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Social Anxiety Disorder (SAD) is characterized by excessive concern or fear of negative evaluation in one or more social situations and ranks as one of the most common psychiatric disorders. SAD has also been characterized by significant deficits in social motivation and a lack of reactivity to pleasurable stimuli (i.e., positive affect; [PA]), particularly within social contexts. Recent neuroimaging work has shifted towards examining positively-valenced motivational systems in SAD focused on reward responses to social and nonsocial stimuli. These studies have revealed aberrant reward processing during social reward tasks in individuals with SAD. However, not all individuals with SAD exhibit reward circuitry dysfunction. Therefore, the current study aimed to examine if functional patterns of connectivity in the brain underlie heterogeneity in PA differences in individuals with SAD. Results revealed several functional connectivity strength differences between SAD and control groups within reward regions. Additionally, associations between regions of interest (ROIs)-couplings (i.e., OFC and insula, OFC and subgenual cingulate, insula and cingulate, and cingulate and subgenual cingulate) and diminished PA were present in individuals with SAD, but not controls. Lastly, results demonstrated that individuals with SAD had higher variability in their reward connectivity strength presentations and reports of PA as compared to controls. These results hold significance for the development of interventions for SAD that focus on the enhancement of PA to bolster social reward responsivity. / M.S. / Social Anxiety Disorder (SAD) is a common disorder where individuals experience persistent excessive fear of one or more social situations. Individuals with SAD also tend to show lower social motivation and a lack of reactivity to pleasurable activities/events (referred to broadly as positive affect; [PA]), particularly within social situations. Current work has focused on areas within the brain that are responsible for reward responses, and have indicated that individuals with SAD show different types of reward processing during social reward situations. However, not all individuals with SAD show these same patterns. Therefore, the current study aimed to examine if connections between reward regions in the brain underlie differences in PA differences in individuals with SAD. Results showed several differences between SAD and control groups within reward regions of the brain. Additionally, specific associations between brain regions of interest and low PA were present in individuals with SAD, but not controls. Lastly, results demonstrated that individuals with SAD had higher variability in their connections between reward regions and reports of PA as compared to controls. These results can help inform the development of treatments for SAD that focus on the improving PA in an attempt to increase responsiveness to social rewards.

Social Anxiety Disorder is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, the core, maladaptive cognition is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets remediation of intense and unfounded FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. The degree to which FNE and biased attention are related processes is unknown. This study sought to assess the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). In addition, this study examines differences in attention bias between a clinically confirmed group of youth SAD and healthy controls. A significant group difference in average latency to fixate on angry faces was found [F(1,65) = 31.94, p < .001, ηp2 = .33]. However, the pattern was not consistent across the other attention bias metrics (i.e., dot probe bias scores and first fixation direction percentage towards angry faces). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions and implications of these findings within the context of refinements to existing interventions are discussed. / Master of Science / Social Anxiety Disorder (SAD) is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, a main feature of the disorder is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. However, the degree to which FNE and biased attention are related processes has not been studied. This study examined the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). This study also examines differences in attention bias between a youth with SAD and healthy youth (no psychological diagnoses). Group differences were found for only one attention bias measure (i.e., youth with SAD were quicker to look at anger faces relative to non-anxious youth). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions of these findings are discussed.

Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype bears conceptual similarities with prior accounts of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar etiologic origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has systematically evaluated the common and potentially distinguishing factors within and between these conceptually similar but diagnostically distinct groups. For example, cognitive features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these distinguishing features to clarify the differential diagnosis remains unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to empirically establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or alternatively whether specific features of each disorder can be used to disambiguate them empirically. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success. / M.S. / Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype has conceptual similarities with descriptions of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has evaluated the common and potentially distinctive factors within and between these distinct groups. For example, features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these differentiating features to clarify the differential diagnosis is unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or whether specific features of each disorder can be used to differentiate them. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success.

