Reduced Heart Rate Variability in Social Anxiety Disorder: Associations with Gender and Symptom Severity

Background: Affective and interpersonal behavioural patterns characteristic of social anxiety disorder show improvement during treatment with serotonin agonists (e.g., selective serotonin reuptake inhibitors), commonly used in the treatment of social anxiety disorder. The present study sought to establish whether, during community psychopharmacological treatment of social anxiety disorder, changes in positive or negative affect and agreeable or quarrelsome behaviour mediate improvement in social anxiety symptom severity or follow from it. Methods: Adults diagnosed with social anxiety disorder (n = 48) recorded their interpersonal behaviour and affect naturalistically in an event-contingent recording procedure for 1-week periods before and during the first 4 months of treatment with paroxetine. Participants and treating psychiatrists assessed the severity of social anxiety symptoms monthly. A multivariate latent change score framework examined temporally lagged associations of change in affect and interpersonal behaviour with change in social anxiety symptom severity. Results: Elevated agreeable behaviour and positive affect predicted greater subsequent reduction in social anxiety symptom severity over the following month of treatment. Elevated negative affect, but not quarrelsome behaviour, predicted less subsequent reduction in symptom severity. Limitations: Limitations included limited assessment of extreme behaviour (e.g., violence) that may have precluded examining the efficacy of paroxetine because of the lack of a placebo control group. Conclusion: The present study suggests that interpersonal behaviour and affect may be putative mechanisms of action for serotonergic treatment of social anxiety disorder. Prosocial behaviour and positive affect increase during serotonergic treatment of social anxiety disorder. Specifically, modulating agreeable behaviour, positive affect and negative affect in individuals’ daily lives may partially explain and refine clinical intervention.

Download Full-text

Modular Cognitive-Behavioral Therapy for a Young Adult With Autism Spectrum Disorder, Comorbid Obsessive Compulsive Disorder, and Social Anxiety Disorder

Clinical Case Studies ◽

10.1177/1534650118770269 ◽

2018 ◽

Vol 17 (3) ◽

pp. 136-149 ◽

Cited By ~ 2

Author(s):

D. Luis Ordaz ◽

Adam B. Lewin ◽

Eric A. Storch

Keyword(s):

Autism Spectrum Disorder ◽

Case Report ◽

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Symptom Severity ◽

Behavioral Therapy ◽

Autism Spectrum ◽

Obsessive Compulsive ◽

Compulsive Disorder

This case report outlines the use of a modular cognitive-behavioral therapy (CBT) protocol used to treat obsessive compulsive disorder (OCD) and social anxiety disorder (SAD) in an 18-year-old female, “Jaina,” with autism spectrum disorder (ASD). Jaina completed 16 weekly CBT sessions that lasted approximately 60 min each. On completing the program, Jaina’s symptom severity for treatment targets of OCD and SAD had reduced based on the Anxiety and Related Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM- 5; ADIS-5). In addition, overall anxiety symptom severity reduction was evident at posttreatment based on the Clinical Global Impression of Severity (CGI-S). This case report supports the use of a modular CBT program (developed for late adolescents and young adults with ASD and comorbid anxiety/OCD) for OCD and SAD.

Download Full-text

Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Acta Neuropsychiatrica ◽

10.1017/neu.2020.6 ◽

2020 ◽

Vol 32 (4) ◽

pp. 169-176

Author(s):

Taryn Williams ◽

Michael McCaul ◽

Guido Schwarzer ◽

Andrea Cipriani ◽

Dan J Stein ◽

...

Keyword(s):

Systematic Review ◽

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Symptom Severity ◽

Meta Analysis ◽

Response To Treatment ◽

Pharmacological Intervention ◽

Quality Of Evidence

AbstractObjective:The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence.Methods:The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD. We performed a standard pairwise meta-analysis using a random effects model and carried out a network meta-analysis (NMA) using the statistical package, R. Quality of evidence was also assessed.Results:We included 67 RCTs in the review and 21 to 45 interventions in the NMA. Paroxetine was most effective in the reduction of symptom severity as compared to placebo. Superior response to treatment was also observed for paroxetine, brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline. Higher dropout rates were found for fluvoxamine. Brofaromine, escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline, and venlafaxine performed worse in comparison to placebo for the outcome of dropouts due to adverse events. Olanzapine yielded a relatively high rank for treatment efficacy and buspirone the worse rank for dropouts due to any cause.Conclusion:The differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine. We suggest paroxetine as a first-line treatment of SAD, with the consideration of future research on the drug olanzapine as well as brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline because we observed a response to treatment.

Download Full-text