Leah M. Adams

Distinguishing Healthy Adults From People With Social Anxiety Disorder: Evidence for the Value of Experiential Avoidance and Positive Emotions in Everyday Social Interactions

Despite the increased attention that researchers have paid to social anxiety disorder (SAD), compared with other anxiety and mood disorders, relatively little is known about the emotional and social factors that distinguish individuals who meet diagnostic criteria from those who do not. In this study, participants with and without a diagnosis of SAD (generalized subtype) described their daily face-to-face social interactions for 2 weeks using handheld computers. We hypothesized that, compared with healthy controls, individuals diagnosed with SAD would experience fewer positive emotions, rely more on experiential avoidance (of anxiety), and have greater self-control depletion (feeling mentally and physically exhausted after socializing), after accounting for social anxiety, negative emotions, and feelings of belonging during social interactions. We found that compared with healthy controls, individuals with SAD experienced weaker positive emotions and greater experiential avoidance, but there were no differences in self-control depletion between groups. Moreover, the differences we found could not be attributed to comorbid anxiety or depressive disorders. Our results suggest that negative emotions alone do not fully distinguish normal from pathological social anxiety, and that assessing social anxiety disorder should include impairments in positive emotional experiences and dysfunctional emotion regulation (in the form of experiential avoidance) in social situations.

Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: a daily process approach.

Diminished positive experiences and events might be part of the phenomenology of social anxiety; however, much of this research is cross-sectional by design, limiting our understanding of the everyday lives of socially anxious people. Sexuality is a primary source of positive experiences. We theorized that people with elevated social anxiety would have relatively less satisfying sexual experiences compared to those who were not anxious. For 21 days, 150 college students described their daily sexual episodes. Social anxiety was negatively related to the pleasure and feelings of connectedness experienced when sexually intimate. The relationship between social anxiety and the amount of sexual contact differed between men and women-it was negative for women and negligible for men. Being in a close, intimate relationship enhanced the feelings of connectedness during sexual episodes for only individuals low in social anxiety. Depressive symptoms were negatively related to the amount of sexual contact, and the pleasure and feelings of connectedness experienced when sexually intimate. Controlling for depressive symptoms did not meaningfully change the social anxiety effects on daily sexuality. Our findings suggest that fulfilling sexual activity is often compromised by social anxiety.

HIV Risk Behaviors of Male and Female Jail Inmates Prior to Incarceration and One Year Post-Release

Individuals cycling in and out of the criminal justice system are at high risk for contracting HIV/AIDS. Most infections are contracted in the community, not during incarceration, but little is known about the profile of risk behaviors responsible for this elevated infection rate. This study investigated pre-incarceration and post-release HIV risk behaviors in a longitudinal study of 542 male and female inmates in a Northern Virginia jail. Although there was a significant decrease in risky behavior from pre-incarceration to post-incarceration, participants reported high levels of unprotected sexual activity and risky IV drug behaviors at both time points, emphasizing the need for prevention programming among this at-risk population. Gender differences in participants’ pre-incarceration and post-release HIV risk behaviors suggest the need for gender-specific interventions to reduce overall HIV risk. Identifying specific HIV risk behaviors of jail inmates is vital to improve treatment and intervention efforts inside and outside of correctional settings.ResumenLos personas que pasan por el sistema de justicia penal están en alto riesgo de contraer el VIH/SIDA. La mayoría de las infecciones se contraen en la comunidad, no durante el encarcelamiento, pero se sabe poco sobre el perfil de riesgo responsable de esta elevada tasa de infección. Esta investigación examinó el compartamiento de riesgo de VIH antes y después del-encarcelamiento en un estudio longitudinal de 542 internos e internas en una cárcel ubicada en el norte de Virginia. Aunque hubo una disminución significativa en las conductas de riesgo desde antes de la cárcel hasta después de la encarcelación, los participantes reportaron altos niveles de actividad sexual sin protección y de riesgo del consumo de drogas IV en ambos momentos, mostrando la necesidad de programas de prevención en esta población en riesgo. Diferencias de género en las conductas de riesgo de los participantes antes de la encarcelación y posterior a la liberación sugieren la necesidad de intervenciones específicas de género para reducir el riesgo de VIH en general. La identificación de determinados comportamientos de riesgo de VIH de los reclusos de la cárcel es de vital importancia para mejorar los esfuerzos de de tratamiento y la intervención dentro y fuera de los establecimientos penitenciarios.