Background: Social anxiety disorder (SAnD) is a highly prevalent condition, characterised by an intense fear of social or performance situations where individuals worry about being negatively evaluated by others. An up to date systematic review of the effectiveness of cognitive behavioural therapies for SAnD is required to guide practice. Objectives: To assess the efficacy and acceptability of cognitive behavioural therapy (CBT) compared with treatment as usual/waiting list (TAU/WL) for individuals with SAnD. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, and international trial registers (ICTRP; ClinicalTrials.gov) in October 2011 and CINAHL in October 2012. We also searched reference lists of retrieved articles, and contacted trial authors for information on ongoing/completed trials. Selection criteria: Randomised and quasi-randomised controlled trials undertaken in out-patient settings, involving adults aged 18-75 years with a primary diagnosis of SAnD, assigned either to CBT or TAU/WL. Data collection and analysis Data on patients, interventions and outcomes were extracted by two review authors independently, and the Risk of bias in each study was assessed. The primary outcomes were social anxiety reduction (based on relative risk (RR) of clinical response and mean difference in symptom reduction), and treatment acceptability (based on RR of attrition). Results: Thirteen studies (715 participants) were included in the review, of which 11 studies (599 participants) contributed data to meta-analyses. Based on four studies, CBT was more effective than TAU/WL in achieving clinical response at post-treatment (RR 3.60, 95% CI 1.35 to 9.57), and on eleven studies (599 participants) it was more effective than TAU/WL in reducing symptoms of social anxiety. No significant difference was found between CBT and TAU/WL for attrition. No significant difference was demonstrated for social anxiety at follow-up and no studies examined follow-up data for clinical response or attrition. Authors' conclusions: The available evidence suggests that cognitive behavioural therapy might be effective in reducing anxiety symptoms for the short-term treatment of SAnD. However, the body of evidence comparing CBT with TAU/WL is small and heterogeneous.

Social anxiety disorder is the third most common mental disorder with the lifetime prevalence rate of 13.3% in the US population. Typically, it causes significant impairment in a wide range of functioning and follows a chronic, unremitting course if untreated. Over the past two decades, there has been a dramatic increase in clinical research aimed at examining underlying mechanisms maintaining social anxiety. One line of research has investigated attentional biases in social anxiety, using various cognitive experiment paradigms, including the emotional Stroop and the modified dotprobe tasks. However, overall findings are equivocal about the nature of attentional biases in social anxiety and several methodological problems limit the interpretability of the data. The present study examined attentional biases associated with social anxiety using a new research paradigm in the field of anxiety disorders: the inattentional blindness paradigm. This paradigm presents a social cue in the absence of the subjects’ expectation while they are engaged in a cognitively demanding task, thereby enabling the more purely attentional aspect of information processing to be examined reducing the influence of potential response biases or effortful strategies. Two independent experiments were conducted using nonclinical student samples consisting of individuals high in social anxiety (HSAs) versus individuals low in social anxiety (LSAs) based on the static and sustained inattentional blindness tasks. Overall, results revealed that HSAs were more likely to detect or identify a socially-threatening cue, relative to LSAs; whereas LSAs were more likely to detect or identify a non-threatening social cue, relative to HSAs. These findings were observed only in the presence of a bogus-speech manipulation. These data suggest the promising utility of the inattentional blindness paradigm in investigating attentional biases in social anxiety and perhaps other psychopathological conditions. Theoretical and clinical implications are discussed. / text

