How CBT can change your brain waves

A lot of coverage of science concentrates on how what goes on in the brain affects the way we feel and think but the relationship can, of course, work both ways with treatments and good and bad events in people's lives having an effect on what happens between our ears. Researchers from McMaster University in Hamilton, Ontario looked into this in a study of 25 people who were having psychotherapy for social anxiety. The participants had 12 once-a-week sessions of cognitive behaviour therapy and were compared to two control groups; one control group had very high social anxiety, one very low social anxiety and neither group received any psychotherapy. The participants had a series of electroencephalograms (EEGs) and the researchers measured their levels of delta-beta-coupling (DBC) which is associated with anxiety. Before treatment the participants DBC levels were similar to the high-anxiety control group and much higher than the low-anxiety one. However, as their treatment went on their DBC levels fell, matching the improvement recorded both by themselves and their doctors. Once they had finished their psychotherapy the participants' DBC levels were similar to those of the low-anxiety group.

Mums, dads and social anxiety

Social anxiety disorder can lead to depression and anxiety and can impede people's functioning in jobs and relationships. It is often thought to run in families but the genetic risk is modest suggesting that parenting and environment play a part too. Researchers know very little about how upbringing affects children's chances of developing anxiety disorder but some researchers think that the way in which children interpret what is going on around them and the influence their parents have on this could play a part. A team of researchers from the University of Amsterdam in the Netherlands looked into this issue further in a study of 144 children aged between eight and 12. The children were presented with a series of ambiguous social scenarios in which either the father or the mother acted anxiously or confidently. In children who were highly socially-anxious the father's behaviour had a greater influence on their levels of confidence or anxiety but for children who had average or low levels of social anxiety the mother's role was more important. The results suggest that fathers could have an important role to play in boosting the confidence of socially-anxious children.

Bogels, Susan, Stevens, Juliette and Majdandzic, Mirjana - Parenting and social anxiety: fathers’ versus

mothers’ influence on their children’s anxiety in ambiguous social situations Journal of Child Psychology and Psychiatry doi:10.1111/j.1469-7610.2010.02345.x

Weekend course tackles fear of blushing

One of the symptoms of social anxiety can be a fear of blushing. A fear of blushing develops when people feel self-conscious, this makes them blush and feel even more self-conscious leading to a vicious circle developing. Researchers from Dresden Technical University used a weekend course of 'task concentration training' to help people suffering from a fear of blushing. Through reading stories, role-playing and watching themselves on video the participants practiced turning their focus away from themselves and to the task in hand - either the words of a conversational partner or the reading of a story. The participants were also given advice on how to practice re-directing their attention over the next six weeks, first in non-threatening situations and then in more difficult ones. At the end of the weekend 37% of the participants showed clinically significant improvement in their fear of blushing and at a six-month follow-up this had risen to 56%.

You can find out more about this research at

http://bps-research-digest.blogspot.com/2010/05/can-fear-of-blushing-be-cured-in.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+BpsResearchDigest+%28BPS+Research+Digest%29&utm_content=Google+Reader

Atomoxetine and social anxiety

It is thought that 12% of people will suffer from social phobia at some point during their lives. Social anxiety disorder can be remarkably debilitating and result in serious functional impairment. The usual method of treating it is with selective serotonin reuptake inhibitors (SSRIs) which increase the amount of serotonin available in the brain. Substances called noradrenergic reuptake inhibitors which have a similar effect on a substance called noradrenalin have shown promise at treating social anxiety in a number of studies and a team of researchers from the University of California, San Diego looked at the effectiveness of the drug atomoxetine which has the same effect - although it is usually used to treat Attention Deficit Hyperactivity Disorder (ADHD). In a study of 27 people with social anxiety disorder - half of whom received atomoxetine and half of whom received a placebo - there was little difference in symptoms between the two group.

Ravindran, Lakshmi N. ... [et al] - A randomized controlled trial of atomoxetine in generalized social anxiety disorder Journal of Clinical Psychopharmacology December 2009, 29(6), 561-564

Why it hurts some people more than others to be left out

A gene called OPRM1 governs the production of the body's natural pain-killers, mu-opioid receptors. People with a rare variation of this gene are more sensitive to pain and researchers at the University of California, Los Angeles have found that they may be more sensitive to social rejection as well. The researchers collected saliva samples from 122 volunteers to see which variation of the gene they had. They then gave them a questionnaire to measure their sensitivity to social rejection. Finally the participants took part in a computer game with other people which - unbeknown to them - was deliberately designed to exclude them. As they were experiencing this exclusion their brains were scanned to see which areas were most active. The study found that people with the 'sensitive' variant of OPRM1 were also more sensitive to social rejection and showed greater activity in their dorsal anterior cingulate cortex and anterior insula in response to social exclusion.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/08/090817142859.htm

Social phobia and paranoia

Although social phobia and paranoia are considered to be separate conditions they do share similarities, both in terms of psychology and behaviour. Both groups of patients think that they are the object of other people's interest and that they are being judged by others. They scan their environment for socially-threatening information and both groups conclude that people are talking about them. A team of Dutch researchers looked into the links between the two conditions in a sample of 7,076 people. They were assessed for social phobia and paranoia at the start of the study, and one, and three years later. The study found that social phobia and paranoia were associated. People with paranoia were four times as likely to develop social phobia and the more paranoid people were the more social phobia symptoms they developed. However social phobia did not seem to lead on to people becoming paranoid.

Rietdijk, J. ... [et al] - Are social phobia and paranoia related, and which comes first? Psychosis February 2009, 1(1), 29-38

Social anxiety and social rejection

An important feature of social anxiety disorder (SAD) is the fear of being negatively evaluated in social situations. Cognitive therapy works by disputing the idea that people with social anxiety are being evaluated negatively but there is growing evidence that socially-anxious people do bring out negative reactions in others. They have been judged by independent raters as less likeable and less comfortable to be around, less friendly, assertive, relaxed and attractive, moodier, more sensitive to demands, more self-pitying and lacking meaning in life. So why do socially anxious people - who are usually desperate to be liked - come across so negatively? It is thought that some of the strategies used by socially-anxious people, such as avoiding eye contact so as not to see others' negative reactions; giving short answers to questions so as not to say anything foolish, or giving long answers so as not to appear boring can backfire leading to socially-anxious people being perceived as socially-inept. There is also the theory that the negativity felt by socially-anxious people might rub off on those they socialize with. It has also been found that socially-anxious people are felt to be somehow less like the people they talk to; something important as people tend to prefer those they see as being similar to themselves. Researchers from the University of Maastricht in the Netherlands studied 90 people; 63 of whom had SAD. The participants were monitored as they held a five-minute getting-to-know-you conversation with another person who was also part of the research team and who rated their social performance. The conversations were videoed and shown to other people who rated their own negative emotions towards the participants, how similar they felt to them and how much they would want to meet them again. The results confirmed the theory that the people with social anxiety were more likely to be rejected, evoked significantly more negative emotions and received lower social-performance ratings. The negative emotions created by the people with social anxiety had a stronger effect on whether people thought they were similar to them or not than their social behaviour. A lower feeling of similarity and higher negative emotions on the part of the observers were in turn associated with social rejection of the people with social anxiety.

Voncken, Marisol J. ... [et al] - Social rejection in social anxiety disorder: the role of performance deficits, evoked negative emotions and dissimilarity British Journal of Clinical Psychology November 2008, 47(4), 439-450

Social phobia: when even happy faces are frightening

People with social phobia fear and avoid engaging others in social interaction. Their social phobia is based on an expectation that they will be evaluated negatively and rejected socially. Social phobia, or social anxiety disorder, is one of the most common mental-health problems and people with social phobia suffer from interpersonal problems and a lower quality of life. One of the problems people with social phobia have is that while they may be as good at getting on with other people as everybody else they tend to interpret other people's reactions in a more negative fashion. Researchers at the University of Manitoba, in Canada, showed 40 people (12 of whom had social phobia) a series of 24 faces on a computer. Some faces were happy, while others showed disgust and anger. The participants were asked to rate the approachability of each of the faces. All the participants rated the disgusted and angry faces as less approachable but the participants with social phobia rated the happy faces as less approachable than the other participants did. Within the group of people with social phobia the less approachable they thought the happy faces were the more severe their symptoms were.

Campbell, D.W. ... [et al] - Happy but not so approachable: the social judgments of individuals with generalized social phobia Depression and Anxiety May 2009, 26(5), 419-424

Atomoxetine, ADHD and anxiety

Attention-deficit hyperactivity disorder (ADHD) is estimated to affect 4.4% of adults in the U.S. Adults with ADHD have more problems with work, family relationships and social interaction, are more likely to smoke and use drugs, and have a significantly lower quality of life. One study found that 29.3% of adults with ADHD also have social anxiety disorder making it the most common anxiety disorder in people with ADHD. The treatment of ADHD often involves stimulants such as Ritalin, but it is unclear how this would affect people who also have social anxiety disorder. Atomoxetine has been found to be effective in adults with ADHD, adults with ADHD and alcohol problems, and children and adolescents with ADHD and anxiety disorders. A team of researchers in the U.S. studied the effectiveness of atomoxetine for adults with ADHD and social anxiety in a study of 442 people. They found that, compared to a placebo, atomoxetine effectively improved the symptoms of both ADHD and social anxiety and was well tolerated by the participants.

Adler, Lenard A. ... [et al] - Atomoxetine treatment in adults with attention-deficit hyperactivity disorder and comorbid social anxiety disorder Depression and anxiety March 2009, 26(3), 212-221

Video feedback for social anxiety

Social phobia is a common distressing condition that is thought to affect over 12% of the population. It often lasts for a long time and can have substantial negative consequences. Social phobia often starts in early adolescence and therapy for it often concentrates on boosting teenagers' social skills. However, recent research has suggested that people with social phobia may have social skills that are just as good as other people's and that the problem lies more with their perception of themselves. It is thought that people with social phobia pay more attention to their symptoms of anxiety and any negative feedback they receive from other people and miss out on more positive signs. A study of 36 adolescents with social phobia by researchers at the University of Manchester looked into the use of video feedback to help teenagers with social phobia. The children were asked to give two speeches to a camera and were asked to rate how anxious they were before making each speech, how well they thought they would perform and how well they had performed. Participants in the video feedback group were shown a video of themselves speaking after their first speech when it was pointed out to them that they did not look nearly as nervous, and had performed much better, than they thought they had. The other participants, in the control group, were simply asked to wait for ten minutes. Those participants who had received video feedback gave a much more positive appraisal of their first speech than the other group, predicted that they would do much better in the second speech and felt less anxiety. Independent observers, who did not know which of the youngsters had received video feedback, found no difference in performance between the two groups.

Parr, Clare J. and Cartwright-Hatton, Sam - Social anxiety in adolescents: the effect of video feedback on anxiety and the self-evaluation of performance Clinical Psychology and Psychotherapy January-February 2009, 16(1), 46-54

Infertility and mental health

A study comparing the mental health of fertile and infertile couples has found that couples who are infertile are more at risk of mental-health problems. The study, by researchers at the University of Siena, compared 81 infertile couples with 70 fertile ones. The infertile women were more likely to suffer from depression and anxiety and also from binge-eating disorder. Infertile men were more likely to show minor symptoms of obsessive-compulsive disorder and social phobia.

You can read more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE5013FX20090102?feedType=RSS&feedName=healthNews

Social anxiety and alcohol problems

Social anxiety disorder is associated with high rates of alcohol problems. People with social anxiety (SA) are nearly three times as likely to develop problems with alcohol and among people seeking treatment for alcohol problems 23-39% meet the diagnostic criteria for social anxiety disorder. A study of 5,877 people by researchers at the University of Michigan found that SA was related to alcohol dependence even after allowing for a number of other factors. People with social anxiety who were also alcoholics had a higher usage of health care, other mental-health problems and greater interpersonal stress than other people with SA. For the majority of people their social anxiety came before their alcohol problems, suggesting that SA increases people's vulnerability to alcohol problems.

Buckner, Julia D. ... [et al] - Implications of comorbid alcohol dependence among individuals with social anxiety disorder Depression and Anxiety December 2008, 25(12), 1028-1037

MRIs and social phobia

MRI scans are increasingly allowing researchers to look into the links between what, physically, goes on in people's brains and how they respond to stimuli and mental-health problems. Researchers from the U.S. National Institute of Mental Health used MRI technology to investigate social phobia. Social phobia is the most common anxiety disorder in the general population and is marked by a person fearing and avoiding social situations and fearing negative judgements by others. Those with the disorder run a greater risk of depression, drug and alcohol problems and suicide attempts. The researchers found that people with social phobia experienced greater blood flow in their amygdala and prefrontal cortex - areas of the brain linked to awareness of oneself, fear, emotion and stress - when they read negative comments about themselves. However, when they read negative comments about others, or neutral or positive comments about themselves or others, there was no change in blood flow in these parts of the brain.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113753&cn=1

Social phobia in childhood

A large body of research in adults indicates that social phobia is linked to social, educational and occupational functional impairment as well as depression, drug abuse and suicide attempts. Among children and adolescents estimates of the rate of social phobia range from 0.3% to 5.4%. However, only a small number of studies have looked at the characteristics of social phobia in children and this research has been limited to clinical samples. A U.S. study of 101 children compared 45 children with social phobia to 56 children who were anxious but who did not have social phobia. The children with social phobia feared and avoided a significantly greater number of social situations. They were more likely to have trouble making friends and to prefer being alone to being with other children. All the children with social phobia also met the criteria for at least one other mental-health problem. Greater severity of social phobia was significantly associated with poorer social skills, poorer leadership skills, greater attention difficulties and greater learning problems in the classroom.

