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Introduction: Machine learning (ML) is an effective tool for predicting mental states and is a key technology in digital psychiatry. This study aimed to develop ML algorithms to predict the upper tertile group of various anxiety symptoms based on multimodal data from virtual reality (VR) therapy sessions for social anxiety disorder (SAD) patients and to evaluate their predictive performance across each data type. Methods: This study included 32 SAD-diagnosed individuals, and finalized a dataset of 132 samples from 25 participants. It utilized multimodal (physiological and acoustic) data from VR sessions to simulate social anxiety scenarios. This study employed extended Geneva minimalistic acoustic parameter set for acoustic feature extraction and extracted statistical attributes from time series-based physiological responses. We developed ML models that predict the upper tertile group for various anxiety symptoms in SAD using Random Forest, extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost) models. The best parameters were explored through grid search or random search, and the models were validated using stratified cross-validation and leave-one-out cross-validation. Results: The CatBoost, using multimodal features, exhibited high performance, particularly for the Social Phobia Scale with an area under the receiver operating characteristics curve (AUROC) of 0.852. It also showed strong performance in predicting cognitive symptoms, with the highest AUROC of 0.866 for the Post-Event Rumination Scale. For generalized anxiety, the LightGBM's prediction for the State-Trait Anxiety Inventory-trait led to an AUROC of 0.819. In the same analysis, models using only physiological features had AUROCs of 0.626, 0.744, and 0.671, whereas models using only acoustic features had AUROCs of 0.788, 0.823, and 0.754. Conclusions: This study showed that a ML algorithm using integrated multimodal data can predict upper tertile anxiety symptoms in patients with SAD with higher performance than acoustic or physiological data obtained during a VR session. The results of this study can be used as evidence for personalized VR sessions and to demonstrate the strength of the clinical use of multimodal data. [ABSTRACT FROM AUTHOR]

Objective: Autism spectrum disorder (ASD) is characterized by high rates of comorbidity with other mental disorders, including anxiety disorders and obsessive–compulsive disorder. Beyond a mere concept of comorbidity, recent literature is speculating the existence of a neurodevelopmental nature of such mental disorders. The aim of the study is to investigate the distribution of social-phobic, obsessive–compulsive and panic-agoraphobic traits within a sample of individuals with ASD, social anxiety disorder (SAD), obsessive–compulsive disorder (OCD) and panic disorder (PD). Methods: 40 participants with ASD, 40 with SAD, 40 with OCD, 40 with PD and 50 HC were assessed with the Social Anxiety Spectrum—Short Version (SHY-SV) questionnaire, the Obsessive—Compulsive Spectrum—Short Version (OBS-SV) questionnaire and the Panic Agoraphobic Spectrum—Short Version (PAS-SV) questionnaire. Statistical analyses included Kruskal–Wallis test and Chi-square test. Results: When analyzing SHY-SV scores, the SAD group obtained the highest scores, with individuals with ASD following closely, significantly surpassing the scores of the remaining diagnostic groups. In the examination of OBS-SV questionnaire scores, individuals with ASD once again secured the second-highest scores, trailing only the OCD group. These scores were notably higher than those of both the PD group and healthy controls. In the analysis of PAS-SV scores, the ASD group once again achieved the highest scores after the PD individuals, although this time the difference was not statistically significant compared to the other diagnostic groups. Discussion: These findings highlight the central role of the autism spectrum in SAD and OCD diagnoses. They provide support for the hypotheses of a neurodevelopmental basis for social anxiety and OCD, contributing to the growing body of evidence supporting a dimensional and interconnected view of mental health conditions. [ABSTRACT FROM AUTHOR]

Introduction: Many studies have demonstrated that social anxiety disorder (SAD) can be effectively treated with psychotherapy, particularly cognitive-behavioral therapy (CBT), including internet-based CBT (ICBT). Despite evidence-based treatments, many individuals do not sufficiently benefit from them. Identifying the active components could help improve the effectiveness of SAD treatment. This study tested the effects of four treatment components (psychoeducation, cognitive restructuring, attention training, and exposure) within ICBT for SAD to investigate its active components. Methods: This randomized full factorial trial consisted of four factors (i.e., treatment components) and 16 conditions. A total of 464 adults with a diagnosed SAD were recruited from the community. The primary outcome was SAD symptoms at 8 weeks (post-assessment). Secondary outcomes included SAD diagnosis, SAD symptoms at follow-up (4 months after post), depression and anxiety symptoms, quality of life, client satisfaction, and adverse effects. Results: Conditions including psychoeducation and exposure were significantly more effective in reducing SAD symptoms at post compared to conditions without these components. Conditions including cognitive restructuring and attention training did not show superiority over conditions without them at post. However, all treatment conditions significantly reduced symptoms compared to the condition without a treatment component. At follow-up, the superiority of psychoeducation and exposure was not significant anymore due to the version without the respective components catching up. Conclusion: The findings suggest that while all treatment components of ICBT for SAD are beneficial compared to no treatment, psychoeducation and exposure include specific active components that significantly improve treatment outcomes more quickly in ICBT for SAD. [ABSTRACT FROM AUTHOR]