O transtorno de ansiedade social (TAS) ou fobia social se caracteriza por ansiedade e medo excessivos em relação à situação social. Os indivíduos diagnosticados com TAS evitam às situações sociais temidas ou as suportam com imenso medo ou ansiedade. Além disso, sentem uma forte sensação de insuficiência e de inadequação diante do outro, também têm um medo excessivo do julgamento alheio, por supor que ele seja sempre desfavorável. Estudos epidemiológicos indicam que o TAS tem grande impacto funcional negativo, tanto social quanto educacional e ocupacional. Os fóbicos sociais, normalmente, recorrem ao saber médico que tende a apresentar uma resposta clara e objetiva: trata-se de um transtorno neurobiológico que deve ser tratado via medicação. A psicanálise se contrapõe às pretensões da ciência de reduzir o ser humano ao corpo biológico e à sedação indiscriminada do sofrimento psíquico através de psicofármacos. Diante disso, o objetivo deste trabalho é abordar o TAS sob a perspectiva da psicanálise. Esse trabalho se baseia em um modelo de pesquisa qualitativa em psicanálise, que permite compreender os fenômenos em sua complexidade. Segundo Freud, a fobia é um meio encontrado pelo indivíduo para se livrar da angústia, que é produzida pelo ego frente à ameaça de castração. O que ocorre na fobia, no fundo, é a substituição de um perigo interno, pulsional, por um externo, perceptivo. Através do conceito de narcisismo, Freud pôde concluir que os sentimentos de inferioridade e de insuficiência, bem presentes no TAS, são decorrentes da impossibilidade de satisfação narcísica através do ideal do ego e da dificuldade de obter satisfação da libido objetal. Já o conceito de superego lhe permitiu compreender que o neurótico atribui ao outro o olhar vigilante do superego, assim como seus julgamentos e suas censuras. Por isso, o fóbico social teme tanto o olhar alheio e tem a sensação clara de estar sendo observado pelo outro. Esse quadro foi denominado por Freud de delírio de observação, o qual revela o quanto a realidade psíquica é composta por fantasias que para o indivíduo adquire o mesmo estatuto de realidade da percepção. A partir dessas considerações, o transtorno de ansiedade social seria, para a psicanálise, uma tentativa do indivíduo de solucionar seu conflito psíquico. Diante da relevância deste quadro, a psicanálise, por meio de sua teoria e de sua prática clínica, pode contribuir para o alívio desse sofrimento humano / The social anxiety disorder (SAD) or social phobia is characterized by an excessive anxiety and fear towards the social situation. The individuals that are diagnosed with SAD avoid the feared social situations or they endure it with an immense fear and anxiety. Moreover, they feel a strong sensation of insufficiency and inadequacy towards others, they also have a great amount of fear of being judged, for supposing that they will always be negatively evaluated. Epidemiological researchs indicate that SAD has a great negative functional impact, in the social, educational and occupational areas. The social phobics usually look for a physician, who generally have a clear and objective answer: it is a neurobiological disorder that must be treated with medication. The psychoanalysis opposes the science´s pretension of reducing the human being to the biological body and to the indiscriminated use of medication to mitigate the psychic suffering. Therefore, the purpose of this thesis is to understand how the psychoanalysis perceives the SAD. This study is based on a qualitative psychoanalysis research, which allows the understanding of the phenomena in its complexity. According to Freud, the phobia is a way that the individual finds to get rid of the anguish that is produced by the ego when dealing with the castration threat. What truly occurs in the phobia is the substitution of an internal, pulsional, fear for an external, perceptive, one. Through the concept of narcisism, Freud could conclude that the feelings of inferiority and insuficiency, widely present on SAD, are consequences of the impossible narcissistic satisfaction through the ideal of the ego and the difficulty of obtaining the objectal libido satisfaction. And the concept of superego allowed him to understand that the neurotics attribute to the other the scrutiny eye of the superego, as well as its judgments and censure. Therefore, the social phobic fears the scrutiny from others and has the clear sensation of being observed by others. Freud has called these symptons observational delirium, which reveals how much of the psychic reality is composed by fantasys, that acquires the same status of the perception´s reality for the individual. From these considerations, the social anxiety disorder would be, for psychoanalysis, an attempt of the individual to solve his psychic conflict. Given the importance of this matter, psychoanalysis, through its theory and clinical practice, may contribute to the mitigation of this human suffering

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). [...]"

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT.