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Background: Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables., Methods: This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables., Results: The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness., Limitations: The present study is cross-sectional, therefore unable to confirm causal interpretations., Conclusion: Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality., Competing Interests: Declaration of competing interest None. Declaration of Generative AI and AI-assisted technologies in the writing process None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Individuals with high social interaction anxiety (SIA) and depression often behave submissively in social settings. Few studies have simultaneously examined the associations between objectively assessed submissive behaviors and SIA or depression, despite their high comorbidity and unknown mechanisms regarding submissiveness., Methods: A sample of 45 young adults self-reported trait SIA and depression, state positive/negative affect (PA/NA) before and after a virtual social interaction. Participants engaged in a four-minute conversation with a confederate who was trained to behave neutrally. Mutual eye gaze, via eye-tracking, and vocal pitch were assessed throughout the interaction., Results: Depression and SIA were positively correlated with NA, poorer self-rated performance, and vocal pitch. Highly socially anxious women engaged in less mutual eye gaze than highly socially anxious men. Also, vocal pitch was inversely associated with mutual eye gaze and positively related to NA and (nonsignificantly) to self-ratings of poor performance. Finally, our data partially replicated past research on the use of vocal pitch during social stress to detect social anxiety disorder., Limitations: The current sample is relatively homogenous in educational attainment, age, and race. All research confederates were women. Future research should examine whether these archival data replicate with the latest telecommunication technologies., Conclusion: Our findings highlight nuanced relationships among SIA, depression, emotions, self-perceptions, and biobehavioral indicators of submissive behavior-in response to an ambiguously negative/positive social interaction. Sex/gender may interact with these effects, emphasizing considerations for research method designs., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Individuals diagnosed with hemifacial spasm (HFS) frequently undergo noticeable alterations in their facial appearance. Such changes can detrimentally influence both their physical and psychological well-being. While prior studies have identified self-esteem and fear of negative evaluation (FNE) as key elements in social anxiety, their role in studies concerning body image and its correlation with social anxiety has been seldom explored. This research seeks to explore how self-esteem and FNE concurrently mediate the relationship between body image and social anxiety among Chinese individuals with HFS., Methods: Chinese patients with HFS (n=151) completed a cross-sectional questionnaire on the first day of admission that assessed body image, social anxiety, self-esteem, and FNE over the past week. Path analysis was used to test the hypothesis of the mediation model., Results: The hypothesized model showed that FNE was positively correlated with body image and social anxiety, while negative associations were found among body image, self-esteem and social anxiety. Self-esteem and FNE play a mediating role between body image and social anxiety., Conclusion: Our findings suggest that self-esteem and FNE may be important psychological pathways that affect body image and social anxiety in Chinese patients with HFS. Supplementing mental health services that help increase self-esteem and reduce FNE should be considered to improve the psychological quality of patients with HFS., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD)., Methods: Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart., Results: There was evidence of same-symptom lagged effects (bs = 0.08-0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity., Limitations: Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD., Conclusions: Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

