade Traço (IDATE-T), Inventário de Depressão de Beck (BDI), Inventário de Estratégias de ?Coping? de Folkman e Lazarus e Adaptação da Escala de Percepção de Estresse (PSS). Os sintomas de ansiedade foram avaliados por meio da Escala Analógica Visual de Humor (VAMS), da Escala de Sintomas Somáticos (ESS) e do IDATE-Estado. As variáveis psicofisiológicas avaliadas foram pressão arterial sistólica (PAS), diastólica (PAD), batimentos cardíacos (BPM), resposta galvânica da pele (GSR) e temperatura. Os níveis plasmáticos de catecolaminas (adrenalina, noradrenalina e dopamina) e hormônios do eixo HPA (cortisol e ACTH) também foram dosados. Realizou-se a contagem de células imunes polimorfonucleares e mononucleares no sangue periférico e mediu-se a atividade citotóxica de células NK e neutrófilos. Dosou-se proteínas de fase aguda e imunoglobulinas (A, D, G, M e E) a produção de citocinas no sangue por ELISA e RT-PCR. Os dados foram submetidos a análises de variância para dados com medidas repetidas testando efeitos de grupo, sexo, momento experimental e interações. As correlações entre as variáveis foram testadas por regressões múltiplas e coeficientes de correlação de Pearson. Os resultados apontam que o SFP foi eficiente para induzir estresse e produzir alterações detectáveis em diversos dos parâmetros investigados. As diferenças entre fóbicos sociais e controles são significativas para traços de personalidade e atuam ao longo do tempo para as medidas psicofisiológicas. Alterações imunes e hormonais estiveram mais frequentemente associadas ao gênero do que ao grupo experimental, e afetaram mais homens. Além disso, as alterações imunes foram de pequena magnitude afetando componentes inespecíficos da resposta imune. Conjuntamente, os resultados apontam uma relativa ativação do eixo HPA em fóbicos mas que não corresponde a alterações imunes de mesma magnitude. Mais estudos com uma amostra maior e a investigação de outros parâmetros são necessários para compreender melhor como a fobia social afeta o sistema imune de homens e mulheres e investigar se as alterações podem aumentar a susceptibilidade a doenças nesse grupo de sujeitos. Uma vez que essa interação seja melhor compreendida poderá subsidiar estratégias mais adequadas para abordar e elaborar estratégias de prevenção e intervenção capazes de promover comportamentos saudáveis. / Interactions among the nervous, immune and endocrine systems are the object of study of Psychoneuroimmunology. Stress protocols have been broadly used as reliable means to investigate the relationship among psychiatric disorders, psychological aspects, personality traits, anxiety and immune response has been studied using these interactions. The Simulated Public Speaking (SPS) is a validated experimental procedure known to activate the Hypothalamus-Pituitary-Adrenal (HPA) axis and produce stress responses in human subjects. This method was used to: 1) compare the immune reactions of individuals with a diagnosis of social phobia to that of individuals without any psychiatric diagnosis; 2) investigate if immune alterations occur subsequent to the exposure to an acute laboratory induced stressor; 3) identify and correlate immune parameters with personality traits, mood, anxiety levels and physiologic measures. Personality traits were investigated with Cloninger?s Temperament and Character?s Inventory (TCI), Positive and Negative Affects Scale (PANAS), State-Trait Anxiety Scale (STAI?T), Beck?s Depression Inventory (BDI), Lazarus?s Coping Strategies Inventory, Perceived Stress Scale (PSS). Anxiety symptoms were investigated along the procedure with the Bodily Symptoms Scale (ESS), STAI-E and the Visual Analogue Mood Scale (VAMS). Psychophysiologic variables assessed were Systolic (PAS) and Diastolic (PAD) Blood Pressure, Heart Rate (BPM), Galvanic Skin Response (GSR) and temperature. Plasmatic circulating levels of cathecolamines (Adrenaline, Noradrenaline and Dopamine) and HPA axis hormones (Cortisol, ACTH) were assessed. Peripheral blood cell population counts were obtained for polymorphonuclear (PMN) and mononuclear cells. Cytotoxic activity of neutrophils and NK cells was assessed, as well as cytokine production by ELISA and RT-PCR. Acute phase proteins and immunoglobulins (A, D, G, M, and E) were dosed on peripheral blood. Data was submitted to variance analysis for data with repeated measures testing effects of group, sex, experimental moment and interactions on variables. Correlations among variables were tested by multiple regressions and Pearson?s correlation deltas. The results show SPS was efficient in inducing stress and produce detectable alterations in several of the parameters investigated. Differences between social phobics and controls are significant for personality traits and, along time for psychophysiologic measures. Hormonal and immune alterations were more often associated to gender rather than to the group subjects belonged to, with men being more susceptible to the procedure. Also, immune changes were of small magnitude, usually affecting inespecific components of the response. Together, the results point to a relatively higher activation of the HPA-axis in social phobics, but one that does not correspond to immune responses of the same magnitude. Further studies with a larger sample and investigation of other parameters are necessary to better understand how social phobia affects the immune system of men and women and to investigate if the alterations can increase susceptibility to diseases in this group of individuals. Once this interaction is better understood it may provide the basis for an improved design to approach and elaborate prevention/intervention strategies and promote healthy behaviours.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Ces travaux de thèse portent sur la reconnaissance automatique du stress chez des humains en interaction dans des situations anxiogènes: prise de parole en public, entretiens et jeux sérieux à partir d'indices audio et visuels.Afin de concevoir des modèles de reconnaissance automatique du stress, nous utilisons : des indices audio calculés à partir de la voix des sujets, capturée par un micro cravate; et des indices visuels calculés soit à partir de l'expression faciale des sujets capturés par une webcam, soit à partir de la posture des sujets capturée par une Kinect. Une partie des travaux portent sur la fusion des informations apportées par les différentes modalités.L'expression et la gestion du stress sont influencées à la fois par des différences interpersonnelles (traits de personnalité, expériences passées, milieu culturel) et contextuelles (type de stresseur, enjeux de la situation). Nous évaluons le stress sur différents publics à travers des corpus de données collectés pendant la thèse: un public sociophobe en situation anxiogène, face à une machine et face à des humains; un public non pathologique en simulation d'entretien d'embauche; et un public non pathologique en interaction face à un ordinateur ou face au robot humanoïde Nao. Les comparaisons inter- individus, et inter-corpus révèlent la diversité de l'expression du stress.Une application de ces travaux pourrait être la conception d'outils thérapeutiques pour la maitrise du stress, notamment à destination des populations phobiques.Mots clé : stress, phobie sociale, détection multimodale du stress , indices audio du stress, indices faciaux du stress, indices posturaux du stress, fusion multimodale / This thesis focuses on the automatic recognition of human stress during stress-inducing interactions (public speaking, job interview and serious games), using audio and visual cues.In order to build automatic stress recognition models, we used audio cues computed from subjects' voice captured via a lapel microphone, and visual cues computed either form subjects' facial expressions captured via a webcam, or subjects' posture captured via a Kinect. Part of this work is dedicated to the study of information fusion form those various modalities.Stress expression and coping are influenced both by interpersonal differences (personality traits, past experiences, cultural background) and contextual differences (type of stressor, situation's stakes). We evaluated stress in various populations in data corpora collected during this thesis: social phobics in anxiety-inducing situations in interaction with a machine and with humans; apathologic subjects in a mock job interview; and apathologic subjects interaction with a computer and with the humanoid robot Nao. Inter-individual and inter-corpora comparisons highlight the variability of stress expression.A possible application of this work could be the elaboration of therapeutic software to learn stress coping strategies, particularly for social phobics.Key words: stress, social phobia, multimodal stress detection, stress audio cues, stress facial cues, stress postural cues, multimodal fusion

As interações entre o sistema nervoso central e os sistemas imune e endócrino são o objeto de estudo da psiconeuroimunologia. Protocolos de indução de estresse têm sido amplamente utilizados como métodos confiáveis de investigação da relação entre transtornos psiquiátricos, aspectos psicológicos, traços de personalidade, ansiedade e a resposta imune. O procedimento de simulação de falar em público (SFP) é um protocolo experimental validado que reconhecidamente é capaz de ativar o eixo hipotálamo-hipófise-adrenal (HPA) e produzir respostas de estresse em sujeitos humanos. Esse método foi utilizado para: 1) Comparar a reatividade imunológica de indivíduos com diagnóstico de fobia social com a de indivíduos sem qualquer diagnóstico psiquiátrico; 2) Investigar se ocorrem alterações imunes subseqüentes à exposição a um estressor agudo induzido em laboratório e 3) identificar e correlacionar parâmetros imunológicos com traços de personalidade, humor, níveis de ansiedade e medidas fisiológicas. Os traços de personalidade foram investigados por meio dos seguintes instrumentos: Inventário de Temperamento e Caráter (TCI), Escala de Afeto Positivo e Negativo (PANAS), Inventário de Ansiedade Traço (IDATE-T), Inventário de Depressão de Beck (BDI), Inventário de Estratégias de ?Coping? de Folkman e Lazarus e Adaptação da Escala de Percepção de Estresse (PSS). Os sintomas de ansiedade foram avaliados por meio da Escala Analógica Visual de Humor (VAMS), da Escala de Sintomas Somáticos (ESS) e do IDATE-Estado. As variáveis psicofisiológicas avaliadas foram pressão arterial sistólica (PAS), diastólica (PAD), batimentos cardíacos (BPM), resposta galvânica da pele (GSR) e temperatura. Os níveis plasmáticos de catecolaminas (adrenalina, noradrenalina e dopamina) e hormônios do eixo HPA (cortisol e ACTH) também foram dosados. Realizou-se a contagem de células imunes polimorfonucleares e mononucleares no sangue periférico e mediu-se a atividade citotóxica de células NK e neutrófilos. Dosou-se proteínas de fase aguda e imunoglobulinas (A, D, G, M e E) a produção de citocinas no sangue por ELISA e RT-PCR. Os dados foram submetidos a análises de variância para dados com medidas repetidas testando efeitos de grupo, sexo, momento experimental e