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Background: Despite considerable research efforts, consistent predictors of cognitive behavioral therapy (CBT) outcome for social anxiety disorder (SAD) are scarce. A dynamic focus on individual symptom reactivity and resilience patterns may show promise in predicting treatment response. This pilot study is the first to investigate whether rate of return to baseline after a one-session positive interpretation training indicates resilience and predicts CBT-response among individuals with SAD. Method: Participants (N = 39) completed an interpretation bias assessment before and after training, and once a day for three days after the training, followed by a six-week CBT-program. Participants completed SAD-assessments pre-treatment, during treatment, and post-treatment. Return to baseline was operationalized as the individualized slope of negative and positive interpretations across interpretation bias assessments. Results: Intention-to-treat analyses showed no significant relation between both negative and positive interpretation bias and CBT-response. Similarly, for completers-only, most analyses also showed no such relationship. Conclusion: These findings suggest that slower return to baseline as a resilience index does not have predictive value for CBT-outcome in individuals with SAD. Future studies should incorporate experience-sampling to capture subtle changes in interpretation bias.

Cognitive models argue that psychopathology is not only associated with biased interpretations, but that these biases play a critical, causal role in the etiology and maintenance of emotional psychopathology. To examine this causal role, training procedures have been developed that modify interpretation biases, so-called Cognitive Bias Modification of Interpretations (CBM-I), to allow examination of the effects of interpretation biases on emotional symptoms. Subsequently, these training procedures have been offered to individuals with, among others, anxiety and depressive symptoms to reduce their maladaptive interpretation biases and associated symptoms. This chapter provides an overview of the different paradigms that have been used to modify interpretations across various forms of psychopathology. Based on recent reviews and meta-analyses, the findings of CBM-I training studies are summarized with a special focus on mediation and moderation. CBM-I training proves to be a valuable and promising approach, although there is room for improvement. At the end of the chapter, we will highlight a few areas that could be improved and offer novel approaches that seem successful in achieving the desired improvement.

Item does not contain fulltext, This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7-12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment.

Contains fulltext : 298918.pdf (Publisher’s version ) (Closed access), Cognitive models argue that psychopathology is not only associated with biased interpretations, but that these biases play a critical, causal role in the etiology and maintenance of emotional psychopathology. To examine this causal role, training procedures have been developed that modify interpretation biases, so-called Cognitive Bias Modification of Interpretations (CBM-I), to allow examination of the effects of interpretation biases on emotional symptoms. Subsequently, these training procedures have been offered to individuals with, among others, anxiety and depressive symptoms to reduce their maladaptive interpretation biases and associated symptoms. This chapter provides an overview of the different paradigms that have been used to modify interpretations across various forms of psychopathology. Based on recent reviews and meta-analyses, the findings of CBM-I training studies are summarized with a special focus on mediation and moderation. CBM-I training proves to be a valuable and promising approach, although there is room for improvement. At the end of the chapter, we will highlight a few areas that could be improved and offer novel approaches that seem successful in achieving the desired improvement.

Contains fulltext : 298916.pdf (Publisher’s version ) (Open Access), Background: Loneliness and social isolation are known to be associated with depression, general anxiety, and social anxiety. However, knowledge on the overlapping and unique features of these relationships, while differentiating between social loneliness (perceived absence of an acceptable social network) and emotional loneliness (perceived absence of close connections), is lacking. Methods We constructed a network analysis to examine the relationships between self-reported social loneliness, emotional loneliness, social isolation, depression, general anxiety and social anxiety in a large sample of university students (N = 7314, 67.4 % female, range 16.3–75.8 years, Mage = 23.9, SDage = 5.7). Hierarchical regression analyses were used to examine whether depression, general anxiety and social anxiety moderated the relationship between social isolation and loneliness types. As comorbidity between anxiety and depression is high, the role of anxiety as a moderator in the relationship between depression and loneliness types was also examined. Results The network analysis showed that social loneliness was most strongly explained by social isolation, whereas emotional loneliness was most strongly explained by social anxiety and depression. General anxiety was solely related to loneliness through depression. The regression analyses showed that general and social anxiety and depression did not moderate the relationship between social isolation and loneliness types. Limitations Differences found between loneliness types may be influenced by a methodological artifact of the DJGLS. Conclusions: These findings highlight the importance of social anxiety over general anxiety in relation to loneliness. Also, it showed unique relationships for social- and emotional loneliness with psycho-social variables, which has important implications for research- and clinical settings., 11 p.

