Nina Heinrichs

The Liebowitz social anxiety scale as a self-report instrument : a preliminary psychometric analysis

The Liebowitz social anxiety scale (LSAS) is a commonly used clinician-administered instrument. The present study reports on the properties of a self-report version of the LSAS (LSAS-SR). About 175 participants diagnosed with social phobia participated in the study. The LSAS-SR showed overall good psychometric properties as indicated by the results of test-retest reliability, internal consistency, and convergent and discriminant validity. Furthermore, the scale was sensitive to treatment change. The construct validity of the LSAS-SR, however, remains to be further explored. These findings support the utility of the LSAS-SR, which has the advantage of saving valuable clinician time compared to the clinician-administered version.

Parent Recruitment and Retention in a Universal Prevention Program for Child Behavior and Emotional Problems: Barriers to Research and Program Participation

Despite the potential of parent training as a prevention and behavioral family intervention strategy, there are a number of important issues related to implementation (e.g., recruitment and retention of families). This paper presents recruitment and retention data from families enrolling in a randomized controlled universal prevention trial for child behavior problems conducted in Germany. The recruitment rate averaged 31% (general project participation), with families of lower socioeconomic status (SES) participating at a lower rate. Project-declining families most often reported intrusion of privacy as their primary concern. In contrast, once parents were enrolled in the project, participation among those randomized to the parent training group averaged 77% (program/intervention participation); non-participation was mostly due to logistical issues. Parents accepting the offer of parent training were more likely to report child behavior problems than did declining parents. Although parents from more disadvantaged areas had a lower overall level of participation in the project once recruited, parents with children having higher levels of behavior problems indeed were more likely to participate in the intervention. Different recruitment methods may be required to engage high-risk families from socioeconomically disadvantaged areas to further improve community-level impact on child mental health.

Information processing in social phobia: a critical review

This review critically discusses the empirical evidence for information-processing biases in social phobia. Distortions in attention, interpretation, and memory processes are analyzed as they apply to individuals with social phobia. The literature provides evidence for a specific attentional bias towards socially threatening stimuli and a specific interpretational/judgment bias towards self-relevant social information. However, there is little evidence to suggest that social phobia is associated with a memory bias for socially threatening stimuli. Furthermore, the relationship between the empirical evidence from information processing studies and the cognitive model of social phobia by Clark and Wells (1995) will be discussed.

''Does One Size Fit All?'' Moderators in Psychosocial Interventions for Breast Cancer Patients: A Meta-Analysis

Background: A variety of psychosocial interventions have been developed to promote better adjustment to breast cancer (BC) and their efficacy has been demonstrated repeatedly. However, the effect sizes (ES) vary considerably across studies.Purpose: This article intends to shed light on potential moderators of intervention efficacy for BC patients, such as the intervention type (e.g., education, supportive), the composition of the sample (only BC patients or BC mixed with other cancer types), and the practitioner of the intervention (psychologist, nonpsychologist).Methods: Fifty-six randomized-controlled studies investigating the effectiveness of psychosocial interventions with adult BC patients were meta-analytically reviewed.Results: The overall ES of d=0.26 was similar to previous meta-analyses and moderated by several variables. The ES varied notably based on the composition of the sample, the profession offering the intervention, and the type of intervention. Studies with samples consisting of only BC patients and studies with nonpsychologist-led interventions showed lower ES. Psychoeducation yielded the strongest ES. These moderators maintained their significance even when controlling for the nature of the control group, the format of the intervention, the timing of the intervention, or the stage of disease.Conclusions: These results suggest that among current interventions, psychoeducation is a treatment of choice for BC patients, preferably prior to surgery and led by individuals with a medical expertise. Other psychosocial interventions appear most effective when administered individually and led by a psychologist. In addition, there is a need for improved psychosocial interventions to enhance the present ES for women with BC.

The Effects of Two Different Incentives on Recruitment Rates of Families into a Prevention Program

This study experimentally manipulated two incentives for participation (monetary: paid participation for sessions and setting: group vs. individual) in a child behavior problem prevention program to analyze their effects on recruitment and retention of families. A population of 690 eligible families from 15 preschools located in socially disadvantaged neighborhoods was invited to participate in a parent training (PT) program. The study recruited parents by using advertisements that had information describing only the indicated condition (i.e., PT in group-unpaid, or PT individual-unpaid, or PT in group-paid, or PT individual-paid). Results demonstrate significant impact of payment on recruitment and initial attendance. Training setting alone (individual or group) did not significantly influence these rates. Editors’ Strategic Implications: A compelling case is made for the utility of monetary incentives to increase proportions of low-income families in prevention research and programs. Evaluators and program designers should note the impressive use of the experimental design and hierarchical linear modeling to test the effects on recruitment.

Restricted Autonomic Flexibility in Children with Social Phobia.