The use of analogue samples, as opposed to clinical groups, is common in mental health research, including research on social anxiety disorder (SAD). Recent observational and statistical evidence has raised doubts about the validity of current methods for establishing analogue samples of individuals with clinically significant social anxiety. Here, we used data from large community samples of clinical and nonclinical participants to determine new cutoff scores on self-report measures of social anxiety symptoms and symptom-related impairment. We then examined whether using these newly determined cutoff scores alone or in combination improves the identification of individuals who have SAD from those who do not, revealing the most ideal cutoff combination to be 34 or above on the Social Phobia Inventory and 11 or above on the Sheehan Disability Scale. Finally, we compared the effects of our new cutoff scores with old cutoff scores by extracting analogue samples of participants with high social anxiety from historical data on seven large groups of undergraduate Psychology research participants from the authors' institution spanning the past 5 years (2018-2023). We observed that the new combined cutoff scores identified markedly fewer students as having high social anxiety, lending credibility to their utility. We also observed a striking increase in levels of social anxiety symptoms in the undergraduate population from before to after the COVID-19 pandemic. Of note, most participants were under 30 and identified as Caucasian or Asian women, indicating that future research is needed to examine whether our findings generalize to diverse populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Social anxiety (SA) is characterized by concerns about the expected occurrence (probability) and anticipated distress (cost) of social threats. Unclear is whether SA correlates specifically with biased expectations of belongingness or status threats., Aims: We aimed to discern if SA is uniquely tied to biased expectancies of either belongingness or status threats., Materials and Methods: We assessed 757 participants' perceptions of exclusion and put-down scenarios, analysing associations between SA and threat perceptions., Discussion: Our findings support the status-sensitivity hypothesis, suggesting individuals with high SA are particularly attuned to the perceived cost of status threats, potentially informing treatment approaches., Conclusion: Understanding SA's link to status concerns enhances therapeutic strategies, emphasizing the need to address status-related situations, cognitions, and emotions in interventions., (© 2024 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Social Anxiety Disorder (SAD) is an anxiety disorder characterized by excessive fear of scrutiny in social situations. Health students are more susceptible to SAD due to academic demands. They may resort to self-medication, particularly beta-blockers (BBs) for managing physical symptoms of SAD. The study aims to investigate the prevalence of beta-blocker use and its relationship with social anxiety disorder among health students at Umm Al-Qura University., Methods: In this cross-sectional study, 461 undergraduate health students participated in a questionnaire with 30 questions divided into three sections: The Social Phobia Inventory (SPIN), BBs usage behavior questionnaire, and demographic characteristics., Results: The study found 56.2% had SAD. A total of 7.8% of the sample reported using BBs, and no significant correlation was found between the usage of BBs and the SAD score (P = 0.085)., Conclusion: The study revealed significant relationships between the presence of SAD with gender, history of mental conditions, and correlation between the use of BBs with history of mental conditions. Although BBs usage is low among health students, the prevalence of SAD is alarming. The results could raise awareness about the need for early detection of SAD among health students., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Quronfulah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT-ED or post-treatment outcomes in CBT-ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target., Method: ED clients (N = 226) aged ≥16 years were treated with CBT-ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post-treatment., Results: Baseline SAD was a weak moderator of early and post-treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology., Discussion: Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre-treatment. SAD symptoms reduced over CBT-ED, but protocol enhancements such as exposure-based strategies that directly target co-occurring social-evaluative concerns may help achieve larger reductions in SAD symptoms., Public Significance: Eating disorders often co-occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by-product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder., Competing Interests: Declaration of Competing Interest This study was part of a larger study for which Julian Schmitz and Brunna Tuschen-Caffier received funding by the German Research Foundation (grant numbers SCHM3056/2-1, TU78/5-1)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Social anxiety disorder is a common psychiatric condition that severely affects quality of life of individuals and is a significant societal burden. Although many risk factors for social anxiety exist, it is currently unknown how social fear sensitivity manifests biologically. Furthermore, since some individuals are resilient and others are susceptible to social fear, it is important to interrogate the mechanisms underpinning individual response to social fear situations. The microbiota-gut-brain axis has been associated with social behaviour, has recently been linked with social anxiety disorder, and may serve as a therapeutic target for modulation. Here, we assess the potential of this axis to be linked with social fear extinction processes in a murine model of social anxiety disorder. To this end, we correlated differential social fear responses with microbiota composition, central gene expression, and immune responses. Our data provide evidence that microbiota variability is strongly correlated with alterations in social fear behaviour. Moreover, we identified altered gene candidates by amygdalar transcriptomics that are linked with social fear sensitivity. These include genes associated with social behaviour (Armcx1, Fam69b, Kcnj9, Maoa, Serinc5, Slc6a17, Spata2, and Syngr1), inflammation and immunity (Cars, Ckmt1, Klf5, Maoa, Map3k12, Pex5, Serinc5, Sidt1, Spata2), and microbe-host interaction (Klf5, Map3k12, Serinc5, Sidt1). Together, these data provide further evidence for a role of the microbiota-gut-brain axis in social fear responses., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Social anxiety disorder (SAD) remains an understudied potential link between the cancer experience and adolescent and young adult (AYA) cancer survivors' poor psychosocial outcomes. We investigated the frequency and duration of, as well as factors associated with, symptoms of SAD among AYAs with cancer. Methods: This longitudinal, mixed-methods study involved online surveys (including a validated screening tool for SAD) at recruitment and 6 months later, and a structured clinical interview. Results: Twenty-eight AYAs (aged 12-30 years, <1-year postdiagnosis, 50% male) completed the first survey ( M  = 6 months postdiagnosis). About 32% reported clinically significant SAD symptoms. Fourteen completed the follow-up survey ( M  = 12 months postdiagnosis), of which 9 (62%) reported persistent or worse symptoms of SAD significantly associated with emotional distress, physical appearance concerns, negative social cognitions, and depression. Conclusion: A subset of AYAs with cancer may experience clinically significant SAD symptoms that can affect their psychosocial well-being. Further work on how to best identify and support AYAs with SAD is needed.