Background: The high comorbidity and symptom overlap of generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD), has led to the study of their shared and disorder-specific neural substrates. However, the morphometric similarity network (MSN) differences among these disorders remain unknown. Methods: MSN derived from T1-weighted images in patients of GAD, PTSD, and SAD, and health controls (HC) using a Siemens 3T magnetic resonance imaging system. Covariance analysis and post hoc tests were used to investigate group differences. In addition, the relationship between MSN and clinical characteristics was analyzed. Results: Increased morphometric similarity (MS) between left bankssts (BA22, superior temporal cortex, STC) and right precentral gyrus, and decreased MS between left precentral gyrus and right cuneus_part1/part2, and between right rostral middle frontal cortex (rMFC) and right STC were common in GAD and PTSD relative to HC and SAD. Compared to the other three groups, SAD exhibited disorder-specific alterations of increased MS between right rMFC and right STC, and between left cuneus and right inferior parietal cortex. Additionally, increased regional MSN in left precentral gyrus was found in PTSD compared to HC and SAD. A mild positive correlation of the MS value between left bankssts and right precentral gyrus and the Hamilton Anxiety Rating Scale scores (uncorrected p = 0.041) was found in PTSD. Conclusions: Our study provides the first evidence for common and distinct brain MSN abnormalities underlying the pathophysiology of GAD, PTSD, and SAD, which may aid in differential diagnosis and determining potential disorder-specific intervention targets. [ABSTRACT FROM AUTHOR]

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC =.83 and.75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p <.001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p =.041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the psychometric characteristics of the Social Phobia Inventory (SPIN) by employing network analysis, confirmatory factor analysis, and the Polytomous Rasch Model. A cross-sectional data set was collected comprising 1,530 participants, with 959 being women and 571 being men. The Bootstrap Exploratory Graph Analysis unveiled the presence of two dimensions, with Items 17, 15, 5, 14, 6, and 9 exhibiting the highest strength centrality index. Notably, the Network Comparison Test indicated no differences in Network Invariance and global strength between the networks of women and men. Furthermore, the confirmatory factor analysis results demonstrated that the two extracted dimensions displayed an acceptable goodness of fit. In addition, the reliability coefficient values were acceptable, exceeding the threshold of 0.70. The Rasch analysis results suggested an overall fit, but some items exhibited overlap, suggesting their potential removal. Furthermore, it was recommended to develop new items to address gaps between existing items, particularly for measuring the lower levels of Social Anxiety Disorder. In conclusion, these findings provide robust evidence supporting the reliability and validity of the SPIN as a tool for measuring Social Anxiety Disorder in Algeria. [ABSTRACT FROM AUTHOR]

Background: It seems that considering the role of emotions in distress tolerance and cognitive flexibility as two important dimensions of social anxiety disorder, which is one of the most debilitating anxiety disorders, using treatments that target emotions can be helpful. Aims: The aim of the present study was to investigate the effectiveness of emotion-focused therapy on cognitive flexibility and distress tolerance married women with social anxiety disorder. Methods: The research method was a semi-experimental pretest-posttest design with a 45-day follow-up strage by control group. The study population included all married women with social anxiety disorder referred to psychological counseling centers in the 18th district of Tehran in 2023 which among those 34 cases were selected through available sampling and according to the inclusion criteria and they were randomly divided into experimental and control groups. The Experimental group received emotion-focused therapy (Johnsano, 2008) sessions for nine 90-minutes sessions. All participants were assessed by the questionnaires of cognitive flexibility Inventory (Dennis & Vander Wal, 2010) and distress tolerance (Simons & Gaher, 2005). Data were analyzed by SPSS-24 software and MANOVA with repeated measure test. Results: The results indicated the effectiveness of emotion-focused therapy on improving cognitive flexibility and distress tolerance (p< 0.01) and maintaining its effectiveness in the follow-up stage (p< 0.01). Conclusion: Considering to the effectiveness of emotion-focused therapy it is suggested to focus on this therapy as one of the auxiliary, supportive and rehabilitation therapy along with drug treatment in reducing the consequences of difficulties in distress tolerance and cognitive flexibility. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionFew reliable patient characteristics have emerged as significant predictors of outcomes for Social Anxiety Disorder (SAD). This study aimed to explore whether affect integration, metacognitions, and maladaptive schemas could serve as predictors of therapeutic outcomes for patients with SAD. Relationships between these psychological constructs and baseline SAD symptomatology were also examined.Eighty-eight patients across three sites participated in Cognitive Behavioral Therapy (CBT) or Metacognitive Therapy (MCT) for SAD in inpatient or outpatient clinics. Measures of predictors and SAD symptomatology were repeatedly assessed. Statistical analyses included longitudinal, multilevel modeling.Difficulties with affect integration, metacognitions and early maladaptive schemas clearly related to higher levels of SAD symptoms at baseline but were not generally predictive of changes in SAD symptoms during therapy. However, examining sub-domains revealed that difficulties with the integration of jealousy and tenderness, and the maladaptive schema of defectiveness/shame, predicted poorer outcomes. In contrast, initial difficulties with the integration of sadness, a greater lack of cognitive confidence, and the maladaptive schema of dependence/incompetence were associated with greater symptom improvement.Identifying issues of affect integration and core self-other beliefs prior to therapy may enhance patient selection and allow for a more individualized treatment. [ABSTRACT FROM AUTHOR]

