Luis-Joaquin Garcia-Lopez

Exploring the relevance of expressed emotion to the treatment of social anxiety disorder in adolescence.

The role that the involvement of parents may play in the treatment outcome of their children with anxiety disorders is still under debate. Some studies dealing with other disorders have examined the role that the expressed emotion (EE) construct (parental overinvolvement, criticism and hostility) may play in treatment outcome and relapse. Given that some of these aspects have been associated with social anxiety for a long time, it was hypothesized that EE may be associated with lower treatment outcome. The sample was composed of 16 adolescents who benefited from a school-based, cognitive-behavioural intervention aimed at overcoming social anxiety. Then, parents were classified with high or low EE. The results revealed that the adolescents whose parents had low EE showed a statistically significant reduction of their social anxiety scores at posttest, as opposed to adolescents of parents with high expressed emotion. These findings suggest that parental psychopathology (parents with high EE) should be taken into consideration to prevent poor adolescent treatment outcome.

Assessment of Social Anxiety in Adolescents

Social anxiety disorder (SAD) is one of the most prevalent mental health disorders in adolescence and tends to be a chronic, stable condition that severely disrupts long-term functioning. Despite this, SAD is under-recognized and undertreated, in part due to it being underestimated by parents and teachers. Accurate detection and diagnosis are needed for adequate treatment. Assessment approaches that incorporate reports from multiple informants have the potential to measure important variations in youths’ symptom presentations, such as when they experience concerns in some social contexts not but others. Significant advancements involve developing clinical procedures that integrate measures of biological processes (e.g., assessments of cardiovascular and brain responses) with traditional clinical tools (e.g., youths’ responses on clinical interviews, questionnaires, and behavioral tasks). In addition, screening with short/brief measures would enhance one of the barriers to implementation of assessment protocols. School is also a place where young people can be easily reached for screening and implementing mental health promotion and protection programs. This chapter reviews clinical assessment procedures for SAD in adolescents, including multi-informant and context-sensitive clinical assessment, physiological assessment methods, and observational and role-play procedures. The chapter also provides suggestions for how to conduct a thorough and sensitive assessment.

Considering Comorbidity in Adolescents with Social Anxiety Disorder.

Social anxiety disorder is a highly prevalent psychiatric disorder, with elevated comorbidity rates with other mental health disorders and may cause severe negative consequences. In adolescence, there is a lack of research on how comorbid disorders to social anxiety tends to form particular associations. With a large sample of adolescents with a clinical diagnosis of social anxiety disorder, data have revealed that certain disorders are more frequent and tend to dwell on concrete aggregates. Thus, it may be particularly useful and efficient for mental health providers, pediatricians and school counselors to screen for generalized anxiety disorder and specific phobia when assessing SAD in youth. Overall, findings stress the presence of comorbidity being the rule rather than the exception in adolescents with social anxiety disorder, and the need for further examination of its impact on assessment and differential diagnosis on this psychiatric disorder.

Validation and Diagnostic Efficiency of the Mini-SPIN in Spanish-Speaking Adolescents

Objectives Social Anxiety Disorder (SAD) is one of the most common mental disorders in adolescence. Many validated psychometric tools are available to diagnose individuals with SAD efficaciously. However, there is a demand for shortened self-report instruments that identify adolescents at risk of developing SAD. We validate the Mini-SPIN and its diagnostic efficiency in overcoming this problem in Spanish-speaking adolescents in Spain. Methods The psychometric properties of the 3-item Mini-SPIN scale for adolescents were assessed in a community (study 1) and clinical sample (study 2). Results Study 1 consisted of 573 adolescents, and found the Mini-SPIN to have appropriate internal consistency and high construct validity. Study 2 consisted of 354 adolescents (147 participants diagnosed with SAD and 207 healthy controls). Data revealed that the Mini-SPIN has good internal consistency, high construct validity and adequate diagnostic efficiency. Conclusions Our findings suggest that the Mini-SPIN has good psychometric properties on clinical and healthy control adolescents and general population, which indicates that it can be used as a screening tool in Spanish-speaking adolescents. Cut-off scores are provided.

