Search

Introduction: There is increasing recognition that first responders' exposure to multiple traumatic events puts themat risk for the development of emotional distress, including depression, substance misuse, posttraumatic stress disorder (PTSD), and suicide. Despite this increased risk and higher prevalence of PTSD and other traumarelated disorders, there are few data on treatment for first responders. Method: This investigation describes the outcome of an intensive outpatient program (IOP), initially developed for military trauma, as applied to the treatment of first responders with PTSD. This treatment is unique in that it utilizes virtual reality to enhance the immersion into the exposure scene. Furthermore, we assessed the utility of both fixed-length and unbounded-length exposure sessions. Results: The results indicate that the intervention was feasible to implement and did not produce iatrogenic effects. Participants reported significantly reduced symptoms of PTSD and related emotional distress, reduced disability, and improved daily functioning. These positive outcomes were maintained at 3-month follow-up. There was no difference in outcomes between the fixed- and unbounded-length sessions. Discussion: These results suggest that an efficacious, short-term intervention incorporating virtual reality has the potential to quickly return first responders to their profession. [ABSTRACT FROM AUTHOR]

Recognizing facial affect is essential for effective social functioning. This study examines emotion recognition abilities in children aged 7-13 years with High Functioning Autism (HFA = 19), Social Phobia (SP = 17), or typical development (TD = 21). Findings indicate that all children identified certain emotions more quickly (e.g., happy [less than] anger, disgust, sad [less than] fear) and more accurately (happy) than other emotions (disgust). No evidence was found for negative interpretation biases in children with HFA or SP (i.e., all groups showed similar ability to discriminate neutral from non-neutral facial expressions). However, distinct between-group differences emerged when considering facial expression intensity. Specifically, children with HFA detected mild affective expressions less accurately than TD peers. Behavioral ratings of social effectiveness or social anxiety were uncorrelated with facial affect recognition abilities across children. Findings have implications for social skills treatment programs targeting youth with skill deficits.

Although children with social phobia (SP) and selective mutism (SM) present similarly in a clinical setting, it remains unclear whether children with SM are unable to speak due to overwhelming anxiety, or whether withholding speech functions as an avoidance mechanism. A total of 35 children (ages 5-12 years) with either SM (n = 10), SP (n = 11), or no diagnosis (n = 14) participated in the current study. Measurements included clinician, child, and parent ratings as well as behavioral observations and psychophysiological measures. Independent evaluators and clinicians rated children with SM as more severely impaired, more anxious, and less socially effective, but the groups did not differ in self- or parent-reported anxiety. Psychophysiological measures indicated that children in the SM group experienced less arousal than other children during social interaction tasks. The authors postulate that lack of speech may serve as an avoidance mechanism and thus account for this lack of arousal. (Contains 3 tables and 2 figures.)

In a randomized trial for children with social phobia (SP), Social Effectiveness Therapy for Children (SET-C; a treatment consisting of exposure and social skills training) and fluoxetine were more effective than pill placebo in reducing social distress and behavioral avoidance, but only SET-C demonstrated significantly improved overall social skill and social competence. In the current study, the authors examined the specific social skills enhanced by SET-C using a recently developed coding schema. At posttreatment, children treated with SET-C displayed a more effective ability to manage the conversational topic (pragmatic social behaviors) and more appropriate motor movement, facial orientation, and posture (paralinguistic social behaviors) than children treated with fluoxetine or placebo. In contrast, children treated with fluoxetine displayed no more pragmatic or paralinguistic skill than children given a pill placebo. There were no group differences on ratings of voice volume and vocal inflection (speech and prosodic social behaviors). Furthermore, only children treated with SET-C improved from pre- to posttreatment on all three skill variables. Findings suggest that pharmacological interventions that only target reduction in anxious arousal may not have an impact on social skill deficits and may not be adequate to optimally treat SP. The relationship of social skill to social avoidance and the importance of social skills training to enhance social competence in the treatment of childhood SP are discussed. (Contains 1 table and 1 figure.)

Social skills deficits are commonly reported among children with social phobia (SP) and children with Asperger's Disorder (AD); however, a lack of direct comparison makes it unclear whether these groups, both of which endorse the presence of social anxiety, have similar or unique skills deficits. In this investigation, the social behaviors of children with SP (n = 30) or AD (n = 30) were compared to a typically developing (TD) peer group (n = 30) during structured role play interactions. Data were analyzed using blinded observers' ratings of overt behaviors and digital vocal analysis of verbal communication. Compared to children with AD and TD children, children with SP exhibited less overall social skill, an ineffective ability to manage the conversational topic (pragmatic social behavior), and deficient speech production (speech and prosodic social behavior). There were no differences in observer ratings between children with AD and TD children. However, using digital analysis of vocal characteristics (i.e., intensity, pitch), distinct vocal patterns emerged. Specifically, children with AD spoke more softly than TD children, and had lower vocal pitch and less vocal pitch variability than children with SP. This pattern may be subjectively heard as monotonic speech. Consistent with a vocal pattern associated with heightened anxiety, children with SP spoke more softly and had less voice volume variation than TD children, and had higher vocal pitch and more vocal pitch variability (jitteriness) than children with AD. Clinical implications of these findings are discussed.