Social Anxiety Disorder is traditionally diagnosed using subjective scales that may lack accuracy. Recently, EEG technology has gained importance for anxiety detection due to its ability to capture stable and objective neurophysiological activities. However, existing methods mainly focus on extracting EEG features during resting states, with limited use of psychologically features like Event-Related Potential (ERP) in task-related states for anxiety detection in deep learning frameworks. We collected EEG data from 63 participants exposed to four facial expressions and extracted task-relevant features. Using the EEGNet model, we predicted social anxiety and evaluated its performance using metrics such as accuracy, F1 score, sensitivity, and specificity. We compared EEGNet's performance with Deep Convolutional Neural Network (DeepConvNet), ShallowConvNet, Bi-directional Long Short-Term Memory (BiLSTM), and SVM. To assess the generalizability of the results, we carried out the same procedure on our prior dataset. EEGNet outperformed other models, achieving 99.16 % accuracy with Late Positive Potential (LPP). ERP components yielded higher accuracy than time-domain and frequency-domain features for social anxiety recognition. Accuracy was better for neutral and negative facial stimuli. Consistency across two datasets indicates stability of findings. Due to limited publicly available task-state datasets, only our own were used. Future studies could assess generalizability on larger datasets from different sources. We conducted the first test of ERP features in anxiety recognition tasks. Results show ERP features have greater potential in social anxiety recognition, with LPP exhibiting high stability and accuracy. Outcomes indicate recognizing social anxiety with negative or neutral facial stimuli is more useful. • The ERP features outperformed other features, LPP may be a biomarker for anxiety detection. • EEGNet performed better in anxiety detection based on Mcnemar's test. • Better anxiety detection performance was observed under neutral and negative facial stimuli. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) and social anxiety disorder (SAD) are highly comorbid. Research to date suggests that social appearance anxiety (SAA), or fear of negative evaluation based on appearance is a type of social anxiety most related to EDs. Additionally, shame, guilt, and pride have each been shown to play a role in both EDs and SAD; however, they are yet to be explored as potential moderators of the relationship between SAA and ED symptoms. The current study tests if shame, guilt, and pride moderate the relationship between SAA and ED symptoms. Using an aggregate dataset of clinical and non-clinical samples (N = 1911), linear regressions were used to examine shame, guilt, and pride as moderators of the relationship between SAA and ED symptoms. We found that the relationship between SAA and ED symptoms was moderated by shame, guilt, and pride, such that at high levels of shame or guilt and low levels of pride, SAA was associated with increased ED symptoms. These findings suggest that shame and guilt may amplify, and pride may minimize, the relationship between SAA and ED symptoms. This research highlights the importance of assessing for high levels of SAA, shame, and guilt, and low levels of pride, independently, and in combination, to identify individuals at highest risk for developing ED symptoms. Future research should explore whether interventions targeting those with most at risk combinations helps to reduce ED symptoms. [ABSTRACT FROM AUTHOR]

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. 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. 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 %). 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. • Network meta-analysis examines interventions for social anxiety disorder. • Internet-delivered CBT is an optimal psychotherapy for social anxiety disorder. • Group CBT has better benefits in enhancing the functioning. • Findings can provide recommendations for health care professionals and patients. [ABSTRACT FROM AUTHOR]

Background: Social anxiety disorder imposes impacts of functional disability, poor educational achievement, loss of work productivity, social impairment, greater financial dependency, and impairment in quality of life. Therefore, the aim of this study was to assess the prevalence and identify determinants of social anxiety disorder among people living with HIV/AIDS. Methods: A cross-sectional study was conducted from 1 to 30 May 2022 among 354 people living with HIV using a simple random sampling technique. The Social Phobia Inventory (SPIN) Scale was used to assess the presence of social anxiety disorder. Data were gathered using chart review tools and a structured questionnaire, which was administered by a pretested face-to-face interviewer. SPSS version 25 was used to analyse the data once they were imported into EpiData Manager version 4.6. Binary and multivariable logistic regressions were performed. After calculating odds ratios with a 95% confidence interval (CI), statistical significance was established at p < 0.05. Results: A total of 336 respondents participated in the study, resulting in a response rate of 94.91%. The magnitude of social anxiety disorder was 32.44% (95% CI: 27.4, 37.2). Being female [adjusted odds ratio (AOR) = 3.55, 95% CI: 1.61, 7.84], having a stage III/IV HIV/AIDS status (AOR = 3.17, 95% CI: 1.10, 9.13), being alcohol dependent (AOR = 2.81, 95% CI: 1.45, 5.44), and having perceived stigma (AOR = 5.62, 95% CI: 2.95, 10.72) were predictors of social anxiety disorder. Conclusion: In this study, approximately one-third of people living with HIV/AIDS had social anxiety disorder. Being female, having a stage III/IV HIV/AIDS status, being alcohol dependent, and having perceived stigma were predictors of social anxiety disorder. Therefore, training for health care providers on the screening, counselling, and management of social anxiety disorder is important. [ABSTRACT FROM AUTHOR]

Objective: Research on the experience of performance anxiety (PA) in musicians is often explored through the use of the term music performance anxiety (MPA). Current diagnostic classifications include PA as a specifier for social anxiety disorder (SAD). This inclusion aims to acknowledge a distinct group of individuals who demonstrate the same cluster of symptoms as SAD but in a performance specific context. This present review aims to examine and sythesise these distinct literatures from a cognitive-behavioural perspective. Method: Relevant literature from the cognitive-behavioural perspective of SAD and MPA were identified, compared, and critically reviewed. Results: Despite a continued focus in the field of clinical psychology on developing diagnostic tools, disorder-specific models, and gold standard treatments for SAD, these advancements are not widely employed when understanding and managing debilitating PA in musicians. This review considers that research investigating debilitating PA in musicians could be examined as a context-specific form of SAD, informed by well-established cognitive-behavioural models and assessment tools, which can aid the development of standardised treatment protocols. Conclusions: Cognitive-behavioural models of SAD could aid in our understanding of PA in musicians, especially when considering treatment targets. Limitations for the model's application are also discussed, recognising the complex nature and research already conducted on MPA. Key Points: What do we already know about this topic: The experience of performance anxiety (PA) in musicians is often referred to using the term music performance anxiety (MPA). Research on social anxiety disorder (SAD) continues to evolve, with the development of cognitive-behavioural models that aid in treatment and conceptualisation. A performance-only specifier has been included in the DSM-5-TR as a specifier for SAD, whilst the term MPA continues to be used when exploring the experience of PA in musicians. What does this topic add: Established cognitive-behavioural models could support our understanding of the development and maintance of PA in musicians. Key models for MPA incorporate components of available cognitive models of SAD, demonstrating shared constructs which may aid in the development of context-specific cognitive-behavioural interventions. Given the development of a performance-only specifier for SAD in DSM-5-TR, the term performance anxiety (PA) may offer a simpler term to characterise the experience of debilitating anxiety surrounding the fear of evaluation despite available skills. Future research is needed support the integration of PA research across fields (i.e. sport, public speaking). This will not negate the complexities of individual performers experiences, rather provide clarity on the shared fear of negative evaluation underlying experienced PA. [ABSTRACT FROM AUTHOR]

Fears of negative evaluation (FNEs) and fears of positive evaluation (FPEs) comprise a bivalent model of evaluation that can explain the aetiology and maintenance of Social Anxiety Disorder (SAD). In this study, we examined an extended version of this model which incorporates two related cognitive processes (concerns about reprisal and discounting of positive outcomes) as partial mediators of the effects of FNEs and FPEs. We built on earlier work by including a broader measure of social anxiety across different social situations and comparing models for groups of participants with and without probable SAD. Structural equation modelling was utilised to test the model in a sample of 890 university students (74.8% female, mean age 29.49). We replicated the findings of Cook et al. in the overall sample and in the group with probable SAD. FNEs and FPEs predicted social anxiety directly and were serially mediated by concerns about reprisal and discounting positive outcomes. The model was also a good fit for those without SAD; however, in the model, FNEs were no longer a direct predictor of social anxiety. The findings confirm the utility of the extended bivalent model and have implications for psychoevolutionary accounts of social anxiety. [ABSTRACT FROM AUTHOR]

Background: It seems that considering the role of emotions in distress tolerance and cognitive flexibility as two important dimensions of social anxiety disorder, which is one of the most debilitating anxiety disorders, using treatments that target emotions can be helpful. Aims: The aim of the present study was to investigate the effectiveness of emotion-focused therapy on cognitive flexibility and distress tolerance married women with social anxiety disorder. Methods: The research method was a semi-experimental pretest-posttest design with a 45-day follow-up strage by control group. The study population included all married women with social anxiety disorder referred to psychological counseling centers in the 18th district of Tehran in 2023 which among those 34 cases were selected through available sampling and according to the inclusion criteria and they were randomly divided into experimental and control groups. The Experimental group received emotion-focused therapy (Johnsano, 2008) sessions for nine 90-minutes sessions. All participants were assessed by the questionnaires of cognitive flexibility Inventory (Dennis & Vander Wal, 2010) and distress tolerance (Simons & Gaher, 2005). Data were analyzed by SPSS-24 software and MANOVA with repeated measure test. Results: The results indicated the effectiveness of emotion-focused therapy on improving cognitive flexibility and distress tolerance (p< 0.01) and maintaining its effectiveness in the follow-up stage (p< 0.01). Conclusion: Considering to the effectiveness of emotion-focused therapy it is suggested to focus on this therapy as one of the auxiliary, supportive and rehabilitation therapy along with drug treatment in reducing the consequences of difficulties in distress tolerance and cognitive flexibility.

Background: Acceptance and commitment therapy (ACT) is a novel third-wave therapy becoming popular in the management of various anxiety disorders. In this systematic review, we wish to gather the data that have been studied to determine the effectiveness of ACT in treating social anxiety disorder (SAD). Methods: This study followed standard systematic review guidelines and was registered with PROSPERO prior to undertaking the review. Databases, namely PubMed, PsycINFO, Ovid MEDLINE, and gray literature (ClinicalTrials.gov, BASE) with relevant keywords, were searched from inception to February 2024. Randomized controlled trials encompassing both clinical and nonclinical populations aged more than 10 years diagnosed with SAD were included. These trials compared ACT with wait list controls (n = 6) and cognitive behavioral therapy (n = 3). The primary outcome focused on the reduction of symptoms associated with social anxiety, while quality of life served as a secondary outcome. Measures of effect were determined through pre-test and post-test mean values, alongside their respective standard deviations. The random effect model was used to calculate pooled effect size. The quality of the included papers was assessed using Cochrane RoB-1. Covidence software was used for the initial selection of studies, and meta-analyses were performed using RevMan software. Results: From the initial 442 study records that were searched, finally 9 studies were included for the systematic review, of which 6 studies were found suitable for meta-analysis. The pooled estimate for studies comparing ACT with wait list found that the overall effect size for social anxiety symptoms was g = −1.28 (95% confidence interval of -1.88, -0.69) favoring ACT intervention significantly. Conclusion: This review found that ACT is efficacious in treating SAD. Most of the studies included were conducted in adolescent females. Varying ACT intervention modalities were incorporated, with the primary outcome assessed using a range of scales. The results of our meta-analysis should be interpreted with caution because of heterogeneity and smaller number of studies being included. ACT can be considered a psychotherapeutic option for the management of SAD.

Abstract Background Social anxiety disorder (SAD) is a common mental health concern affecting students globally and in Saudi Arabia. This study aimed to assess the prevalence of SAD among nursing students and examine its association with various parenting styles. Methods This cross-sectional study included 141 female nursing students at the College of Nursing at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Participants completed the Parental Authority Questionnaire (PAQ) and Social Phobia Inventory (SPIN). The study data were collected using Microsoft Forms. An ordinal logistic regression analysis was performed to examine the association between SAD and parenting styles. Results The prevalence of SAD among the nursing students was 47.5%, with 6.4% having severe SAD and 2.8% having very severe SAD. The authoritative parenting style was the most frequently reported, with 58.2% of the students reporting having an authoritative mother and 44.7% reporting having an authoritative father. Maternal (odds ratio [OR] = 0.181, 95% confidence interval [CI] = 0.062, 0.527, p = 0.001) and paternal (OR = 0.186, 95% CI = 0.060, 0.574, p = 0.003) authoritative parenting styles were associated with a decrease in the odds of experiencing symptoms of SAD among nursing students. Additionally, a paternal authoritarian parenting style (OR = 2.816, 95% CI = 1.011, 8.218, p = 0.048) was associated with an increase in the odds of experiencing SAD symptoms. However, maternal authoritarian parenting style was not significantly associated with SAD symptoms among students (p > 0.05). Conclusions The parenting style is an influential factor contributing to the experience of SAD in nursing students. In this study, both authoritative and authoritarian parenting styles were significantly associated with the symptoms of SAD. Nursing educators and mental health professionals must establish appropriate strategies to help students cope with SAD. Moreover, educational programs targeting parents must be implemented to increase their awareness of the impact of parental practices on their children’s mental health.

The Mini Social Phobia Inventory (Mini-SPIN) is a short 3-item measure of social anxiety disorder (SAD). Using existing data, the current study examined the psychometric properties of the Mini-SPIN using a large, treatment seeking sample of children aged 6–16 years with data available for youth (n = 695, 170) and their caregivers (n = 703, 177) at pre-treatment and follow-up, respectively. The ability of the Mini-SPIN to discriminate between those with and without SAD was examined at pre-treatment and 6-month follow-up, across caregiver and child report. The criterion group validity, internal consistency and construct validity of the measure was also examined. Results revealed that at pre-treatment the Mini-SPIN demonstrated good discriminant validity in detecting cases of SAD from non-SAD (with cut-off of 4 on child report, and 6 on caregiver report). At 6-month follow-up, the discriminant ability of the Mini-SPIN was found to be less than acceptable for child reported scores, but acceptable for caregiver reported scores. The Mini-SPIN further demonstrated good criterion group validity, internal consistency and construct validity across caregiver and child report. Overall, the findings from the current study lend further support for the use of the Mini-SPIN as a screening tool for SAD. [ABSTRACT FROM AUTHOR]

Background: A common symptom of SAD is significant impairment in interpersonal relationships that can affect various aspects of life as well as daily functioning and lead to decreased quality of life. Individuals with high social anxiety will tend to withdraw from social environments. Purpose: This can eventually lead to loneliness and depression. Therefore, early detection is needed to find a diagnosis early on and prevent the condition from worsening. This review aims to determine the clinical picture in patients with SAD and to find out the instruments that /have been used for clinical enforcement in the field. Methods: We conducted a comprehensive search for full-text articles comprising case reports, case-control studies, cohort studies, and cross-sectional studies published between January 1, 2013, and December 30, 2023. The search encompassed databases such as PubMed, ScienceDirect, SAGE, and Scopus. It's important to note that this review does not delve into other clinical conditions associated with Social Anxiety Disorder (SAD), such as anxiety and depression, as they have been addressed in separate discussions. Additionally, the identification of anxiety and depression is excluded from this review. Results: Out of 78 articles that were screened, only 56 met the eligibility criteria to be selected for further review. The initial steps that need to be taken include 1) defining the research objectives; 2) establishing inclusion criteria; 3) developing a search strategy for data retrieval or study selection; 4) collecting data; 5) assessing the quality of studies; and 6) synthesizing the results. Risk of bias was performed using FEAT principles and reviewers’ discussion. A total of 11 final articles that were reviewed showed a significant correlation between anxiety disorder and detection. Conclusion: As individuals with SAD are large in number, based on this review, early detection is required using methods used by local health regions such as through interviews or clinical symptom assessment. This aims to find cases as quickly as possible and provide appropriate interventions.

In Indonesia, 448.126 divorce cases were reported in 2023. Losing parent(s) as a consequence of parental divorce or death results in children becoming broken-home. In the absence of a parent figure, children experience harmful psychological effects, including ongoing social anxiety until they become young adults. This may disrupt young adults’ developmental task to form intimacy hence leading to poor psychological well-being. Young adults from broken home families must possess hardiness to cope with daily stress and traumatic experiences. Therefore, this study aimed to investigate the role of social anxiety disorder and hardiness in psychological well-being among broken-home young adults. Participants of this study were 200 young adults with broken-home family. The scales used were The Indonesian version of the Psychological Well-being Scale, The Social Phobia Inventory (SPIN), and the DRS-15 Dispositional Resilience Scale. Data was analyzed using the Multiple Regression Model. The results showed that there was a significant contribution of social anxiety disorder and hardiness on psychological well-being, with a total contribution of 53.8 percent. It is recommended for future interventions to detect social anxiety disorder potency, as well as to include hardiness variable in optimizing psychological well-being quality, especially in broken-home young adults.

Background Anxiety and obesity can have negative impacts on the health of children. Understanding the relationship between obesity and mental disorders in children and adolescents will help develop effective prevention and intervention strategies. This research investigates the impact of anxiety-related emotional disorders and self-esteem on obesity among Chinese children aged 6-12 in Anhui Province. Methods Utilizing a non-experimental, cross-sectional study design, data were from 136 participants collected through standardized instrument measures from Chinese children: the “Chinese screening for overweight and obesity among school-age children and adolescents” in the “Health Industry Standards of the People’s Republic of China” as the standard for identifying obesity, the Screen for Anxiety-Related Emotional Disorders (SCARED) for assessing anxiety disorder, and the Children’s Self-Esteem Scale (CSES) for evaluating self-esteem. Statistical analysis, including descriptive statistics, Pearson correlation analysis, and multiple regression analyses was performed using SPSS version 26 to determine the predictive relationships between the variables. Results The analysis revealed that anxiety-related emotional disorders and self-esteem contribute significantly to the prediction of obesity among Chinese children, accounting for a 13.7% variance. The study highlights the critical roles of anxiety-related emotional disorders and self-esteem in determining children’s obesity. It suggests that underscores the necessity for comprehensive interventions that address both physical and mental health aspects to combat childhood obesity effectively. The study concludes that addressing anxiety and self-esteem is essential for developing effective strategies to reduce obesity rates among Chinese children, meeting the research objectives, and contributing to the development of holistic health programs for children’s well-being.

Background The use of mindfulness in the treatment of anxiety and depression is becoming more and more widespread, but there are few reports that it has fundamentally changed patients’ sense of life. Case Presentation This report showed 9 year’s progress of treatment for Social Anxiety Disorder and Persistent Depressive Disorder in a 41-year-old female patient experiencing a long-term painful married life with a reckless husband and controlling mother-in-law. During the past 25 months, she received 180 sessions of mindfulness training, resulting in complete remission of the anxiety and depression symptoms. After the 30th session she experienced an episode of the catharsis during the mindfulness training and experienced what can be called Mindfulness-To-Meaning, which is characterized by durable eudaimonic well-being in the face of adversity. Conclusions The psychological mechanisms that supported arriving at Mindfulness-To-Meaning are delineated as: Heightened (1) awareness which promoted (2) verbalization of the primary theme of suppression, in which the stress was (3) appraised metacognitively. Then (4) decentering permitted integrating this painful theme into a new adaptive self and world view, which resulted in (5) emotional catharsis, or release. Furthermore (6) positive appraisal of this experience enhanced awareness and led to the experience of (7) Mindfulness-To-Meaning.

Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised. The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA. The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores. This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity. • Investigated factors influencing Public Speaking Anxiety (PSA) in virtual scenarios • Mixed-effect model shows interaction of audience size, room dimensions, and engagement. • Identified three key factors: Large Audience Engagement, Evaluation Anxiety, and Audience Disengagement • Factors significantly predict PSA scores in diverse public speaking situations. • Introduced a new framework for standardising audience size relative to room capacity [ABSTRACT FROM AUTHOR]

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. 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. 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. The present study is cross-sectional, therefore unable to confirm causal interpretations. 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. • Parental behavior is of great relevance for SAD and can uncover its heterogeneity. • Based on recalled parental behavior cluster analysis can identify two subgroups of SAD. • Subgroups account for 50.7 % and 49.3 % of 505 individuals with SAD. • Less care and overcontrol characterize the clinically more severe subgroup. • Subgroups differ significantly in character dimensions according to the TCI. [ABSTRACT FROM AUTHOR]

Studies comparing the brain functions of major depressive disorder (MDD) and social anxiety disorder (SAD) at the regional and network levels remain scarce. This study aimed to elucidate their pathogenesis using neuroimaging techniques and explore biomarkers that can differentiate these disorders. Resting-state fMRI data were collected from 48 patients with MDD, 41 patients with SAD, and 82 healthy controls. Differences in the amplitude of low-frequency fluctuations (ALFF) among the three groups were examined to identify regions showing abnormal regional spontaneous activity. A seed-based functional connectivity (FC) analysis was conducted using ALFF results as seeds and different connections were identified between regions showing abnormal local spontaneous activity and other regions. The correlation between abnormal brain function and clinical symptoms was analyzed. Patients with MDD and SAD exhibited similar abnormal ALFF and FC in several brain regions; notably, FC between the right superior frontal gyrus (SFG) and the right posterior supramarginal gyrus (pSMG) in patients with SAD was negatively correlated with depressive symptoms. Furthermore, patients with MDD showed higher ALFF in the right SFG than HCs and those with SAD. Potential effects of medications, comorbidities, and data type could not be ignored. MDD and SAD showed common and distinct aberrant brain function patterns at the regional and network levels. At the regional level, we found that the ALFF in the right SFG was different between patients with MDD and those with SAD. At the network level, we did not find any differences between these disorders. [Display omitted] • Local brain activity and its connectivity during rest were compared in MDD and SAD. • MDD and SAD showed similar ALFF and rsFC in several brain regions. • In the right superior frontal gyrus, MDD had increased ALFF than SAD. • Different ALFF and rsFC were significantly correlated with clinical data. [ABSTRACT FROM AUTHOR]

Social anxiety disorder is a prevalent mental health condition that significantly impairs social interactions, academic performance, and professional functioning in children, adolescents, and youth. This study aimed to investigate the global prevalence of social anxiety disorder across these developmental stages. Six electronic databases (PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar) were systematically searched for studies related to the prevalence of social anxiety disorder in children, adolescents and youth. Random-effects models were employed for data analysis and Comprehensive Meta-Analysis Version 2.0. Heterogeneity was assessed using the I2 index. A total of 38 studies were included in the final analysis. The global prevalence of social anxiety disorder was estimated to be 4.7% in children, 8.3% in adolescents, and 17% in youth. These findings suggest a progressive increase in the prevalence of SAD across these developmental stages. Considering the prevalence of social anxiety disorder in this study, policymakers can use the findings of this study to inform and develop effective prevention strategies for individuals and communities most susceptible to this disorder. [ABSTRACT FROM AUTHOR]

The present study focused on the emotional experience of anger among individuals with and without social anxiety disorder (SAD). Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling measurement (ESM) in which they reported on daily social interactions and emotions. Using multilevel linear modeling we found that individuals with SAD experienced more anger compared to individuals without SAD. We also found a Diagnosis × Social Context interaction such that interactions with distant others were associated with elevated anger compared to interactions with close others for individuals with SAD but not for individuals without SAD. Finally, we found that for individuals with SAD (but not those without SAD) anger on a given day (day t) was associated with elevated anxiety on the following day (day t + 1), above and beyond previous anxiety, sadness and guilt (i.e. anxiety, sadness and guilt reported on day t). This suggests that anger may play a unique role in maintaining or exacerbating anxiety among individuals with SAD. Additional implications of our findings for models of psychopathology and for treatment of SAD are discussed. [ABSTRACT FROM AUTHOR]

Introduction: While abnormal responses to threat, including overgeneralization to conditioned fear, have been postulated to play a critical role in pathological anxiety, the relevance of previous findings to social anxiety disorder (SAD) is unclear. We investigated conditioned and generalized fear responses in patients with SAD using socially relevant stimuli. Methods: A total of 26 patients with SAD and 25 healthy controls participated in a fear conditioning and generalization paradigm consisting of two neutral faces as conditioned stimuli (CS+ or CS-) and an angry face with contemptuous comments as unconditioned stimuli. Eight morphed faces of two conditioned stimuli in each continuum were given to test generalization. Behavioral data and physiological responses were acquired. Results: Successful conditioning was observed in the risk ratings for both groups, while only a marginal indication of conditioning was noted in physiological measures. During the generalization phase, patients rated the risk higher than CS-when the stimuli close to CS- contained a portion of CS+ features. Larger skin conductance responses to this stimulus were linked to higher fear of negative evaluation. In addition, patients spent a longer time evaluating safe and ambiguous stimuli than healthy controls and exhibited consistently high levels of subjective arousal. Discussion: Taken together, our findings suggest that SAD patients may exhibit a tendency towards overgeneralization of fear responses and show distinct patterns in processing generalized threat stimuli compared to healthy controls. Even though overgeneralization was not evident in physiological measures, it is necessary to consider this behavioral characteristic in the clinical management of patients with SAD. [ABSTRACT FROM AUTHOR]

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) commonly cooccurs with social anxiety disorder (SAD). With changes to diagnostic criteria of psychiatric disorders in the DSM-5, the present study sought to observe the associations between daily alcohol use, AUD, and social anxiety in a large sample of individuals with lifetime (N = 1255) and past-year (N = 908) SAD. The sample was derived from a large nationally representative study of adults in the United States. Of note, we found that at the symptom level, daily alcohol use and AUD were significantly related to panic attacks due to social anxiety, subjective distress, and impairment in relationships. Daily alcohol use and AUD were significantly associated with lifetime SAD severity; however, only past-year daily alcohol use was significantly related to past-year SAD severity. We also found that AUD was significantly related to greater treatment-seeking for SAD, and both AUD and daily alcohol use were significantly associated with lifetime history of suicide attempts even after covarying for SAD severity. The present study provides an updated investigation of alcohol use in individuals with DSM-5 SAD, and it underscores the significance of daily alcohol use as an important factor to consider in individuals with SAD. • Social anxiety is highly comorbid with alcohol use; further investigation using DSM-5 criteria is necessary. • We examined AUD and daily alcohol use in lifetime and past-year samples of individuals with SAD. • Daily alcohol use and AUD were significantly associated with lifetime SAD severity. • Only daily alcohol use was associated with past-year SAD. • AUD was related to greater odds of treatment seeking and suicide attempt history. [ABSTRACT FROM AUTHOR]

Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1‐week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14–17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group‐based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974 [ABSTRACT FROM AUTHOR]

Social anxiety disorder is a highly complex, chronic, disabling, and costly anxiety disorder that requires effective treatment with empirical support. Emotion-focused therapy (EFT) shows great promise in effective treatment of social anxiety disorder. It is particularly suitable for the treatment of social anxiety disorder since pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in social anxiety disorder, are also primary therapeutic targets in EFT. Therefore, the present study aimed to review the new developments of emotion-oriented treatment for social anxiety disorder. In this systematic review study, a query was conducted on international and domestic databases from 2010 to 2024. To search, a combination of "emotionoriented therapy and social anxiety disorder," "emotion management and social anxiety disorder," "emotion regulation and social anxiety disorder," and "excitement and social anxiety" in both Farsi and English languages in Magiran, SID, IranDoc, Google Scholar, ScienceDirect, Springer, and PubMed databases were used. The search yielded 131 articles, of which 23 papers were included in the study according to the inclusion and exclusion criteria. The findings were analyzed in three areas: " emotion-focused therapy perspective on the etiology of social anxiety disorder," "change process in emotion-focused therapy for social anxiety and its relationship," and "effectiveness of emotion-focused therapy for social anxiety." As evidenced by the obtained results, EFT leads to corrective emotional experiences in social situations so that when people face social situations in which there is a possibility of being judged, they will not have unpleasant emotional experiences as before. Accordingly, they will have less negative thoughts and obtain more positive results from that event after facing a particular event. [ABSTRACT FROM AUTHOR]

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Social anxiety disorder (SAD), a highly prevalent and impairing psychological condition in adolescents, is characterized by persistent fear of social and performance situations. Existing evidence suggests that racism and discrimination may heighten risk for SAD and present barriers to treatment in Black youth. Yet, intervention research on SAD in Black adolescents is virtually nonexistent. This paper discusses the development of the first culturally responsive, school-based intervention for SAD in Black adolescents, referred to as Interacting and Changing our Narratives (ICON). Following recommendations by Castro et al. (Ann Rev Clin Psychol 6(1):213–239, 2010), a multiple stage process was used to adapt an empirically based, school intervention for SAD to be culturally responsive to the unique lived experiences of Black teenagers. Utilizing a university-community-school partnership, key stakeholders, including content area experts, school personnel, caregivers and students, were invited to participate in this process. Their recommendations guided the modifications, and were clearly reflected in the newly developed intervention. Initial piloting showed high acceptability and feasibility of ICON, and informed further revisions prior to a controlled trial. This adaptation process highlights the significant value of learning directly from the community for which an intervention is being developed. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Social Sciences (IJSS) / Uluslararasi Sosyal Bilimler Dergisi is the property of International Journal of Social Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and aims: Due to its nature, social anxiety can disturb the social adjustment of adolescents. The purpose of this study was to compare the effectiveness of cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) on the social adjustment of adolescents with social anxiety disorder. Methods: This research employed a quasi-experimental design with a pre-/post- test format alongside a control group. The statistical population consisted of male students diagnosed with social anxiety disorder in the second year of high school within the first district of Babol city during the 1401-1402 academic year. A total of 45 participants were selected from this population using purposeful sampling, ensuring they met the study's inclusion criteria. These participants were randomly assigned to three groups: 15 in the CBT group, 15 in the ACT group, and 15 in the control group. Data were collected using social adjustment questionnaire, and the analysis of covariance (ANCOVA) was utilized for data analysis. Results: The findings indicated that both CBT and ACT significantly improved social adjustment in adolescents with social anxiety disorder (p<0.001), with no significant difference in effectiveness between the two treatments. Conclusion: CBT and ACT, both can be recommended for enhancing social adjustment among adolescents with social anxiety disorder. [ABSTRACT FROM AUTHOR]

Background: Shame is an important emotion in social anxiety disorder (SAD). However, gender differences in shame, as well as the temporal relationship between shame and anxiety in SAD have not been examined. The present study aimed to address these gaps. Methods: Participants were 88 individuals (44 with SAD and 44 without SAD) who completed a 21-day experience sampling measurement (ESM). Specifically, participants reported on their emotions once a day at random times. Results: Hierarchical Linear Modeling indicated that individuals with SAD reported significantly more shame compared to individuals without SAD. In addition, women reported significantly more shame compared to men. Importantly, gender differences in shame were more pronounced among individuals with SAD compared to those without SAD. Finally, we found that for individuals without SAD, shame on a given day significantly predicted anxiety on the following day among men but not among women, whereas for individuals with SAD, shame on a given day significantly predicted anxiety on the following day among both men and women. Conclusions: Our findings suggest that shame may play a role in the maintenance of SAD. In addition, our findings suggest that social anxiety disorder may impact women's experience of shame more than men's. [ABSTRACT FROM AUTHOR]