Optimal Cut-Off Score of Social Phobia and Anxiety Inventory-Brief Form

No cut-off scores for the Social Phobia and Anxiety Inventory-Brief (SPAI-B) are available to screen for young adults with and without social anxiety disorder (SAD). In addition, there is a currently heated debate on the utility of the performance-only specifier in DSM-5. The present study is aimed at covering these gaps. Participants included 124 young adults in higher education with a clinical diagnosis of SAD and 81 healthy controls. The SPAI-B scores revealed a continuum of severity among the nonclinical population, performance-only specifier participants, and those with both performance and social interactional fears. Data suggested to use a rounded cut-off of 24 to screen for patients with both performance and interactional fears, and a rounded cut-off score of 23 for young adults with performance-only specifier. Findings demonstrated that the SPAI-B is particularly useful as a screening measure among young adults in higher education, but the limited discriminative capacity of the performance-only specifier may call into question the clinical utility of this recently established specifier.

Exploring the role of the DSM-5 performance-only specifier in adolescents with social anxiety disorder

The DSM-5 social anxiety disorder section has recently added the performance-only specifier for individuals whose anxiety is limited to speaking or performing in public. The impact of the DSM-5 performance-only specifier remains a neglected area. The sample comprised 44 healthy controls and 50 adolescents with a clinical diagnosis of SAD (20% met criteria for the performance-only specifier). Findings revealed that adolescents with the specifier had a later age of onset; lower levels of depression, social anxiety symptomatology and clinical severity; and a lesser degree of comorbidity relative to adolescents with SAD but excluding the performance-only specifier. Specifiers only evidenced higher (cognitive) social anxiety symptomatology compared to healthy controls. Results of this study also suggested that the performance-only specifier may correspond to a mild form of social anxiety disorder. Data also revealed that SAD exists on a continuum of severity among healthy controls, specifier participants, and those with both interactional and performance fears, which is consistent with a dimensional structure for SAD. Finally, findings suggested a unique comorbid pattern for specifiers and those adolescents with SAD but excluding the performance-only specifier. The implications of these findings for the etiology, assessment, classification, and treatment of social anxiety in youth are discussed.

Psychometric properties of the social anxiety subscale of the Youth Anxiety Measure for DSM-5 (YAM-5-I-SAD) in a clinical sample of Spanish-speaking adolescents

BACKGROUND The Youth Anxiety Measure-I for DSM-5 has recently been developed to assess youths anxiety symptomatology. As social anxiety is one of the most common disorders in adolescence, this scale includes a subscale measuring social anxiety. However, psychometric properties of the YAM-5-I social anxiety subscale (YAM-5-I-SAD) in clinical samples are lacking. This paper aims to bridge the gap. METHODS The sample comprised 24 clinically diagnosed and 24 healthy control Spanish-speaking adolescents aged 14-17 years. RESULTS Data revealed that the YAM-5- I-SAD yielded excellent sensitivity, which makes it particularly useful as a screening tool to early detect socially anxious adolescents. In addition, the YAM-5-I-SAD evidenced good internal consistency and construct validity. LIMITATIONS Data are limited to the social anxiety subscale. CONCLUSIONS The YAM-5-I-SAD is a sensitive and specific measure to screen for adolescents with social anxiety.

Stopping the past from intruding the present: Social anxiety disorder and proactive interference.

It has recently been suggested that social anxiety disorder (SAD) entails a deficit in downregulating unwanted (even non-threatening) memories. In the present study we test this hypothesis by comparing a sample of young adults diagnosed with SAD and healthy controls in their ability to resist proactive interference in a working memory task. Where participants performed similarly in the control condition of the memory task, participants with SAD were more susceptible to interference in the experimental condition than the healthy controls. This finding is in line with previous studies that show anxiety to be associated with impoverished executive control and, specifically, suggests that SAD entails a reduced ability to get rid of interfering memories. Clinical implications are discussed.