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  • 1. Bejerot, Susanne
    et al.
    Edman, Gunnar
    Anckarsäter, Henrik
    Berglund, Gunilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gillberg, Christopher
    Hofvander, Björn
    Humble, Mats B.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Råstam, Maria
    Ståhlberg, Ola
    Frisén, Louise
    The Brief Obsessive - Compulsive Scale (BOCS): A self-report scale for OCD and obsessive–compulsive related disorders2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, p. 549-559Article in journal (Refereed)
    Abstract [en]

    Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive–compulsive symptoms and diagnosis of obsessive–compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date. Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population. Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category “Obsessive–compulsive related disorders”, accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive–compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS. Results: Principal component factor analysis produced five subscales titled “Symmetry”, “Forbidden thoughts”, “Contamination”, “Magical thoughts” and “Dysmorphic thoughts”. The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62–70% Cronbach's α = 0.81; Severity Scale: sensitivity = 72%, specificities = 75–84%, Cronbach's α = 0.94). Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive–compulsive symptoms in clinical psychiatry.

  • 2.
    Bejerot, Susanne
    et al.
    Karolinska Institutet.
    Riksson, Jonna M.
    Karolinska Institutet.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Social anxiety in adult autism spectrum disorder2014In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 220, no 1-2, p. 705-707Article in journal (Refereed)
    Abstract [en]

    A link has been suggested between Autism Spectrum Disorder (ASD) and anxiety disorders. The aim of the study was to examine the severity of social anxiety measured by the Liebowitz Social Anxiety Scale Self-Report and prevalence of Social Anxiety Disorder (SAD) in adults with ASD, with SAD and a non-ASD comparison group. Individuals with ASD showed significantly higher scores of social anxiety and social avoidance relative to the comparison group, but significantly lower scores relative to the SAD sample.

  • 3. Beskow, Jan
    et al.
    Ehnvall, Anna
    Gyllensten, Kristina
    Frodi, Ann
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Palm Beskow, Astrid
    Selstam Grundén, Annika
    Svanborg, Cecilia
    Omgivning och kultur: 5:e ringen2011In: Psykologisk coaching: för varaktig förändring / [ed] Kristina Gyllensten, Astrid Palm Beskow, Stephen Palmer, Stockholm: Natur och kultur, 2011, 1, p. 162-173Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Många av de mest framgångsrika coacher som är verksamma i Sverige idag jobbar med kognitiv och beteendeinriktad coaching. Med detta arbetssätt som grund skapas ett coachingsamtal som kan leda till genomgripande förändring. I denna bok varvas teori och praktik. Målgruppen är praktiserande coacher, terapeuter, chefer, psykologer, rådgivare och alla andra som vill jobba med en professionell coachingteori som grund.

  • 4. Clason, J.
    et al.
    Johansson, F.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Individual Cognitive Therapy for Professional Actors with Performance Anxiety2015In: Annals of Depression and Anxiety, ISSN 2381-8883, Vol. 2, no 6, article id 1066Article in journal (Refereed)
    Abstract [en]

    Performance anxiety, which could be regarded as a type of social anxiety disorder, is a common and debilitating condition among professional artists. In spite of this, no clinical research has previously been done on treatment methods for professional actors with PA. In the current study A-B single case experimental designs and parametric statistics were used to report the treatment process of five actors with PA who were treated with 11-12 sessions of Individual Cognitive Therapy (ICT). ICT was found to reduce PA in four of the five cases, and resulted in significantly lower frequencies of safety behaviors and negative social thoughts. It was concluded that ICT could be an effective course of treatment for actors with PA.

  • 5. Hedman, Erik
    et al.
    Andersson, Gerhard
    Ljótsson, Brjánn
    Andersson, Erik
    Rück, Christian
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindefors, Nils
    Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 3, p. e18001-Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting.

    Methods: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n = 64) or CBGT (n = 62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points.

    Results: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%–76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%–58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68–17.66 (Cohen’s d between group = 0.41) and 22.51–15.69 (Cohen’s d between group = 0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F = 1.58; df = 2, 219; p = .21).