Bernstein, Gail A. ... [et al] - Symptom presentation and classroom functioning in a nonclinical sample of children with social phobia Depression and Anxiety 65(9), 752-760

SSRIs for social anxiety

Social anxiety disorder has been defined as anxiety owing to a marked and persistent fear of one or more social of performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. A 1994 study found social anxiety disorder to be the third most common of psychiatric disorders behind depression and alcoholism. A more recent survey found that 6.8% of people suffered from it in any one year with 12.1% of people suffering from it over the course of their lifetime. Symptoms typically begin in the mid-teens and are more common among women than men. Current treatments for social anxiety disorder involve drugs and psychotherapy. A review of studies into the effectiveness of serotonin specific reuptake inhibitors (SSRIs) in treating social anxiety disorder found that they were all more effective than a placebo. The study found that the drugs did not differ in their effectiveness although they all had different side effects and it concluded 'overall, a fair amount of evidence supports the efficacy of escitalopram, fluvoxamine, paroxetine, sertraline and venlafaxine in [treating] social anxiety disorder'.

Hansen, Richard A. ... [et al] - Efficacy and tolerability of second-generation antidepressants in social anxiety disorder International Clinical Psychopharmacology May 2008, 23(3), 170-179

Social anxiety in adolescence - what are the risk factors?

A U.S. study of 770 adolescents looked into the risk factors for the development of social anxiety disorder in this group. They found that social anxiety disorder remained constant over time. Childhood negative effect, shyness and chronic illness during childhood were all associated with adolescent social anxiety. Childhood shyness was more likely to turn into social anxiety disorder in girls than in boys. Childhood shyness and childhood chronic illness combined had a much stronger impact on the risk of adolescent social anxiety disorder than their individual effects.

Hayward, Chris ... [et al] - The developmental psychopathology of social anxiety in adolescents Depression and Anxiety, 2008, 25(3), 200-206

Social anxiety disorder in childhood

Social anxiety disorder (SAD) is characterized by a marked and persistent fear of one or more situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The feared situations are avoided or are endured with intense anxiety or distress. In children the most feared social situations usually include those where the child is expected to speak (e.g. talking to peers, reading aloud in class, joining in a conversation) but also other situations such as musical or athletic performances. However, it is unclear whether children with SAD have a distorted perception of their own abilities or whether they do actually have worse social skills than other children. A Norwegian study of 150 children compared those with social anxiety to those with ADHD and a healthy control group. The researchers found that those children with SAD did have a lower verbal IQ and worse motor skills than other children.

Kristensen, Hanne and Torgessen, Svenn - Is social anxiety disorder in childhood associated with developmental deficit/delay? European Child and Adolescent Psychiatry March 2008, 17(2), 63-72

Social anxiety and insomnia

Anxiety is commonly associated with insomnia. Social anxiety disorder is one of the most common forms of anxiety and a U.S. study of 176 college students looked into the links between social anxiety and insomnia. The researchers found that social anxiety was associated with increased insomnia symptoms, sleep dissatisfaction, sleep-related functional impairment, perception of a sleep problem to others and distress about sleep problems. The relationship between social anxiety and insomnia was mediated (influenced) by depressive symptoms which were thought to play an important role in the link between social anxiety and poor-quality sleep.

Buckner, Julia D. ... [et al] - Social anxiety and insomnia : the mediating role of depressive symptoms Depression and Anxiety 2008, 25(2), 124-130

Feet in mouth on constant replay - post-event processing and social anxiety disorder

People with social anxiety disorder often conduct lengthy post-mortems after social events going over and over what they said and did wrong and castigating themselves for often imaginary faux pas mercilessly. Psychologists call this process post-event processing, or PEP for short. This reinforces people's negative beliefs about their social performance and distracts from any positive aspects of their social lives. A study of 125 people in Canada looked at 75 people attending a group therapy session for social anxiety and 50 people experiencing exposure therapy for the condition. Significant PEP occured after both events and the more anxious people were before both tasks the worse their PEP. The levels of PEP were about the same after both events and the participants' PEP was found to be specifically related to their social performance rather than being a general negative train of thought about life as a whole.

Kocovski, Nancy L. and Rector, Neil A. - Post-event processing in social anxiety disorder: idiosyncratic priming in the course of CBT Cognitive Therapy and Research February 2008, 32(1), 23-36

Psychological interventions for social phobia

Social phobia is characterized by a marked and persistent fear of social or performance situations in which the person may be scrutinized by others and fears coming across in a way that would be embarrassing or humiliating. It is a chronic disorder that usually begins in early adolescence and results in considerable impairment that increases over an individual's lifespan. A lifetime prevalence ranging from 3-13% has been reported by epidemiological and community studies. A review of 30 studies into psychological interventions for social phobia has found that cognitive behaviour therapy (CBT) involving cognitive restructuring and exposure to feared or avoided social situations or behavioural experiments is an "efficacious and specific treatment for social phobia". Exposure therapy was also found to be effective. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure with some studies reporting that the interventions were equivalent while others found that CBT produced better outcomes. There was little evidence to support the use of social-skills training.

Ponniah, K. and Hollon, S. D. - Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials Psychological Medicine January 2008, 38(1), 3-14