The identification of psychopathological markers has been the focus of several scientific fields. The results were inconsistent due to lack of a clear nosology. Network analysis, focusing on the interactions between symptoms, provided important insights into the nosology of mental disorders. These interactions originate several topological properties that could constitute markers of psychopathology. One of these properties is network connectivity, which has been explored in recent years. However, the results have been inconsistent, and the topological properties of psychopathological networks remain largely unexplored and unknown. We compared several topological properties (i.e., connectivity, average path length, assortativity, average degree, modularity, global clustering) of psychopathological networks of healthy and disordered participants across depression (N = 2830), generalized anxiety (N = 13,463), social anxiety (N = 12,814), and obsessive-compulsive disorder (N = 16,426). Networks were estimated using Bayesian Gaussian Graphical Models. The Janson-Shannon measure of divergence was used to identify differences between the network properties. Network connectivity distinguished healthy and disordered participants' networks in all disorders. However, in depression and generalized anxiety, network connectivity was higher in healthy participants. The presence and number of motifs also distinguished the networks of healthy and disordered participants. Other topological properties (i.e., modularity, clustering, average path length and average degree) seem to be disorder-specific. The psychopathological significance of network connectivity must be clarified. Some topological properties of psychopathological networks are promising markers of psychopathology and may contribute to clarifying the nosology of mental disorders., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Castro reports financial support was provided by Fundação para a Ciência e Tecnologia. Joana Cardoso reports financial support was provided by Fundação para a Ciência e Tecnologia. Ana Sofia Araujo reports financial support was provided by Fundação para a Ciência e Tecnologia. Ana Rita Rodrigues reports financial support was provided by Fundação para a Ciência e Tecnologia., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents., Methods: Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829., Results: In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %)., Conclusion: These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Cognitive therapy for social anxiety disorder (CT-SAD) has extensive empirical support and is recommended in several national guidelines. However, ensuring access to evidence-based psychological therapies such as CT-SAD remains a global challenge. An internet-delivered version of this treatment protocol (iCT-SAD) has recently been developed in the UK as a way to overcome this challenge, demonstrating comparable outcomes to face-to-face CT-SAD whilst requiring less therapist time per client. Initial findings also suggest its cross-cultural transferability, but the previous studies in other cultural settings used the English language programme and only included English-fluent participants as a second language. It is not yet known what outcomes can be achieved once the programme has been translated and adapted for a different cultural context. Therefore, this trial aims to evaluate the clinical efficacy of Japanese iCT-SAD when combined with treatment as usual (TAU) in clients with SAD., Methods: This two-arm, parallel-group, superiority randomised controlled trial will recruit 60 Japanese participants with SAD, randomly assigning them to either Japanese iCT-SAD + TAU or TAU alone at a ratio of 1:1. The primary outcome measure is the self-report Liebowitz Social Anxiety Scale, and secondary.outcomes include other measures of social anxiety symptoms and processes, general mood and functioning, and response to treatment. We will also assess treatment acceptability and gather participant feedback. Assessments will take place at baseline (week 0), mid-treatment (week 8), and post-treatment (week 15), with a further 3-month follow-up (week 27) for the iCT-SAD + TAU arm. The primary analyses will be conducted on an intent-to-treat basis, comparing the primary and secondary outcome measures between groups using linear mixed-effect models, along with additional mediation analysis., Discussion: Investigating the efficacy of translated and culturally adapted iCT-SAD in different cultural contexts is an important step in evaluating the global reach of internet interventions. This trial will provide valuable insights into the effects of iCT-SAD combined with usual care, and how this treatment could be delivered in routine clinical settings in Japan., Trial Registration: International Standard Randomized Controlled Trials (ISRCTN), ISRCTN82859645, registered on January 19, 2024. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052702, registered on November 6, 2023., (© 2024. The Author(s).)

Background: According to the cognitive behavioral model of social anxiety, attentional bias to negative emotional information causes and maintains anxiety. The goal of attentional bias modification (ABM) is to reduce anxiety by reducing attention bias to negative emotional information., Method: We used questionnaires and experiments to explore the improvement effect of ABM training on social anxiety in college students. In Study 1, we used dot-probe tasks to investigate the attentional bias to negative emotional information and the relationship with social anxiety severity in college students. In Study 2, college students with high social anxiety were divided into two groups: attentional bias modification training task group (ABM) and attention control condition task group (ACC). The ABM group received a continuous intervention for 10 days to observe changes in social anxiety levels and attentional bias scores in the pretest and posttest stages., Results: The results showed that the correlation of attentional bias to negative emotional information and social anxiety severity was significant. Meanwhile, the high social anxiety participants responded more quickly to negative emotional information. After the intervention, social anxiety levels and attentional bias scores of the training group were significantly reduced., Conclusions: The results showed that attentional bias modification training can reduce attentional bias to negative emotional information in college students with social anxiety and effectively improve their social anxiety., (© 2024. The Author(s).)

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety., (Copyright © 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Background: The measurement of process variables derived from cognitive behavioural theory can aid treatment development and support the clinician in following treatment progress. Self-report process measures are ideally brief, which reduces the burden on patients and facilitates the implementation of repeated measurements., Aims: To develop 13 brief versions (3-6 items) of existing cognitive behavioural process scales for three common mental disorders: major depression, panic disorder, and social anxiety disorder., Method: Using data from a real-world teaching clinic offering internet-delivered cognitive behavior therapy ( n =370), we drafted brief process scales and then validated these scales in later cohorts ( n =293)., Results: In the validation data, change in the brief process scales significantly mediated change in the corresponding domain outcomes, with standardized coefficient point estimates in the range of -0.53 to -0.21. Correlations with the original process scales were substantial ( r =.83-.96), internal consistency was mostly adequate (α=0.65-0.86), and change scores were moderate to large (| d| =0.51-1.18). For depression, the brief Behavioral Activation for Depression Scale-Activation subscale was especially promising. For panic disorder, the brief Agoraphobic Cognitions Questionnaire-Physical Consequences subscale was especially promising. For social anxiety disorder, the Social Cognitions Questionnaire, the Social Probability and Cost Questionnaire, and the Social Behavior Questionnaire-Avoidance and Impression Management subscales were all promising., Conclusions: Several brief process scales showed promise as measures of treatment processes in cognitive behaviour therapy. There is a need for replication and further evaluation using experimental designs, in other clinical settings, and preferably in larger samples.

