Karen Rowa

Refining and validating the Social Interaction Anxiety Scale and the Social Phobia Scale.

Background: The Social Interaction Anxiety Scale and Social Phobia Scale 6 are companion measures for assessing symptoms of social anxiety and social phobia. The scales have good reliability and validity across several samples, 3 , 6 however, exploratory and confirmatory factor analyses have yielded solutions comprising substantially different item content and factor structures. These discrepancies are likely the result of analyzing items from each scale separately or simultaneously. The current investigation sets out to assess items from those scales, both simultaneously and separately, using exploratory and confirmatory factor analyses in an effort to resolve the factor structure. Methods: Participants consisted of a clinical sample (n5353; 54% women) and an undergraduate sample (n5317; 75% women) who completed the Social Interaction Anxiety Scale and Social Phobia Scale, along with additional fear‐related measures to assess convergent and discriminant validity. Results: A three‐factor solution with a reduced set of items was found to be most stable, irrespective of whether the items from each scale are assessed together or separately. Items from the Social Interaction Anxiety Scale represented one factor, whereas items from the Social Phobia Scale represented two other factors. Conclusion: Initial support for scale and factor validity, along with implications and recommendations for future research, is provided. Depression and Anxiety, 2009.

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. METHODS Participants included 86 individuals with a principal diagnosis of obsessive-compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. RESULTS The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. CONCLUSIONS The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.

Psychological Treatments for Social Phobia

Objective: To review the empirical status of psychological treatments for social phobia (SP), commenting both on cognitive-behavioural interventions and on more recent iterations of those approaches. We also review the effective components of cognitive-behavioural therapy (CBT). Method: We qualitatively reviewed the empirical literature on the psychological treatment of SP. We include empirical studies, metaanalyses, and recent conference presentations in this review. Results: Cognitive and behavioural interventions for SP appear to be more effective than wait-list controls and supportive therapy. Comparisons of CBT and pharmacologic treatment have produced inconsistent results. Several new treatments for SP demonstrate promising results. Conclusion: Evidence suggests that various psychosocial treatments for SP are better than wait-list controls and credible placebo interventions. Ongoing projects investigate the relative efficacy of combining medication and psychosocial treatments over monotherapies; this line of research is important to continue. Further research should also focus on which components of CBT are most effective.

Evidence-based assessment of anxiety disorders in adults.

This article discusses issues related to the development and dissemination of evidence-based assessment strategies for anxiety disorders and associated problems. It begins with a review of the criteria that should be considered when determining whether particular assessment procedures are evidence-based. These include such factors as reliability, validity, cost-effectiveness, consumer acceptability, utility across different populations, and ease of dissemination. The importance of considering the purpose of the assessment process when deciding whether a procedure is evidence-based is emphasized. Next, the major assessment domains that are particularly important in the area of anxiety disorders (e.g., triggers for anxiety symptoms, avoidance behaviors) are reviewed. Finally, some potential obstacles to the dissemination of evidence-based assessment procedures are discussed along with suggestions for managing these obstacles.

In the absence of rose-colored glasses: Ratings of self-attributes and their differential certainty and importance across multiple dimensions in social phobia

Sixty-seven individuals with social phobia (social anxiety disorder) and 60 healthy controls rated their perceived standing relative to others on 13 self-attribute dimensions, their level of certainty concerning those standings, and the importance of each dimension. As expected, individuals with social phobia provided self-ratings that were significantly more negative than controls across all dimensions. In addition, positive self-views were equated with higher levels of certainty and importance for controls, but not for individuals with social phobia. Thus, whereas reports of control participants reflected a healthy, positive framing of self-views, the ratings of clinical participants demonstrated an orientation toward self-framing that was neither positive nor negative. Together, these novel findings shed light on the nature of self-appraisals in social anxiety. Implications of these results are discussed in terms of contemporary cognitive-behavioral models of social phobia.

Social comparison processes in social phobia

This study used diaries to investigate social comparison processes in 59 individuals with social phobia (SP) and 58 nonclinical controls. Although groups did not differ on the total number of comparisons made during the 2-week study period, those with SP made significantly more upward comparisons (i.e., comparisons where the individual assesses him- or herself as not measuring up to others) and significantly fewer downward comparisons (i.e., comparisons where the individual assesses him- or herself as superior to others) relative to controls. SP was also associated with comparisons on a greater number of dimensions or attributes and more comparisons on particular dimensions. Those in the SP group tended to experience greater changes in affect following social comparisons than those in the comparison group. For example, upward comparisons tended to lead to increased anxiety and depression, particularly for the socially anxious participants. Implications for these findings are discussed.