    Conclusions: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT.

  • 6. Hedman, Erik
    et al.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hesser, Hugo
    Clark, David M.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet.
    Andersson, Erik
    Ljótsson, Brjánn
    Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 10, p. 696-705Article in journal (Refereed)
    Abstract [en]

    According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.

  • 7. Hedman, Erik
    et al.
    Ström, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Stünkel, Angela
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 4, p. e61713-Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt, depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD.

  • 8.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bättre långtidseffekter av Becks kognitiva terapi jämfört med Acceptance and Comittment Therapy vid måttliga ångest- och depressionstillstånd2013In: En i veckan, ISSN 2001-2829, p. 2013/05/30-Article, book review (Other (popular science, discussion, etc.))
    Abstract [sv]

    Medan Becks kognitiva terapi (KT) är väl beforskad och betraktas som en empiriskt validerad KBT-metod, är Acceptance and Comittment Therapy (ACT) jämförelsevis mer oprövad, även om allt fler studier talar för preliminärt goda effekter av metoden t.ex. vid depressions och ångesttillståndKT syftar till symptomförändring genom förändring av individens tolkning av händelser (s.k. kognitiv omstrukturering) via beteendeexperiment, verbal disputation eller direkta beteendetekniker som t.ex. aktivering. ACT syftar primärt inte till symptomförändring utan till att hjälpa patienten att ”acceptera” svåra inre upplevelser (tankar, bilder, känslor, sensationer) för att kunna engagera sig i värdekonsistenta beteendeförändringar.

    Den aktuella långtidsuppföljningen 18 månader efter behandling (Forman et al., 2012), bygger på en tidigare studie där 132 personer med måttliga ångest- eller depressionstillstånd (> 9 poäng på Beck Depression Inventory eller Beck Anxiety Inventory) randomiserades till KT eller ACT (Forman et al., 2007). Resultaten av originalstudien visade inga skillnader i behandlingseffekter mellan metoderna.

    Deltagarnas genomsnittsålder var 26.7 år (SD: 6.4) och majoriteten var kvinnor (79.5%). Patienterna erhöll i genomsnitt 16 (KT) till 18 (ACT) behandlingssessioner av terapeuter som utbildats för att administrera båda metoderna. Det framkom inga skillnader beträffande terapeutens ”tro” på den ena eller andra metoden och terapeuternas kompetens att utföra KT och ACT skattades som ”god”, ”mycket god” eller ”utmärkt” i över 90% av de skattade sessionerna.

    Vid 18-månadersuppföljningen fann man att patienter som fått KT jämfört med patienter som fått ACT, signifikant bättre hade vidmakthållit behandlingseffekterna när det gällde minskade depressionssymptom, en ökad generell funktionsnivå samt en ökad livskvalitet. Man fann även att patienter som fått KT uppnått klinisk signifikant förändring (Jacobsen & Truax, 1991) i högre grad än patienter som fått ACT, vilket visades i samtliga utfallsmått. Medan 81.1% och 72.2% bland patienterna i KT visade kliniskt signifikant förändring av depressions- och ångestsymtom, befanns motsvarande andel i ACT vara 60.7 respektive 56%. Medan 46.4% och 37.8% av patienterna i KT visade kliniskt signifikant förändring av generell funktionsnivå och livskvalitet var motsvarande andel i ACT 22.6 respektive 22.9%.

    Studien är intressant då det är den första som direkt jämfört ACT med annan etablerat KBT-metod. Den ger inte belägg för att ACT skulle vara att alternativ till KT utan ger snarare ytterligare bekräftelse på de goda effekterna av den senare metoden.

    Referens: Forman, E.M., Shaw, J.A., Goetter, E.M., Herbert, J.D., Jennie A. Park, J.A.,Yuen, E.K. (2012). Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression. Behavior Therapy43, 801–811.