Fear of positive evaluation (FPE) is becoming recognised as an important component of social anxiety that is distinct from fear of negative evaluation (FNE). While core belief scales exist for fear of negative evaluation (FNE), none has been developed for FPE. Therefore, this paper describes the development and validation of a measure of core beliefs that is specific to FPE. An exploratory factor analysis was performed on 60 initial items with an Australian undergraduate sample, in which a confirmatory factor analysis was performed with an independent Australian general population sample. A series of further analyses were performed to test convergent and divergent validity. The Positive Evaluation Core Beliefs Scale (PECS) emerged as a 17-item two-factor psychometrically valid measure that correlates more strongly with measurement of FPE than FNE. The PECS measure offers a new opportunity for researchers and clinicians to better explore cognitions associated with social anxiety., Competing Interests: Declaration of Competing Interest Dr. Cook reports an Australian Commonwealth Government Research Training Program Scholarship during the conduct of the study; Dr. Bryant reports none; Dr. Phillips reports none., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The bivalent fear of evaluation (BFOE) model of social anxiety divides fear of evaluation into two distinct valences: fear of positive evaluation (FPE) and fear of negative evaluation (FNE). However, there is evidence that the two most widely utilized and psychometrically supported measures of FNE and FPE contain items which are ambiguous with regard to valence of evaluative fear. To formally address this, the BFOE Scale (BFOES) was developed, by merging items from measures of FNE and FPE into a single scale with an integrated response format. The present studies examined the psychometric profile of the BFOES across a large pooled archival dataset (N = 2216), which included approximately 10 % (n = 224) patients with social anxiety disorder (SAD). The factorial validity, internal consistency, and construct validity of the BFOES were examined. Additionally, item response theory analyses were employed for the purpose of merging items from self-report scales which utilized different Likert-type response formats. Results from both studies provided support for the psychometric profile of the BFOES. The implications of the BFOES for the assessment of social anxiety, and theoretical models of fear of evaluation and SAD, are discussed., Competing Interests: Declaration of Competing Interest none., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This review aimed to systematically gather empirical data on the link between social anxiety disorder and ADHD in both clinical and non-clinical populations among adolescents and adults., Method: Literature searches were conducted in PsycInfo, PubMed, Scopus, and Web of Science, resulting in 1,739 articles. After screening, 41 articles were included. Results were summarized using a narrative approach., Results: The prevalence of ADHD in adolescents and adults with SAD ranged from 1.1% to 72.3%, while the prevalence of SAD in those with ADHD ranged from 0.04% to 49.5%. Studies indicate that individuals with both SAD and ADHD exhibit greater impairments. All studies were judged to be of weak quality, except for two studies which were rated moderate quality., Discussion: Individuals with SAD should be screened for ADHD and vice versa, to identify this common comorbidity earlier. Further research is needed to better understand the prevalence of comorbid ADHD and SAD in adolescents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD ( n  = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD ( n  = 50) and individuals with SAD and no MDD ( n  = 120) to examine the role of MDD as a moderator of the social anxiety-depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Appearance-related safety behaviors (ARSBs) have been identified as a key mechanistic target in individuals with elevated appearance concerns, social anxiety symptoms, and body dissatisfaction. The aim of the present study was to experimentally test the effect of fading these behaviors in individuals with body dysmorphic disorder (BDD), social anxiety disorder, and/or an eating disorder (ED). Ninety-four female participants were randomized to either a 1-month text message-based ARSB fading condition ( n = 47) or a self-monitoring control condition ( n = 47). Findings demonstrated that individuals in the ARSB fading condition saw significantly greater reductions in postmanipulation appearance concerns, appearance importance, ED symptoms, general anxiety, and depression. ARSB fading also led to lower BDD and social anxiety disorder symptoms, though this was only found among those who met for these respective diagnoses. Furthermore, we found that changes in appearance importance partially mediated the effect of condition on appearance concerns, BDD symptoms, social anxiety symptoms, and ED symptoms. Compared to the control, the ARSB fading group also demonstrated less reactivity to an in vivo appearance-related stressor task. This study provides strong evidence for the importance of ARSBs in the maintenance of appearance-related psychopathology among a clinical sample. Findings demonstrate the potential utility of reducing ARSBs as an overarching treatment strategy for appearance-related psychopathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT., Objective: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD., Methods: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS., Results: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS., Conclusions: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT., (©Xu Wen, Mengke Gou, Huijing Chen, Tomoko Kishimoto, Mingyi Qian, Jürgen Margraf, Thomas Berger. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Individuals with social anxiety often exhibit atypical processing of facial expressions. Previous research in social anxiety has primarily emphasized cognitive bias associated with face processing and the corresponding abnormalities in cortico-limbic circuitry, yet whether social anxiety influences early perceptual processing of emotional faces remains largely unknown. We used a psychophysical method to investigate the monocular advantage for face perception (i.e., face stimuli are better recognized when presented to the same eye compared to different eyes), an effect that is indicative of early, subcortical processing of face stimuli. We compared the monocular advantage for different emotional expressions (neutral, angry and sad) in three groups (N = 24 per group): individuals clinically diagnosed with social anxiety disorder (SAD), individuals with high social anxiety in subclinical populations (SSA), and a healthy control (HC) group of individuals matched for age and gender. Compared to SSA and HC groups, we found that individuals with SAD exhibited a greater monocular advantage when processing neutral and sad faces. While the magnitudes of monocular advantages were similar across three groups when processing angry faces, individuals with SAD performed better in this condition when the faces were presented to different eye. The former findings suggest that social anxiety leads to an enhanced role of subcortical structures in processing nonthreatening expressions. The latter findings, on the other hand, likely reflect an enhanced cortical processing of threatening expressions in SAD group. These distinct patterns of monocular advantage indicate that social anxiety altered representation of emotional faces at various stages of information processing, starting at an early stage of the visual system., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=-.25, CI=-0.49 to -0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=-.098 [-0.19-0.008]) and depression (beta=-0.18 [-0.34-0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Social anxiety disorder (SAD) is a prevalent and debilitating psychiatric disorder that is associated with impairments in functioning and detrimental outcomes such as suicide, poor physical quality of life (QOL), and overall mental health. The goal of the present study was to examine the past year comorbidities of DSM-5 SAD among a large nationally representative sample of US adults (N = 36,309) and to examine correlates of physical QOL and overall mental health among individuals with past-year SAD (N = 980)., Methods: The study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to examine diagnostic correlates of SAD as well as how symptoms and features of SAD are related to QOL using survey-weighted regression analyses., Results: We found that comorbid depression, anxiety disorders, posttraumatic stress disorder, and borderline personality disorder were positively associated with SAD. Further, presence of these disorders was also associated with poorer mental health among those with SAD. We also found that specific feared situations (eg, eating and drinking in public) and social anxiety symptoms (panic attack and avoidance) were linked to both forms of QOL (all p s <0.01)., Conclusion: The present findings highlight that SAD is comorbid with other impairing disorders and that these comorbidities, specific feared situations, and SAD symptoms are related to worse QOL in individuals with SAD., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Background: In order to gain a deeper understanding of the relationship between physical activity and adolescent mental health in the post COVID-19 pandemic era, self-esteem and social anxiety were used as mediating variables to explore the potential mechanisms by which physical activity affects adolescent mental health., Methods: The study used the HELP-II Health Promoting Lifestyle Scale, the SPIN Social Phobia Scale, the Self-Esteem Scale, and the 10-item Kessler Psychological Distress Scale to administer questionnaires to 400 Chinese secondary school students, and SPSS 26.0 and PROCESS 3.3 were used to process the data., Results: The findings showed that (1) physical activity was significantly and positively associated with mental health; (2) self-esteem and social anxiety played a fully mediating role between physical activity and adolescent mental health respectively; (3) self-esteem and social anxiety played a chain mediating role between physical activity and adolescent mental health., Conclusion: This study reveals the relationship and influencing mechanism between physical activity and adolescent mental health in the post COVID-19 pandemic era. Appropriate interventions for physical activity, self-esteem, and social anxiety may be beneficial to adolescent mental health. The protective role of self-esteem in adolescent mental health should be the focus of future studies, and further investigations into the association between the COVID-19 and adolescent mental health are warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Feng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms., Competing Interests: The authors declare there are no competing interests., (©2024 Wake et al.)

Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted., (© 2024 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Individuals suffering from social anxiety disorder (SAD) are increasingly turning to online support communities for self-disclosure and social support. Despite the extensive body of research on online mental health discourses, the cultural nuances within SAD-related discussions remain underexplored. In this study, we examine the cultural differences in online expression of social anxiety by analyzing individuals' self-disclosure and support-seeking behaviors in social media posts. Using two-week data ( n = 1,681) from two SAD support communities on the Reddit and Douban groups, we used both qualitative thematic analysis and quantitative semantic analysis to discern prevalent themes and linguistic attributes characterizing these online expressions. Our findings not only uncover common themes such as sharing personal experiences and seeking mutual validations in both communities but also identify their divergences, as Western users primarily sought advice and information in posts, whereas Chinese users were more inclined toward networking. Cultural variations in language use were evident, particularly in individuals' affect and their expression of personal and social concerns. Western users were more likely to convey negative emotions and delve into personal matters related to SAD, whereas Chinese users tended to grapple more with workplace anxieties. This study contributes to the cultural understanding of online mental health discourses and offers insights for crafting culturally sensitive interventions and supports for people with SAD.

Event centrality is defined by the extent to which a memory of an event has become central to an individual's identity and life story. Previous research predominantly focused on the link between event centrality and trauma-related symptomatology. Nevertheless, it can be argued that the perception of (adverse) events as central to one's self is not exclusive to Posttraumatic Stress Disorder (PTSD). Other disorders where adverse events are linked to the onset of symptoms might also be related to event centrality. This study examined the relevance of event centrality for Social Anxiety Disorder (SAD) and for Major Depressive Disorder (MDD) separately. Moreover, we examined which cognitive and emotion regulation variables (i.e., trait anxiety, rumination, worry, intrusions and avoidance, and posttraumatic cognitions) mediated these relationships. No significant correlation was found between event centrality and social anxiety. However, a significant positive correlation was found between event centrality and depression. In a combined group, this relation was mediated by all cognitive and emotion regulation variables except for worry.

Introduction: The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls., Methods: Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups., Results: No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies., Conclusions: SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

During the COVID-19 epidemic, face-to-face mental health services faced obstacles. Using Internet-based interventions was a good solution and had the potential to overcome these treatment barriers. However, there is no strong research evidence about the effectiveness of these methods for social anxiety disorder in different cultures and developing countries. Therefore, the present study aimed to investigate the effectiveness and application of Internet-based cognitive-behavioral therapy for social anxiety disorder in Iran. The current study was a pretest-posttest follow-up experimental design. Fifty-four adolescents with social anxiety disorder were selected from Lorestan province (Iran) by cluster sampling method and randomly assigned to three groups: face-to-face, internet-based, and wait-list control. At the beginning and end of the study and 3-month follow-up, three groups were interviewed and answered questionnaires related to the primary and secondary symptoms of social anxiety disorder. Two experimental groups were treated with the same therapeutic intervention during 10 weekly sessions. ANCOVA analysis showed that both forms of intervention effectively reduced social phobia, fear of negative evaluation and social interaction anxiety and increased emotion regulation. Also, a significant decrease in secondary outcomes, including physical symptoms, insomnia, social dysfunction, and depression symptoms, was observed in both groups. The treatment effects were stable during a 3-month follow-up. Our findings showed that although Internet-based cognitive-behavioral therapy for adolescents with social anxiety disorder can be effective, several clinical, cultural, and implementation weaknesses should be considered., (Copyright © 2023 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet., Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA., Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science., Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics., Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder., (©Javier Fernández-Álvarez, Desirée Colombo, Juan Martín Gómez Penedo, Maitena Pierantonelli, Rosa María Baños, Cristina Botella. Originally published in JMIR Mental Health (https://mental.jmir.org), 04.04.2024.)

Objective: To examine the fear of negative evaluation as a predictor, and to explore the association of social anxiety with psychological correlates among women with polycystic ovaries., Methods: The cross-sectional study was conducted from August 2020 to November 2021 after approval form the University of Central Punjab, Lahore, Pakistan, and comprised unmarried women aged 18-26 diagnosed with polycystic ovary syndrome. The sample was raised from different clinics and hospitals based in Lahore and Gujranwala cities. The sample was divided into obese, hirsutism and acne vulgaris groups. Data was collected using a demographic proforma along with standardised Derriford Appearance Scale, Brief Fear of Negative Evaluation Scale, University of California, Los Angeles, Loneliness Scale and the Social Interaction Anxiety Scale. Data was analysed using SPSS 24., Results: Of the 180 patients, 60(33.3%) were in each of the 3 groups. The overall mean age was 21.4+/-2.27 years. A significant association of fear of negative evaluation was found with appearance distress, social anxiety and loneliness (p<0.05). The fear of negative evaluation and appearance distress also significantly predicted loneliness in the subjects (p<0.01). The obese group scored significantly higher in terms of fear of negative evaluation and social anxiety compared to the other groups (p<0.05)., Conclusion: Women with polycystic ovaries were found to be suffering from adverse psychological outcomes and social anxiety.

Introduction: Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample., Material and Methods: We used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression., Results: Estimated prevalence for SAD was 1.1% (95% CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse., Conclusions: Among this large Andalusian population sample, the prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had previously reported such a strong association with paranoia., (Copyright © 2021 The Author(s). Published by Elsevier España S.L.U. All rights reserved.)

Social anxiety disorder (SAD), also known as social phobia, is a psychological condition in which a person has a persistent and overwhelming fear of being negatively judged or observed by other individuals. This fear can affect them at work, in relationships and other social activities. The intricate combination of several environmental and biological factors is the reason for the onset of this mental condition. SAD is diagnosed using a test called the "Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), which is based on several physical, emotional and demographic symptoms. Artificial Intelligence has been a boon for medicine and is regularly used to diagnose various health conditions and diseases. Hence, this study used demographic, emotional, and physical symptoms and multiple machine learning (ML) techniques to diagnose SAD. A thorough descriptive and statistical analysis has been conducted before using the classifiers. Among all the models, the AdaBoost and logistic regression obtained the highest accuracy of 88 % each. Four eXplainable artificial techniques (XAI) techniques are utilized to make the predictions interpretable, transparent and understandable. According to XAI, the "Liebowitz Social Anxiety Scale questionnaire" and "The fear of speaking in public" are the most critical attributes in the diagnosis of SAD. This clinical decision support system framework could be utilized in various suitable locations such as schools, hospitals and workplaces to identify SAD in people., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background and Objectives: Although cognitive behavioral group therapy (CBGT) is an effective treatment for social anxiety disorder, many socially anxious patients are still symptomatic after treatment. A possible improvement for CBGT could come from the more experiential group psychotherapy, psychodrama (PD). The integration of CBGT and PD (labeled CBPT) might offer an even more effective treatment than CBGT or PD alone. With the present study, we investigated first whether three kinds of group therapy (CBGT, PD, and CBPT) are superior to a waitlist (WL). Second, we investigated whether CBPT is more effective than CBGT or PD alone., Methods: One hundred and forty-four social anxiety patients were randomly assigned to three active conditions or a WL. After wait, WL-participants were randomized over the active treatment conditions., Results: The results of a multilevel analysis showed that all treatments were superior to WL in reducing social anxiety complaints. Only CBGT and CBPT differed significantly from WL in reducing fear of negative evaluations. There were no significant differences between active conditions in any of the variables after treatment and after six-month follow up, neither were there significant differences in treatment dropout., Limitations: First there is the lack of a long-term follow-up. Second, because of loss of participants, we did not reach the planned numbers in the active treatment groups in comparison to WL. Moreover, this study was not designed as a non-inferiority or equivalence trial., Conclusions: Although the integrative CBPT showed good results, it was not more effective than the other treatments., Competing Interests: Declaration of competing interest Given their role as an Editorial Board Member, Arntz A., had no involvement in the peer-review of this article and had no access to information regarding its peer-review. All other authors have declared no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Few studies have examined the use of concentrated and intensified cognitive behaviour therapy for treating social anxiety disorder (SAD). The aim of this study was to examine the feasibility of the Bergen 4-Day Treatment (B4DT) for treating SAD., Methods: This study adopted an open trial design without a control group. Thirty consecutively referred patients who were diagnosed with SAD were treated and assessed at pre-treatment, at post-treatment, and at the 3-month follow-up. The Liebowitz Social Anxiety Scale was used to assess symptoms of SAD; the Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms; and the Patient Health Questionnaire-9 was used to assess symptoms of anxiety and depression. The Client Satisfaction Questionnaire-8 was administered posttreatment., Results: Overall, patients reported a high level of satisfaction with the B4DT. Large effect sizes were observed for symptoms of SAD (d = 1.94-2.66) and for the secondary outcomes, i.e., generalized anxiety (d = 0.86-0.99) and depression (d = 0.62-0.83). The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%., Conclusions: The B4DT is a promising treatment approach for patients with SAD. In the future, controlled trials should be performed to compare the efficacy of this treatment approach with standard outpatient treatment. Practical consequences, policy implications, and suggestions for future research are discussed herein., (© 2024. The Author(s).)