SPINning factors: Factor analytic evaluation of the Social Phobia Inventory in clinical and nonclinical undergraduate samples

The Social Phobia Inventory (SPIN) was designed to assess three dimensions of social anxiety (i.e., fear, avoidance, and physiological arousal) as posited by the scale authors (Connor et al., 2000). Despite expectations of a 3-factor solution, analyses of the SPIN to date have provided support for 3- and 5-factor solutions (Radomsky et al., 2006). Moreover, a 3-item version, the Mini-SPIN (Connor et al., 2001), has good sensitivity and specificity for generalized social anxiety disorder (SAD), implying some item redundancy. Another recent psychometric analysis of the SPIN was performed in a diagnostically diverse clinical sample (Antony et al., 2006); however, the study did not include a comprehensive evaluation of the factor structure. The current study was designed to comprehensively assess the SPIN factor structure using exploratory (EFA) and confirmatory (CFA) factor analyses in undergraduate (N=227) and clinical samples (N=355) using current recommendations for factor analyses (Osborne et al., 2008). Results suggest a 10-item 3-factor solution may be an ideal fit for clinical samples; however, using the undergraduate sample, the same solution was significantly better than precedent solutions but nonetheless not ideal. Implications and recommendations for future research are discussed.

Development of a Measure of Egodystonicity

The term egodystonicity is a distinguishing feature of obsessional thoughts (American Psychiatric Association, 2000) but has not been consistently nor comprehensively defined. These two studies present the development and initial validation of the Ego-Dystonicity Questionnaire (EDQ). A definition of the term egodystonicity was developed, drawing from existing definitions and theoretical models of obsessive-compulsive disorder (OCD). An item pool was developed and refined through initial testing, the product of which was a 37-item self-report measure. Respondents identify a specific type of thought (e.g., their most upsetting obsession, most upsetting worry) and then answer each item with respect to that thought. In study 1, two nonclinical samples (N = 278) and one sample of individuals with OCD (N = 17) were administered the EDQ along with self-report measures of mood, personality, OCD symptoms, and appraisal of obsessional thoughts. A principal components analysis of the nonclinical sample yielded four factors. Scales based on these factors had acceptable internal reliability. The EDQ distinguished between obsessional thoughts and common worries, and individuals in the clinical sample had higher scores than the nonclinical sample. The EDQ showed low to moderate correlations with OCD symptoms, mood, and appraisal of obsessions but was not associated with personality traits such as neuroticism. In study 2, individuals with OCD (N = 28) completed the EDQ in reference to their most or least upsetting obsession. As predicted, egodystonicity varied according to obsession type. These data indicate that the EDQ is a valid measure with potential for use in understanding and treating obsessional problems.

Diary Records of Thought Suppression by Individuals with Obsessive-Compulsive Disorder

Impairment in mental control is a primary complaint of many sufferers of obsessive-compulsive disorder (OCD). Most OCD sufferers work very hard to rid themselves of their obsessions, to little avail. Although active resistance is a defining feature of obsessions, it is typically not assessed in measures of OCD severity and little is known about the frequency of attempts at thought control or its impact on functioning while control strategies are engaged. In the present study, 37 individuals diagnosed with OCD kept a diary of their suppression attempts over a 3-day period, recording the circumstances under which the attempt at suppression occurred, the suppression strategy used, its outcome, and its impact on concentration, mood, peace of mind, and ability to proceed with planned activities. Results indicated that individuals with OCD engage in frequent, strenuous, time-consuming and ultimately unsuccessful attempts to control thoughts. Suppression was used as a means of avoiding the hassles associated with experiencing an obsession and with performing a compulsive ritual. Consistent with other research, suppression was also used as a means of neutralizing harm potentiated by the obsession. These findings suggest that thought suppression efforts and their impact may contribute significantly to the severity of impairment associated with OCD, and that it might be useful for clinical and research purposes to evaluate suppression as a severity indicator.

Emotional distress tolerance across anxiety disorders.

Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n=674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.