26 mei 2022, Item does not contain fulltext, Objective: The current study examined whether children with a social anxiety disorder (SAD) demonstrate divergent facial emotion processing and a disorder-specific negative interpretation bias in the processing of facial emotional expressions. This study aimed to overcome previous study limitations by including both a nonsocially anxious control group and a healthy control group to examine whether childhood SAD is characterized by a general emotion labeling deficit, and/or by a negative interpretation bias, indicated by systematic misclassifications, or a lower threshold for recognizing threatening emotions. Method: Participants were 132 children aged 7-12 years (Mage = 9.15; 45.5% female). Children with SAD (n = 42) were compared to children with other, nonsocial, anxiety disorders (n = 40) and healthy control children (n = 50) on a novel facial emotion recognition task. Children judged ambiguous happy/neutral, angry/neutral and fear/neutral faces that were morphed at different intensities (10%, 30%, 50%, 70%). Results: Children with SAD did not differ from other groups in their accuracy of identifying emotions. They did not show systematic misclassifications or a heightened sensitivity to negative, threatening faces either. Rather, children with nonsocial anxiety disorders showed a generally heightened sensitivity to emotional faces. Conclusions: The current study does not provide evidence for a general deficit in labeling of emotional faces in childhood SAD. Childhood SAD was not characterized by an interpretation bias in processing emotional faces. Children with nonsocial anxiety disorders may benefit from assistance in accurately interpreting the degree of emotionality in interpersonal situations.

Item does not contain fulltext, Objective: This study examined the content-specificity of dysfunctional social beliefs to Social Anxiety Disorder (SoAD) in a large, clinically referred sample of children with a variety of anxiety, mood and externalizing disorders. The effects of comorbidity on the content-specificity of dysfunctional social beliefs were examined. Method: Participants included 912 children aged 7-12 years (Mage = 9.15; 45.5% female) who presented at a specialized clinic for assessment and treatment of anxiety disorders. Children with SoAD were compared to children with nonsocial anxiety disorders, children with SoAD and mood disorders, and children with SoAD and externalizing disorders, on self-reported dysfunctional social threat beliefs, physical threat, hostility, and personal failure beliefs. Results: Children with SoAD endorsed significantly higher levels of dysfunctional social threat beliefs when compared to children with nonsocial anxiety disorders. However, children with SoAD and mood comorbidity scored significantly higher on dysfunctional social beliefs than all other groups. Conclusions: Results suggest that within childhood anxiety disorders, dysfunctional social beliefs are content-specific for SoAD. Externalizing comorbidity does not seem to change the level of dysfunctional social beliefs in this group. However, mood comorbidity leads to endorsement of higher levels of dysfunctional social beliefs. These results provide support for, and refine, the content-specificity hypothesis and highlight the importance of taking comorbidity into account when examining and treating dysfunctional beliefs in youth.

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Radboud University, 24 november 2021, Promotores : Rinck, M., Hudson, J.L., Becker, E.S., Rapee, R.M. Co-promotor : Klein, A.M., Contains fulltext : 239921.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 233438.pdf (Publisher’s version ) (Open Access), Background: Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies’ outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). Methods: To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. Results and Conclusions: This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.

Contains fulltext : 220290.pdf (publisher's version ) (Open Access), To draw valid and reliable conclusions from child studies involving facial expressions, well-controlled and validated (child) facial stimuli are necessary. The current study is the first to validate the facial emotional expressions of child models in school-aged children. In this study, we validated the Radboud Faces Database child models in a large sample of children (N = 547; 256 boys) aged between 8 and 12. In addition, associated validation measures such as valence, clarity, and model attractiveness were examined. Overall, the results indicated that children were able to accurately identify the emotional expressions on the child faces in approximately 70% of the cases. The highest accuracy rates were found for "happiness," whereas "contempt" received the lowest accuracy scores. Children confused the emotions "fear" and "surprise," and the emotions "contempt" and "neutral" with one another. Ratings of all facial stimuli are available (https://osf.io/7srgw/) and can be used to select appropriate stimuli to investigate the processing of children’s facial emotional expressions.

21 oktober 2021, Item does not contain fulltext, This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7-12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment.

Contains fulltext : 230744.pdf (publisher's version ) (Open Access), A recent systematic review has reported that poor reading is reliably associated with anxiety. However, we currently lack evidence-based intervention for children who have both poor reading and anxiety (PRAX). In this study, we tested a new PRAX intervention in 8- to 12-year-old children using a double-baseline intervention case series design. Analyses of both group and individual data revealed that 12 weeks of PRAX intervention significantly improved children’s reading and spelling accuracy, and significantly reduced both anxiety disorders and symptoms. These results support PRAX intervention as a treatment for comorbid reading and anxiety problems in children and pave the way to a randomised controlled trial.

Item does not contain fulltext, Among children and adolescents, specific phobia is one of the most common anxiety disorders. Although phobias are usually considered to have a relatively "simple" clinical presentation, they can interfere substantially with daily life for youth. Evidence-based treatments are available for specific phobia in youth. In all evidence-based treatments, exposure is the key working element. This chapter advises clinicians how to setup and carry out exposure treatment for specific phobia with children and adolescents in clinical practice. This chapter offers recommendations on the assessment process, developing and carrying out a treatment plan, involving the family in treatment, maintaining therapeutic improvements and handling challenging issues.