In this study, the authors examined the relations among clinician ratings of treatment improvement and discrepancies between parent and blinded laboratory rater reports of child social functioning administered before and after treatment for social anxiety disorder. Participants included a clinic sample of 101 children (7-16 years old; M = 11.67, SD = 2.57; 51 girls, 81% Caucasian) receiving treatment as part of a two-site controlled trial. Overall, clinician ratings reflected lack of improvement when parents reported persistent (i.e., pre- to posttreament) social functioning deficits not reported by blinded raters. However, when blinded raters reported persistent social skill deficits not reported by parents, we did not observe the same effect on clinician ratings as we did when the direction of discrepant reports was reversed. We replicated these observations in a subset of participants (n = 81) providing parent and child pre-post reports of social anxiety symptoms. These findings have implications for the interpretations of clinical ratings as "primary outcome measures" within controlled trials. (Contains 3 footnotes, 5 tables, and 1 figure.)

Discrepancies between informants' reports of children's behavior are robustly observed in clinical child research and have important implications for interpreting the outcomes of controlled treatment trials. However, little is known about the basic psychometric properties of these discrepancies. This study examined the relation between parent-child reporting discrepancies on measures of child social phobia symptoms, administered before and after treatment for social phobia. Participants included a clinic sample of 81 children (7-16 years old [M = 11.75, SD = 2.57]; 39 girls, 42 boys) and their parents receiving treatment as part of a multisite controlled trial. Pretreatment parent-child reporting discrepancies predicted parent-child discrepancies at posttreatment, and these relations were not better accounted for by the severity of the child's pretreatment primary diagnosis. Further, treatment responder status moderated this relation: Significant relations were identified for treatment non-responders and not for treatment responders. Overall, findings suggest that informant discrepancies can be reliably employed to measure individual differences over the course of controlled treatment trials. These data provide additional empirical support for recent work suggesting that informant discrepancies can meaningfully inform understanding of treatment response as well as variability in treatment outcomes.

Empirically supported treatments (EST) hold much promise in relieving psychological distress and dysfunction. However, various obstacles to effective training and clinical practice have truncated dissemination efforts. One such obstacle is the perceived applicability of EST procedures to raw world clinical practice. This article proposes a rubric for supervision that emphasizes case conceptualization, the use of immediacy in session, tolerating negative affect, harvesting open attitudes, cultural responsiveness, and technical proficiency. Several specific training strategies and supervisory processes are recommended. (Contains 1 figure.)

The article discuses a study conducted to investigate the impact of children with high-functioning autism (HFA) on parental stress, sibling adjustment, and family functioning; the study involves a sample of parents of 15 children with HFA and parents of 15 matched control children who completed questionnaires measuring the dependent variables. The results indicate parents of children with HFA experience significantly more parenting stress than parents of children with no psychological disorder, which was found to be directly related to characteristics of the children. The study further shows that the higher intellectual functioning in children with HFA does not compensate for the stress associated with parenting children with autism spectrum disorders. Because the intervention efforts directed at children with HFA will not eliminate the child's primary symptoms, treatment programs may need to address parental stress, which in turn will help optimize treatment outcome for the child and the family. (Contains 1 table and 1 figure.)

Based on findings from the adult literature, this study examined the role of negative self-images (NSI) in social phobia during adolescence. NSI was manipulated among 21 nonphobic (IMAG) adolescents (M age = 14.05 years, SD = 1.56) during two social tasks. Self and observer-rated anxiety and performance as well as co-occurring cognition were compared to 21 adolescents with social phobia (SOC) and 21 control adolescents not instructed to use self-imagery. Few differences in observer-rated anxiety or performance were found between the IMAG and control groups, whereas SOC adolescents were consistently rated as more anxious and poorer social performers. Nonsignificantly higher rates of anxiety were reported by the IMAG group compared to controls, but anxiety was not associated with decrements in performance or social skill. A significantly fewer number of on-task thoughts reported by IMAG adolescents suggests that inability to attend to the interaction itself, rather the presence of NSI, served to increase anxiety. (Contains 4 tables.)

A study examines the effectiveness of fluoxetine, pill placebo and Social Effectiveness Therapy for Children (SET-C) for children and adolescents with social phobia. The results conclude that both fluoxetine and SET-C are effective for social phobia but SET-C is better for enhancing social skills.

Social Effectiveness Therapy for Children (SET-C) is a comprehensive behavioral treatment combining social skills training, peer generalization experiences, and individualized in vivo exposure for the treatment of social phobia in youth. SET-C results in positive treatment outcome and its effects are maintained at least 3 years later. In this investigation, maintenance of treatment gains 3, 4, and 5 years later was examined using a multidimensional assessment strategy consisting of self-report, parental report, clinician ratings, and direct behavioral assessment. Furthermore, the overall functioning of adolescents treated with SET-C 5 years earlier was compared with that of a group of adolescents who never suffered from psychological disorders. All posttreatment gains were maintained 5 years later, and the general functioning of SET-C treatment responders was not significantly different from those who never had a disorder. The data indicate that SET-C results in long-term positive effects for youth suffering from social phobia. (Contains 4 tables.)

We examined different cognitive phenomena in relation to social phobia among children (aged 7 to 11) and adolescents (aged 12-16) separately. Fifty socially phobic youths were compared to 30 normal control children on measures of social anxiety, social expectation as well as self-and observer-rated performance during two social tasks involving a same-aged peer. Additionally, a video-mediated recall procedure was conducted immediately following the two behavioral tasks to examine specific types of self-talk. Results indicated that socially phobic youths had lower expectations of their performance and rated their actual performance worse than controls during a social interaction task, but not a read-aloud task. Self-ratings of decreased performance among socially phobic youths were corroborated by blind observers. Although differences in specific types of self-talk were found between the two groups, these findings were generally moderated by age. Furthermore, certain cognitive symptoms associated with the disorder were more commonly found among older socially phobic youths. The current findings highlight the importance of considering developmental factors in the presentation and treatment of social phobia in youths.