  • 9.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Inlärning och beteende2011In: Psykologisk coaching - för varaktig förändring / [ed] Kristina Gyllensten, Astrid Palm Beskow, Stephen Palmer, Stockholm: Natur och kultur, 2011, 1Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Många av de mest framgångsrika coacher som är verksamma i Sverige idag jobbar med kognitiv och beteendeinriktad coaching. Med detta arbetssätt som grund skapas ett coachingsamtal som kan leda till genomgripande förändring. I denna bok varvas teori och praktik. Målgruppen är praktiserande coacher, terapeuter, chefer, psykologer, rådgivare och alla andra som vill jobba med en professionell coachingteori som grund.

  • 10.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Social ångeststörning (social fobi)2013In: KBT inom psykiatrin / [ed] Lars-Göran Öst, Stockholm: Natur och kultur, 2013, 2, p. 93-112Chapter in book (Other academic)
  • 11.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Working alliance in individual and group cognitive therapy for social anxiety disorder2014In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 220, no 1-2, p. 716-718Article in journal (Refereed)
    Abstract [en]

    The tripartite model of working alliance, including the therapeutic bond and agreement on tasks and goals, was examined in 54 patients who received individual or group cognitive behavior therapy (CBT) for social anxiety disorder (SAD) in a randomized trial. Alliance was significantly stronger in individual relative to group CBT but generally not related to outcome.

  • 12.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Predictors of response to individual and group cognitive behaviour therapy of social phobia2014In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 87, no 1, p. 32-43Article in journal (Refereed)
    Abstract [en]

    ObjectivesIncreased knowledge of factors that predict treatment outcome is important for planning and individualizing of treatment. This study analysed predictors of response to individual cognitive therapy (ICT), and intensive (3-week) group cognitive treatment (IGCT) for social phobia. MethodParticipants (n=54) met diagnostic criteria for social phobia within a randomized controlled trial. Predictors assessed were fear of negative evaluation, anticipatory worry, self-directedness (SD) and cluster C personality disorder. Results were analysed by means of multiple regression analyses with both groups combined, and for each of the treatment groups. ResultsAnticipatory worry, an aspect of a harm-avoidance personality trait, was the strongest negative predictor of outcome in ICT and IGCT both at post-treatment and 1-year follow-up. Whereas low SD, signs of cluster C personality disorder and fear of negative evaluation were negative predictors of post-treatment outcome in ICT, the corresponding pattern of results was not to be found in IGCT. ConclusionsAnticipatory worry appears to be a particularly important trait for explaining variance in the outcome of social phobia. The finding is consistent with the assumed stability of such personality traits over time. Further studies are warranted to replicate the finding.

  • 13.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Clark, David M.
    Bejerot, Susanne
    Karolinska Institutet.
    Intensive group cognitive therapy and individual cognitive therapy for social phobia: Sustained improvement at 5-year follow-up2011In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 25, no 8, p. 994-1000Article in journal (Refereed)
    Abstract [en]

    Little is known about the long-term outcome of treatments for social phobia. At 5 years post-treatment we contacted the 67 patients who had been treated with intensive group cognitive therapy (IGCT) or individual cognitive therapy (ICT) in a randomized controlled trial (Mörtberg, Clark, Sundin, & Åberg Wistedt, 2007) that originally compared IGCT, ICT, and treatment as usual (n = 100 for the full trial). Seventy-two

    percent (48 patients) who received IGCT or ICT agreed to participate in the follow-up assessment. All re-completed the original self-report measures of symptoms and disability and a quality of life measure. A subset was also interviewed. Seventy-five percent (36 patients) had sought no further treatment for social phobia. Comparisons between post-treatment and 5-year follow-up indicated that patients who had received either treatment showed further improvement in social phobia symptoms and disability during the follow-up period. These improvements were present in patients who had no additional treatment, as well as in the total sample. In conclusion, it appears that the effects of IGCT and ICT are maintained and improved upon at 5 years post-treatment.