17 januari 2020, Item does not contain fulltext, Objective: This study examined the content-specificity of dysfunctional social beliefs to Social Anxiety Disorder (SoAD) in a large, clinically referred sample of children with a variety of anxiety, mood and externalizing disorders. The effects of comorbidity on the content-specificity of dysfunctional social beliefs were examined. Method: Participants included 912 children aged 7-12 years (Mage = 9.15; 45.5% female) who presented at a specialized clinic for assessment and treatment of anxiety disorders. Children with SoAD were compared to children with nonsocial anxiety disorders, children with SoAD and mood disorders, and children with SoAD and externalizing disorders, on self-reported dysfunctional social threat beliefs, physical threat, hostility, and personal failure beliefs. Results: Children with SoAD endorsed significantly higher levels of dysfunctional social threat beliefs when compared to children with nonsocial anxiety disorders. However, children with SoAD and mood comorbidity scored significantly higher on dysfunctional social beliefs than all other groups. Conclusions: Results suggest that within childhood anxiety disorders, dysfunctional social beliefs are content-specific for SoAD. Externalizing comorbidity does not seem to change the level of dysfunctional social beliefs in this group. However, mood comorbidity leads to endorsement of higher levels of dysfunctional social beliefs. These results provide support for, and refine, the content-specificity hypothesis and highlight the importance of taking comorbidity into account when examining and treating dysfunctional beliefs in youth.

Contains fulltext : 218120.pdf (publisher's version ) (Open Access), The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.

Background: Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies’ outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). Methods: To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. Results and Conclusions: This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b)

Contains fulltext : 203457.pdf (publisher's version ) (Open Access), Objective: Worry is an important perpetuating factor of Medically Unexplained Symptoms (MUS). Former research has shown that a worry postponement instruction is effective in reducing Subjective Health Complaints (SHC) in non-clinical samples. This study aimed to (1) replicate these findings in a MUS-analogue student-sample and (2) assess alexithymia as a moderator.Design: The current study had an experimental design with two waves of data collection: pre- and post-intervention.Main outcome measures: A MUS-analogue student-sample consisting of 114 undergraduate students with high self-reported health worry and a minimum of two doctor visits in the previous year with no current diagnosis for a (chronic or acute) disease were instructed to register their worry frequency and duration eight times per day via an experience sampling-application on their smartphones. The intervention group additionally postponed their worries to a 30-minute period in the evening. SHC were assessed pre- and post-intervention.Results: The intervention did not have an effect on worry or SHC. Alexithymia did not moderate this effect (ps > .05).Conclusion: Our study did not find evidence for the effectiveness of the worry reduction intervention on SHC in a MUS-analogue student-sample. This finding contributes to several previous studies that have found mixed evidence for the effectiveness of the worry reduction intervention on SHC and suggests that the worry intervention may not be effective in all cases.

Contains fulltext : 207287.pdf (publisher's version ) (Open Access), The current study examined whether children varying in their levels of social anxiety, separation anxiety and spider fear exhibit a negative interpretation bias specific for their fears. Furthermore, age and gender were assessed as moderators of this relation. Children (N = 603) of the age of 7-12 years were asked to solve ambiguous scenarios reflecting social threat, separation threat or spider threat. Children's levels of anxiety were assessed with self-report questionnaires. Results indicated that children scoring higher on self-reported social anxiety, separation anxiety or spider fear, displayed a negative interpretation bias for the threat-scenarios pertaining to their specific anxiety or fear, even after controlling for comorbidity with other anxiety subtypes. Contrary to our hypotheses, we did not find moderating effects of age or gender. These results indicate that even in a community sample, content-specificity of negative interpretation biases is present.

Contains fulltext : 207293.pdf (publisher's version ) (Open Access), Facial expressions play a central role in diverse areas of psychology. However, facial stimuli are often only validated by adults, and there are no face databases validated by school-aged children. Validation by children is important because children still develop emotion recognition skills and may have different perceptions than adults. Therefore, in this study, we validated the adult Caucasian faces of the Radboud Faces Database (RaFD) in 8- to 12-year-old children (N = 652). Additionally, children rated valence, clarity, and model attractiveness. Emotion recognition rates were relatively high (72%; compared to 82% in the original validation by adults). Recognition accuracy was highest for happiness, below average for fear and disgust, and lowest for contempt. Children showed roughly the same emotion recognition pattern as adults, but were less accurate in distinguishing similar emotions. As expected, in general, 10- to 12-year-old children had a higher emotion recognition accuracy than 8- and 9-year-olds. Overall, girls slightly outperformed boys. More nuanced differences in these gender and age effects on recognition rates were visible per emotion. The current study provides researchers with recommendation on how to use the RaFD adult pictures in child studies. Researchers can select appropriate stimuli for their research using the online available validation data.