Social anxiety disorder is the third most common disorder in the general population. Social phobia has a significant impact on nursing colleagues' self-esteem. The purpose of the current study was to assess social anxiety and its relation to self-esteem among nursing students. The study was a cross-sectional study. Data were collected from 231 nursing students through a convenience sampling method. The instruments of the study included "Social Phobia Inventory (SPIN)" and the "Rosenberg self-esteem scale." The results indicated that the social anxiety mean was 15.1 ± 11.1 (ranging from 0 to 68) and the self-esteem was 19.9 ± 4.5 (ranging from 0 to 30). The current study indicates that female and social anxiety are predictors of self-esteem among nursing students. Also, the present study concludes that lower social anxiety is associated significantly with higher self-esteem among Palestinian undergraduate nursing students ( r  = -.35, P  < .001). The study concludes that there are inverse correlation between social anxiety and self-esteem among Palestinian undergraduate nursing students. Even though most students showed modest levels of social anxiety and normal self-esteem., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD., Method: There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models., Results: Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment., Conclusion: The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.

Social phobia (SP) is a common mental disorder in youth often accompanied by absence from school, which may require daycare or inpatient intervention (DC/IN). Objective: The present explorative study investigates changes in anxiety-specific implicit assumptions and interpretation bias following DC/IN. Methods: The study included 16 youths with SP ( M age = 15.8 [ SD = 1.24], females: 62.5 %) participating in DC/IN. We assessed the main outcomes using the Implicit Association Test and Affective Misattribution Procedure. Results: A large effect was shown for reducing implicit assumptions of feeling anxious ( p = .142; η 2 p = .171) and for reducing the implicit interpretation bias ( p = .137; η 2 p = .162). No change was indicated by effect size in implicit assumptions of feeling socially rejected ( p = .649; η 2 p = .016). Social phobia symptoms initially correlated with changes in implicit assumptions of feeling anxious ( r = .45). Conclusion: Effect sizes indicate that implicit anxiety-specific assumptions and interpretation bias descriptively improved following DC/IN. Thus, DC/IN may lead to meaningful improvements of anxiety-specific cognition in some individuals with high SP symptoms, emphasizing the relevance of cognitive behavioral approaches in the treatment of SP. Several limitations are discussed.