BACKGROUND Psychophysiological hyperresponsiveness to social-evaluative stress plays a key role in current theories of social phobia (SP). Owing to the early onset of this disorder, the study of children with SP can help to improve etiological models. However, research to date has failed to clarify whether children with SP are physiologically hyperresponsive to stress or not. In addition, the existence of elevated pre-stressor baseline group differences complicates the interpretation of acute stress responses and therefore poses a challenge for this line of research. Drawing on current models of autonomic control to explain the relationship between baseline and stress responding in SP children and healthy controls (HC), we acquired a broad set of autonomic measures in our study. METHOD To index baseline and stress reactivity and to assess autonomic flexibility, we assessed a comprehensive array of sympathetic and parasympathetic measures in SP children (aged 8 to 12 years; n = 30) and healthy control children (HC, n = 26), while exposing them to the Trier Social Stress Test for Children (TSST-C). RESULTS At baseline, the SP children showed higher levels of sympathetic (heart rate, electrodermal activity) and lower levels of parasympathetic (respiratory sinus arrhythmia, RSA) activation when compared to the HC children. During the TSST-C, the SP children showed similar HR responses but a limited RSA reactivity and a slower HR recovery relative to the HC children. CONCLUSION Our study extends previous research by showing elevated baseline arousal and comparable stress responding in SP children relative to HC children. In addition, based on the autonomic flexibility model, we provide a potential explanation for the null findings of previous studies during stress. The pattern of elevated baseline heart rates and reduced RSA point to restricted autonomic flexibility in children with SP.

Prävention kindlicher Verhaltensstörungen

Zusammenfassung. In dem vorliegenden Uberblicksartikel werden Programme zur universellen, selektiven und indizierten Pravention psychischer Storungen bei Vor- und Grundschulkindern beschrieben und hinsichtlich ihrer Effektivitat bewertet. Wenn man strenge Kriterien zur Beurteilung der empirischen Effizienz anlegt, dann gibt es international sieben universelle und 13 selektiv/indizierte wahrscheinlich wirksame Praventionsprogramme, die psychopathologischen Symptomen wie Aggression, Depression oder Angst bei Kindern vorbeugen konnen. In Deutschland gibt es nur wenige solche Ansatze, von denen sich die meisten noch im Evaluationsprozess befinden. Nur drei universelle Programme konnen als vermutlich effektiv eingestuft werden. Auf der anderen Seite werden eine Vielzahl von Programmen angeboten und verbreitet, die keine empirische Absicherung erfahren haben oder sich als nicht wirksam erwiesen haben. Es ist daher dringend notwendig, vorhandene Ansatze einer Wirksamkeitsprufung zu unterziehen und die Verbreitun...

Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia

Reports of exaggerated anxiety and physiological hyperreactivity to social-evaluative situations are characteristic of childhood social phobia (SP). However, laboratory research on subjective, autonomic and endocrine functioning in childhood SP is scarce, inconsistent and limited by small sample sizes, limited breadth of measurements, and the use of non-standardized stressor tasks. We exposed 8–12-year-old children with DSM-IV SP (n = 41) and matched healthy control children (HC; n = 40) to the Trier Social Stress Test for Children (TSST-C) while measuring subjective anxiety, heart rate (HR) and salivary alpha-amylase (sAA) as well as salivary cortisol. The SP children showed heightened reactivity to the TSST-C on subjective anxiety compared to the HC children but not a heightened reactivity in HR, sAA or cortisol. However, the SP children showed chronically elevated HR levels throughout the whole laboratory session. Whereas subjective anxiety seems to respond specifically to social-evaluative stress in childhood SP, HR levels may be chronically elevated suggesting a more generalized autonomic hyperreactivity.

Social anxiety and social norms in individualistic and collectivistic countries.

Background: Social anxiety is assumed to be related to cultural norms across countries. Heinrichs et al. [2006: Behav Res Ther 44:1187–1197] compared individualistic and collectivistic countries and found higher social anxiety and more positive attitudes toward socially avoidant behaviors in collectivistic rather than in individualistic countries. However, the authors failed to include Latin American countries in the collectivistic group. Methods: To provide support for these earlier results within an extended sample of collectivistic countries, 478 undergraduate students from individualistic countries were compared with 388 undergraduate students from collectivistic countries (including East Asian and Latin American) via self‐report of social anxiety and social vignettes assessing social norms. Results: As expected, the results of Heinrichs et al. [2006: Behav Res Ther 44:1187–1197] were replicated for the individualistic and Asian countries, but not for Latin American countries. Latin American countries displayed the lowest social anxiety levels, whereas the collectivistic East Asian group displayed the highest. Conclusions: These findings indicate that while culture‐mediated social norms affect social anxiety and might help to shed light on the etiology of social anxiety disorder, the dimension of individualism–collectivism may not fully capture the relevant norms. Depression and Anxiety, 2010.© 2010 Wiley‐Liss, Inc.

Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort?

BackgroundApproximately 20% of children experience internalizing or externalizing DSM-IV-TR disorders. This prevalence rate cannot be reduced through treatment only. Effective preventive interventions are therefore urgently needed. The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems.MethodsBased on their respective preschool, N = 280 families were randomly assigned either to the parent training or to the control group. The efficacy was analyzed using multi-source assessments, including questionnaires by mother and father, behavioral observation of mother-child interaction, and teacher evaluations.ResultsAt the 2-year follow-up, both parents in the Triple P intervention reported significant reductions in dysfunctional parenting behavior, and mothers also an increase in positive parenting behavior. In addition, mothers reported significant reductions in internalizing and externalizing child behavior. Single-parent mothers in the Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group. Neither mother-child interactions nor teacher ratings yielded significant results.ConclusionsThe results support the long-term efficacy of the Triple P - group program as a universal prevention intervention for changing parenting behavior in two-parent households, but not necessarily in single-parent mothers.