  • 14.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hoffart, Asle
    Boecking, Benjamin
    Clark, David M.
    Shifting the Focus of One's Attention Mediates Improvement in Cognitive Therapy for Social Anxiety Disorder2015In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 43, no 1, p. 63-73Article in journal (Refereed)
    Abstract [en]

    Background: Cognitive therapy is an effective treatment for social anxiety disorder but little is known about the mechanisms by which the treatment achieves its effects. Aims: This study investigated the potential role of self-focused attention and social phobia related negative automatic thoughts as mediators of clinical improvement. Method: Twenty-nine patients with social phobia received individual cognitive therapy (ICT) in a randomized controlled trial. Weekly process and outcome measures were analysed using multilevel mediation models. Results: Change from self-focused to externally focused attention mediated improvements in social anxiety one week later. In contrast, change in frequency of, or belief in, negative social phobia related negative automatic thoughts did not predict social anxiety one week later. Conclusions: Change in self-focused attention mediate therapeutic improvement in ICT. Therapists should therefore target self-focused attention.

  • 15.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Tillfors, Maria
    Furmark, Tomas
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 300-314Article in journal (Refereed)
    Abstract [en]

    Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

  • 16.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Tilfors, Kerstin
    Bejerot, Susanne
    Screening for ADHD in an Adult Social Phobia Sample2012In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 16, no 8, p. 645-649Article in journal (Refereed)
    Abstract [en]

    Objective: Recent studies have suggested a link between a primary anxiety disorder and ADHD. Method: A total of 39 participants with a primary diagnosis of social phobia were compared with 178 patients with ADHD and 88 patients with other psychiatric disorders on measures for childhood and adult ADHD (the Wender Utah Rating Scale and the Adult ADHD Self-Report Scale). Results: Childhood symptoms of ADHD were reported by 7.8% of the social phobia participants, and 5.1% scored within the range of adult ADHD. The social phobia group reported significantly fewer ADHD symptoms than both of the comparison groups, who frequently reported social anxiety. Conclusion: Participants with social phobia recruited from the general population are less likely to suffer from ADHD. In contrast, patients with ADHD and patients with other psychiatric disorders appear to be likely to suffer from social anxiety.

  • 17.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Tillfors, Maria
    van Zalk, Nejra
    Kerr, Margaret
    An atypical anxious-impulsive pattern of social anxiety disorder in an adult clinical population2014In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 55, no 4, p. 350-356Article in journal (Refereed)
    Abstract [en]

    An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self-directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self-directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self-directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.

  • 18. Tillfors, Maria
    et al.
    Mörtberg, Ewa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Van Zalk, Nejra
    Kerr, Margaret
    Inhibited and impulsive subgroups of socially anxious young adults: Their depressive symptoms and life satisfaction2013In: Open Journal of Psychiatry, ISSN 2161-7325, E-ISSN 2161-7333, Vol. 3, no 1A, p. 195-201Article in journal (Refereed)
    Abstract [en]

    Purpose: Socially anxious people are typically thought of as being behaviorally inhibited; however, an atypical subgroup, which is impulsive rather than inhibited, has recently been identified. Theoretically, inhibition and impulsivity could be viewed as different strategies for coping with anxiety that have the same goal—escape from negative emotions—but they seem to have different implications. Previous studies have found that the socially anxious-impulsive subgroup was higher on risk-prone behavior, as for example drug use, compared with a socially anxious-inhibited subgroup. In this study, we aimed to identify these subgroups in a general population, and asked whether they also experience various levels of depressive symptoms and life satisfaction, as well as moderating effects of gender. Methods: Cluster analysis was used to identify subgroups of young adults (20 - 24 years old; N = 772) characterized by different profiles of social anxiety and impulsivity. These subgroups were compared on levels of internal adjustment, and the moderating effects of gender were also tested. Results: We identified five clusters, including an Anxious-Inhibited and an Anxious-Impulsive cluster. In the interaction between gender and cluster membership, gender showed evidence of moderation regarding both depressive symptoms and life satisfaction, with the young women in the Anxious-Inhibited and the Anxious-Impulsive clusters faring worst. Conclusions: We replicated previous findings demonstrating the existence of a socially anxious-impulsive subgroup, thus solidifying current knowledge that may be important when it comes to diagnostics and treatment. This may prove particularly important for young women regarding internalizing symptoms.

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