Failure to capitalize on sharing good news with romantic partners: Exploring positivity deficits of socially anxious people with self-reports, partner-reports, and behavioral observations

Extending prior work on social anxiety and positivity deficits, we examined whether individual differences in social anxiety alter the ability to share and respond to the good news of romantic partners (i.e., capitalization support) and how this influences romantic relationship satisfaction and commitment. In this study of 174 heterosexual couples (average age of 21.5 with 58.3% identifying as Caucasian), greater social anxiety was associated with the provision and receipt of less supportive responses to shared positive events as measured by trait questionnaires, partner reports, and behavioral observations in the laboratory. In longitudinal analyses, individuals in romantic relationships with socially anxious partners who experienced inadequate capitalization support were more likely to terminate their relationship and report a decline in relationship quality six months later. As evidence of construct specificity, social anxiety effects were independent of depressive symptoms. Taken together, social anxiety influenced a persons ability to receive and provide support for shared positive events; these deficits had adverse romantic consequences. Researchers and clinicians may better understand social anxiety by exploring a wider range of interpersonal contexts and positive constructs. The addition of capitalization support to the social anxiety literature offers new insights into interpersonal approaches and treatments.

Can a one-hour session of exposure treatment modulate startle response and reduce spider fears?

Preliminary evidence suggests that 3 hours of behavior therapy can reduce fear responses to phobic stimuli. Most of this research, however, has relied on self-reports and clinician assessments, and failed to include a comparison group. To extend this literature, with 32 adults with spider phobia, we investigated the effects of a single hour of in vivo exposure on subjective and electrophysiological aspects of fear; comparisons were made to a wait-list control group. Pre- and post-assessments included phobia-relevant questionnaires and startle reflex responses to spider, negative, neutral and positive stimuli. Compared to the control group, our one-hour treatment reduced self-reported and physiological responses to spider stimuli. These data provide preliminary support for the ability of affective startle modulation to be changed by very brief exposure therapy.

Parents and friendships: A longitudinal examination of interpersonal mediators of the relationship between child maltreatment and suicidal ideation

This study examined parental relationship quality, friendship quality, and depression as mediators of the association between child maltreatment (CM) and adolescent suicidal ideation (SI). Participants were 674 adolescents (46% female; 55% African American) involved in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Data were collected via youth self-report at ages 12, 16, and 18. CM before age 12 predicted poor parental relationships and depression, but not poor friendships, at age 16. Age 16 depression was negatively associated with parental relationship quality and positively associated with SI at age 18. An indirect path from CM to SI via depression was significant, suggesting that the early CM affects depression severity, which in turn is associated with SI. Strong friendship quality (age 16) was associated with SI at age 18; however, there was no significant indirect path from CM to SI via friendships. Results suggest that: 1) CM before age 12 affects parental relationships in adolescence; 2) depression and friendships are related to suicide ideation in later adolescence; and 3) depression partially mediates the association between CM and SI. Results highlight the importance of assessing for a history of CM, quality of interpersonal relationships, and depression severity among youth reporting SI.

Depression Trajectories During the First Year After Spinal Cord Injury

OBJECTIVE To determine the number and type of longitudinal depression trajectories during the first year after spinal cord injury (SCI) and to identify baseline predictors of these trajectories. DESIGN Cohort study. SETTING Rehabilitation and postacute community settings. PARTICIPANTS Of 168 consecutive admissions to inpatient rehabilitation for acute SCI, 141 (115 men, 26 women) patients were enrolled in a randomized controlled trial telephone follow-up intervention, which showed no outcome differences, and completed assessments on at least 2 of the 4 follow-up occasions (3, 6, 9, and 12 months after SCI). Participants were on average 41 years old, most were non-Hispanic (96%) and white (86%), and 61.7% had tetraplegia. INTERVENTIONS Data were drawn from the ineffective randomized controlled trial. MAIN OUTCOME MEASURE Patient Health Questionnaire-9 (PHQ-9). RESULTS Unconditional linear latent class growth analysis models of PHQ-9 total scores revealed an optimal 3-class solution: stable low depression (63.8%), mild to moderate depression (29.1%), and persistent moderate to severe depression (7.1%). Preinjury mental health history and baseline pain, quality of life, and grief predicted class membership. CONCLUSIONS The modal response to SCI was stable low depression, whereas persistent moderate to severe depression primarily represented a continuation or relapse of preinjury depression. This line of research has the potential to improve identification of subgroups destined for poor outcomes and to inform early intervention studies.

Perceived Susceptibility to AIDS Predicts Subsequent HIV Risk: A Longitudinal Evaluation of Jail Inmates

Theories of health behavior change suggest that perceived susceptibility to illness precedes health-protective behavior. We used a cross-lagged panel design to explore the relationship between perceived susceptibility to AIDS, and HIV risk behavior pre-incarceration and post-release in a sample of 499 jail inmates, a group at high risk for HIV. We also explored moderators of this relationship. HIV risk was calculated with a Bernoulli mathematical process model. Controlling for pre-incarceration HIV risk, perceived susceptibility to AIDS predicted less post-release HIV risk; the reverse relationship was not supported. Consistent with health behavior change theories, perceived susceptibility seemed to partially guide behavior. However, this relationship was not true for everyone. African-Americans and individuals high in borderline personality features exhibited no relationship between perceived susceptibility and changes in HIV risk. This suggests that targeted interventions are needed to use information about risk level to prevent HIV contraction.

Stress-induced drinking in parents of boys with attention-deficit-hyperactivity disorder: heterogeneous groups in an experimental study of adult-child interactions

Research on whether parents of children with externalizing disorders are at elevated risk for alcohol problems is equivocal. To reduce this ambiguity, we examined how individual differences in stress reactivity might moderate the drinking behavior of such parents. Parents (119 mothers, 44 fathers) of ADHD sons interacted with different child confederates during each of two counter-balanced sessions. In one, the confederate portrayed a friendly, cooperative, “normal” boy; in the other, the confederate portrayed a “deviant” boy who exhibited behavior characteristic of externalizing disorders. Following each interaction, parents were given an opportunity for ad lib consumption of alcohol while anticipating a second interaction. Latent class analysis identified three subgroups of parents using distress scores and alcohol consumption: minimal stress reactivity; reacts to child deviance with increased distress, but not increased drinking; marked stress-induced drinking. Decisions about the nature and proper treatment of parents raising children with ADHD may be compromised by failure to attend to individual differences in stress reactivity and inclinations to use drinking to cope.

The need for multi-level mitigation of medical mistrust among social network members contributing to antiretroviral treatment nonadherence in African Americans living with HIV: Comment on Bogart et al. (2016).

In the context of heightened awareness of discrimination faced by African Americans in the United States (US) exemplified by the Black Lives Matter movement, exploring the equity of health care toward African Americans is timely. To this end, Bogart et al. (2016), in this issue, present an analysis of one potential source of disparate engagement in treatmentdmedical mistrust of social network membersdamong African Americans living with HIV. Compared to Whites, African Americans experience considerable disparity in general health and well-being, with higher rates of impairment, illness and death (Williams, 2012). Across multiple health conditions, African Americans have an earlier onset of disease, with worse disease courses. Economic constraints contribute to poorer health for African Americans. For example, Simons et al. (2016) found that low income was associated with accelerated