interações. As correlações entre as variáveis foram testadas por regressões múltiplas e coeficientes de correlação de Pearson. Os resultados apontam que o SFP foi eficiente para induzir estresse e produzir alterações detectáveis em diversos dos parâmetros investigados. As diferenças entre fóbicos sociais e controles são significativas para traços de personalidade e atuam ao longo do tempo para as medidas psicofisiológicas. Alterações imunes e hormonais estiveram mais frequentemente associadas ao gênero do que ao grupo experimental, e afetaram mais homens. Além disso, as alterações imunes foram de pequena magnitude afetando componentes inespecíficos da resposta imune. Conjuntamente, os resultados apontam uma relativa ativação do eixo HPA em fóbicos mas que não corresponde a alterações imunes de mesma magnitude. Mais estudos com uma amostra maior e a investigação de outros parâmetros são necessários para compreender melhor como a fobia social afeta o sistema imune de homens e mulheres e investigar se as alterações podem aumentar a susceptibilidade a doenças nesse grupo de sujeitos. Uma vez que essa interação seja melhor compreendida poderá subsidiar estratégias mais adequadas para abordar e elaborar estratégias de prevenção e intervenção capazes de promover comportamentos saudáveis. / Interactions among the nervous, immune and endocrine systems are the object of study of Psychoneuroimmunology. Stress protocols have been broadly used as reliable means to investigate the relationship among psychiatric disorders, psychological aspects, personality traits, anxiety and immune response has been studied using these interactions. The Simulated Public Speaking (SPS) is a validated experimental procedure known to activate the Hypothalamus-Pituitary-Adrenal (HPA) axis and produce stress responses in human subjects. This method was used to: 1) compare the immune reactions of individuals with a diagnosis of social phobia to that of individuals without any psychiatric diagnosis; 2) investigate if immune alterations occur subsequent to the exposure to an acute laboratory induced stressor; 3) identify and correlate immune parameters with personality traits, mood, anxiety levels and physiologic measures. Personality traits were investigated with Cloninger?s Temperament and Character?s Inventory (TCI), Positive and Negative Affects Scale (PANAS), State-Trait Anxiety Scale (STAI?T), Beck?s Depression Inventory (BDI), Lazarus?s Coping Strategies Inventory, Perceived Stress Scale (PSS). Anxiety symptoms were investigated along the procedure with the Bodily Symptoms Scale (ESS), STAI-E and the Visual Analogue Mood Scale (VAMS). Psychophysiologic variables assessed were Systolic (PAS) and Diastolic (PAD) Blood Pressure, Heart Rate (BPM), Galvanic Skin Response (GSR) and temperature. Plasmatic circulating levels of cathecolamines (Adrenaline, Noradrenaline and Dopamine) and HPA axis hormones (Cortisol, ACTH) were assessed. Peripheral blood cell population counts were obtained for polymorphonuclear (PMN) and mononuclear cells. Cytotoxic activity of neutrophils and NK cells was assessed, as well as cytokine production by ELISA and RT-PCR. Acute phase proteins and immunoglobulins (A, D, G, M, and E) were dosed on peripheral blood. Data was submitted to variance analysis for data with repeated measures testing effects of group, sex, experimental moment and interactions on variables. Correlations among variables were tested by multiple regressions and Pearson?s correlation deltas. The results show SPS was efficient in inducing stress and produce detectable alterations in several of the parameters investigated. Differences between social phobics and controls are significant for personality traits and, along time for psychophysiologic measures. Hormonal and immune alterations were more often associated to gender rather than to the group subjects belonged to, with men being more susceptible to the procedure. Also, immune changes were of small magnitude, usually affecting inespecific components of the response. Together, the results point to a relatively higher activation of the HPA-axis in social phobics, but one that does not correspond to immune responses of the same magnitude. Further studies with a larger sample and investigation of other parameters are necessary to better understand how social phobia affects the immune system of men and women and to investigate if the alterations can increase susceptibility to diseases in this group of individuals. Once this interaction is better understood it may provide the basis for an improved design to approach and elaborate prevention/intervention strategies and promote healthy behaviours.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Denna studie tar sin grund i fyra förskollärares erfarenheter av selektiv mutism i förskolan. Studiens syfte är att bidra med kunskap kring förskollärares metoder i arbetet med selektiv mutism i förskolan. Föreliggande studies metod tar sin grund i ett kvalitativt tillvägagångssätt med en fenomenologisk inriktning. Empiriinsamlingen grundas i semistrukturerade intervjuer med de fyra utvalda förskollärarna. Resultatet av studien påvisar att förskollärarnas upplevelser i arbetet med selektiv mutism är ytterst likvärdigt, både när det kommer till fördelaktiga arbetsmetoder samt den bristfälliga samverkan som bedrivs i detta arbete. Resultatet påvisar även att intervjuade förskollärare upplever att det finns en utbredd okunskap om selektiv mutism inom både förskolan och hälso- och sjukvården, förskollärarna förtydligar att det krävs utveckling inom detta område.