Alyssa A. Rheingold

Social Skills Training Augments the Effectiveness of Cognitive Behavioral Group Therapy for Social Anxiety Disorder.

Cognitive Behavioral Group Therapy (CBGT) is the most widely researched intervention program for social anxiety disorder (SAD, also known as social phobia), with a number of studies demonstrating its effectiveness. Another common treatment, social skills training (SST), has also been shown to be efficacious for SAD. The present study compared the standard CBGT intervention with a protocol in which SST was integrated into CBGT. Participants met diagnostic criteria for the generalized subtype of SAD, and most also met criteria for avoidant personality disorder and other comorbid Axis I disorders. The results revealed improvement in a variety of outcome measures for both treatments, but significantly greater gains for the CBGT plus SST condition. In fact, the effect sizes obtained for this treatment were among the largest found to date in any study of SAD. Clinical implications are discussed, and directions for future research are suggested.

Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial

Early identification and treatment of social anxiety disorder (SAD) is critical to prevent development of a chronic course of symptoms, persistent functional impairment, and progressive psychiatric comorbidity. A small but growing literature supports the effectiveness of cognitive behavior therapy (CBT) for anxiety disorders, including SAD, in adolescence. The present randomized controlled trial evaluated the efficacy of group vs. individual CBT for adolescents with generalized SAD in relation to an educational/supportive psychotherapy that did not contain specific CBT elements. All three treatments were associated with significant reductions in symptoms and functional impairment, and in improved social skills. No differences between treatments emerged on measures of symptoms, but the CBT conditions demonstrated greater gains on behavioral measures. The implications of the findings are discussed.

Cognitive Bias in Adolescents with Social Anxiety Disorder

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed.

Losing a loved one to homicide: Prevalence and mental health correlates in a national sample of young adults

The present study examined the prevalence, demographic distribution, and mental health correlates of losing a loved one to homicide. A national sample of 1,753 young adults completed structured telephone interviews measuring violence exposure, mental health diagnoses, and loss of a family member or close friend to a drunk driving accident (vehicular homicide) or murder (criminal homicide). The prevalence of homicide survivorship was 15%. African Americans were more highly represented among criminal homicide survivors. Logistic regression analyses found that homicide survivors were at risk for past year posttraumatic stress disorder (OR = 1.88), major depressive episode (OR = 1.64), and drug abuse/dependence (OR = 1.77). These findings highlight the significant mental health needs of homicide survivors.

Predictors of fear of crime in older adults.

Very little is known about factors that predict fear of crime in older adults. Indeed, the topic itself remains a source of controversy, with early studies indicating higher levels of crime fear with age, and new, more methodologically rigorous studies demonstrating the opposite trend. The present exploratory investigation included 106 older adults and assessed the relationship between demographic variables, interpersonal violence, psychopathology, and fear of crime. In addition, this study built on previous research in that specific feared outcomes (e.g., hospitalization) were also considered. Initial findings indicate that being female, non-Caucasian, having depressive symptoms, and reporting social isolation are predictive of general fear of crime ratings. Different predictor sets were noted for fear of crime against person and fear of crime against property. Reported perceptions of negative crime outcomes were associated with being female, non-Caucasian, and having low income.

Loss, Trauma Exposure, and Mental Health in a Representative Sample of 12-17-Year-Old Youth: Data from the National Survey of Adolescents.

More than 2 million children and adolescents experience the death of a close relative each year. Additionally, a substantial number of adolescents experience the death of a friend. This study investigated various factors that may be associated with exposure to the death of a family member or friend, including gender, age, race, socioeconomic status, and mental health and substance use problems, in a nationally representative sample of 4,023 adolescents. Results indicated that adolescent girls, adolescents with lower household incomes, and African American adolescents were at increased risk of death of a family member within the past year. Death of a family member was not related to the report of mental health or substance use problems. Results also indicated that girls, older adolescents, adolescents with lower household incomes, and those of minority race/ethnicity (with the exception of Asian/Pacific Islanders) were at increased risk of death of a friend within the past year. Death of a friend was related to depression, posttraumatic stress disorder, and substance abuse/dependence. However, after controlling for demographics and victimization history, substance abuse/dependence was the only outcome variable that maintained a statistical association with death of a friend within the past year.

STANDARD VERSUS EXTENDED COGNITIVE BEHAVIOR THERAPY FOR SOCIAL ANXIETY DISORDER: A RANDOMIZED-CONTROLLED TRIAL

Although cognitive behavior therapy (CBT) has been shown to be generally effective in the treatment of social anxiety disorder (SAD), not all individuals respond to treatment, and among those who do respond the degree of improvement is sometimes far from optimal. Little research has examined the impact of variations in the format of treatment delivery in this area. Participants were randomly assigned to either a standard, 12-session CBT program for generalized SAD in which treatment was delivered in successive weekly sessions (standard treatment) or a similar program in which the 12 sessions were delivered over 18 weeks (extended treatment). Intent-to-treat analyses revealed that the standard treatment program resulted in superior outcome in terms of self-rated symptom and impairment levels, categorical ratings of responder status, and lower dropout rates. Analyses of treatment completers only revealed comparable gains between the two conditions by post-treatment. However, the standard treatment condition revealed a more rapid improvement in magnitude initially. These findings suggest no benefit from extending the course of CBT treatment over a greater length of time, and suggest that such extension may in fact substantially increase the likelihood of premature termination.

Current Psychopathology in Previously Assaulted Older Adults

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.

Prevention of Child Sexual Abuse: Evaluation of a Community Media Campaign

Given that mass media techniques have been an effective tool within the public health field for affecting behavioral change, these strategies may prove successful for the primary prevention of child sexual abuse (CSA). This study was an independent evaluation of a CSA media campaign. Two hundred parents were recruited from eight sites across the United States. Results indicated that the combined mass media campaign affected knowledge about CSA at the time of intervention compared to no intervention. No significant differences were found in regards to CSA attitudes. A significant positive impact on primary prevention response behaviors assessed using hypothetical vignettes was found; however, no significant findings were noted for several other behavioral responses. Knowledge and behavioral gains were not maintained at the one-month follow-up. Small sample size at follow-up may have affected findings. Results of this study imply that media campaigns alone may not significantly affect primary prevention of CSA.

Behavioral Activation and Therapeutic Exposure for Bereavement in Older Adults

The development and clinical trial of a 5-session behavioral intervention for complicated bereavement (CB) is presented. We conceptualized CB in terms of Major Depression (MDD) and Post-traumatic Stress Disorder (PTSD) and consequently applied treatment components of Behavioral Activation and Therapeutic Exposure (BA-TE). In order to assure standardization of treatment, control costs, and engage patients, a multi-media, multi-context format was adopted to address avoidance and withdrawal behaviors conceptualized as central pathogenic responses in CB. Participants (N = 26) were assessed before and after BA-TE treatment via structured clinical interview and standardized questionnaires in terms of PTSD, MDD, CB, and health concerns. The number of days since the death of the loved one was widely variable and served as a covariate for all outcome analyses. ANCOVAS revealed statistically significant improvement, irrespective of how many days since death had elapsed prior to initiation of intervention, on structured interviews and self-report measures for most outcome variables.