Introduction: Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention., Objective: This randomized controlled trial investigated self-reported affective and physiological responses during ImRs., Methods: Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases., Results: Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline., Conclusions: These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Cannabis use and social anxiety disorder (SAD) are prevalent during emerging adulthood. Previous work has demonstrated that SAD is related to cannabis use in adults; however, less is known about what correlates relate to this association in emerging adults. A subsample of individuals ages 18-25 years old from the NESARC-III (N = 5194) was used to (a) evaluate the association between cannabis use and SAD and (b) examine what correlates may be associated with cannabis use and SAD in emerging adulthood. Weighted cross-tabulations assessed sociodemographics and lifetime psychiatric disorder prevalence estimates among the emerging adult sample. Multinomial logistic regressions examined associations between sociodemographics and psychiatric disorders and four groups (i.e., no cannabis use or SAD; cannabis use only; SAD only; cannabis use + SAD). The prevalence of co-occurring cannabis use and SAD was 1.10%. Being White, a part-time student, or not a student were associated with increased odds of having co-occurring cannabis use + SAD (OR range: 2.26-3.09). Significant associations also emerged between major depressive disorder, bipolar I disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder and co-occurring cannabis use + SAD (AOR range: 3.03-19.05). Results of this study may have implications for better identifying and screening emerging adults who are at risk of co-occurring cannabis use and SAD., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Abstract: Social anxiety disorder (SAD) is a specific subtype of anxiety disorder where individuals experience uncomfortable social situations that induce anxious feelings including nervousness and panic. Computer technology has been applied in interventions for many mental health disorders. We aim to understand and explore the use of virtual reality exposure therapy (VRET) to treat adults with SAD. We conducted a literature search using relevant mesh keywords in PubMed and PsycINFO. Six studies met inclusion criteria in our final qualitative synthesis review. Results showed a significant reduction in SAD symptom severity based on primary measures in all studies, suggesting that VRET is an effective option in treating SAD. Studies have shown the success of VRET in formats such as a single-user implementation, one-session treatment, and self-training intervention. In conclusion, VRET is effective in reducing SAD symptoms. The limitations of most studies included a small sample size and weak ecological validity. Future research can examine VRET with a more extensive clinical sample and broader social behaviors., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Numerous previous studies have used event-related potentials (ERPs) to examine facial processing deficits in individuals with social anxiety disorder (SAD). However, researchers still need to determine whether the deficits are general or specific and what the dominant factors are behind different cognitive stages. Meta-analysis was performed to quantitatively identify face processing deficits in individuals with SAD. Ninety-seven results in 27 publications involving 1032 subjects were calculated using Hedges' g. The results suggest that the face itself elicits enlarged P1 amplitudes, threat-related facial expressions induce larger P2 amplitudes, and negative facial expressions lead to enhanced P3/LPP amplitudes in SAD individuals compared with controls. That is, there is face perception attentional bias in the early phase (P1), threat attentional bias in the mid-term phase (P2), and negative emotion attentional bias in the late phase (P3/LPP), which can be summarized into a three-phase SAD face processing deficit model. These findings provide an essential theoretical basis for cognitive behavioral therapy and have significant application value for the initial screening, intervention, and treatment of social anxiety., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success., Competing Interests: Declaration of Competing Interest TMB receives salary support and equity from Big Health Inc. No other authors report any declarations., (Copyright © 2023. Published by Elsevier B.V.)

Background and Objectives: People with Social Anxiety Disorder (SAD) evaluate themselves negatively before, during, and after anxiety-provoking social situations, which leads to negative consequences (e.g., performance deficits, memory impairments, and post-event processing). Despite decades of research, little is known regarding whether these evaluations generalize to how they view others. Social projection theory-the belief that others are similar to oneself-might further extend the basic Cognitive Behavioural Therapy (CBT) model. Our aim was to understand whether the degree to which people negatively evaluate a visibly anxious person causes them to negatively evaluate themselves., Methods: 172 unselected participants completed several baseline questionnaires. We then randomly assigned participants to provide high-, medium-, or no-evaluation of a videotaped anxious person (i.e., other-evaluations) while we assessed their state anxiety. After, they evaluated the anxious person on multiple criteria. Participants then participated in an impromptu conversation task and subsequently evaluated their own performance., Results: Although our manipulation was effective, we found no emotional or behavioural differences between conditions. However, people in the high-evaluation condition recalled significantly fewer facts about their conversation partner than did people in the medium- and no-evaluation conditions., Limitations: After data cleaning, the sample size was slightly smaller than planned; most analyses were nonetheless appropriately powered. Our findings may not generalize beyond unselected undergraduate students; replication in a clinical sample is warranted., Conclusions: These findings highlight the cognitive consequences (i.e., memory impairments) of other-evaluations, which cognitive behavioural therapists should consider when treating individuals with SAD., Competing Interests: Declaration of competing interest The authors report no conflict of interest. This work was supported by a Social Sciences and Humanities Research Council of Canada (SSHRC) Doctoral Scholarship to the first author [grant number 752-2019-1659] and a Discovery Grant from the Natural Sciences and Engineering Research Council of Canada (NSERC) to the second author [RGPIN 2017–05295]. Neither funding source had any role in: study design; data collection, analysis, or interpretation; writing of the report, or; decision to submit the article for publication., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: According to the self-medication and biopsychosocial models, individuals with social anxiety disorder (SAD) are at increased risk of developing an alcohol use disorder (AUD) as alcohol represents a maladaptive coping mechanism for some sufferers of SAD. The SAD-to-AUD causation was earlier supported in Norwegian longitudinal twin data and later questioned using longitudinal data from the USA., Methods: We re-analyzed partly the same USA-based data (National Comorbidity Surveys, n = 5001), conducting theoretical and simulation analyses on different formulations of temporality and using real-data Logistic regression analysis to investigate whether baseline SAD was associated with AUD at the follow-up., Results: Upon proper analysis of temporality, SAD preceded AUD. Specifically, SAD was the only one of the seven anxiety disorders that predicted 10-year later AUD after adjusting for all other anxiety disorders and AUD at the baseline (odds ratio was 1.70% and 95% confidence interval 1.12-2.57). SAD was also associated with incident AUD (OR = 1.64, 95% CI = 1.14-2.37). We provide formal, simulation-based, and data-based arguments on how certain flawed models of incidence attenuate the temporal association., Conclusions: We demonstrated temporality and specificity in SAD-to-AUD association, which are considered signs of causation. We further identified and discussed problems in previous statistical analyses with different conclusions. Our findings add support for models positing causal effects of SAD on AUD, such as the self-medication and biopsychosocial models. The available evidence suggests that treating SAD should incur better chances of preventing AUD compared to treating other anxiety disorders, which lack comparable evidence on causation., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial competing interests to disclose., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)