A Review of “Social skills and social phobia: An investigation of DSM-IV subtypes”

Article summary provided by Hillary Greene

RESEARCHER HIGHLIGHT:

This review highlights work led by key anxiety researcher Dr. Deborah Beidel, director of the Anxiety Disorders Clinic and psychology professor at the University of Central Florida. Dr. Beidel has extensive professional experience pertaining to the development and treatment of anxiety disorders and has been recognized for excellence in her research and clinical work. Her current research focuses heavily on behavioral interventions for anxiety disorders in children and adults. For example, Dr. Beidel and colleagues are currently conducting an NIMH-funded study examining how virtual reality technology with avatars may be used to help children overcome difficulties associated with social anxiety disorder (SAD). This technology allows children to engage in realistic social situations tailored to their specific ability levels, such as in school settings with peers, while providing opportunities for them to build social skills and reduce anxiety responses. Dr. Beidel also pursues research designed to expand understanding regarding the development and characteristics of different anxiety disorders and subtypes, as represented in the following review.

THE MAIN POINT:

Although social phobia, or social anxiety disorder (SAD), has been well studied in general, little research has examined differences between the generalized and non-generalized subtypes of SAD, particularly in regards to social skills deficits. Therefore, this study examined multiple aspects of social anxiety and skills deficits through comparison of persons with generalized social phobia (GSP), non-generalized social phobia (NGSP), and healthy controls and found support for differences in social skills deficits among these groups. The details and implications of this study are discussed below (Beidel, Rao, Scharfstein, Wong, & Alfano, 2010).

THE DETAILS:

What were the goals of this study?

The main goal of this study was to increase understanding of social skills deficits within the subtypes of social anxiety disorder (SAD) by comparing the extent of social skills deficits in persons with generalized social phobia (GSP), non-generalized social phobia (NGSP), and healthy individuals without disorders. Specifically, this study sought to examine the degree of statistical and clinical significance in skills deficits among these groups in order to expand knowledge relevant for clinicians determining appropriate interventions for individuals with SAD.

How did this study address these goals?

This study recruited individuals through clinical referrals and media advertisements, screened individuals by phone, and conducted semi-structured diagnostic interviews in person to determine study eligibility for interested adults. Individuals were grouped by primary diagnosis, either generalized social phobia (GSP; fear in most social situations), non-generalized social phobia (NGSP; fear in one or two social situations), or normal controls (no diagnoses). Individuals were assessed with a self-report measure of social anxiety symptoms, clinician-rated measures of clinical problems severity, behavioral avoidance, and depression, and laboratory behavioral assessments of social skills, which included performance tasks assessing social abilities and anxiety during structured social interactions, unstructured interactions, and impromptu speech tasks. Behavioral assessments were videotaped and evaluated by trained raters.

What were the main results of this study?

Overall, the NGSP and GSP groups had significantly greater social skills deficits compared to the normal controls group. The GSP group had the greatest anxiety and lowest social skills compared to other groups and the NGSP group had greater anxiety and lower social skills than normal controls. Note, these group differences in anxiety responses were consistent across observer ratings and self-report ratings, providing strong support via multiple methods of assessment for this finding.  Furthermore, this study also considered the role of depression on social skills deficits and found that depression levels did not change the group differences identified in social skills and anxiety levels.

Specific social skills deficits also were found across these groups. For skill in transitioning in conversation, the GSP group showed significantly greater difficulty compared to other groups and the NGSP showed significantly greater difficulty compared to the normal controls group. For skill in maintaining task focus in conversation, the GSP showed significantly greater difficulties compared to other groups while the NGSP showed similar ability to the normal controls group. Note, although higher anxiety with the GSP versus other groups related to greater impairment in task focus, GSP persons still recalled most of the conversation topics. In regards to the impromptu speech task, the GSP and NGSP groups performed similarly and both SP groups showed significantly greater anxiety and shorter speech times than the normal controls group, which is consistent with the pervasiveness of public speaking anxiety across both SP groups.

Lastly, this study found important differences across GSP, NGSP and healthy controls groups in regards to percentage of persons with clinically significant impairments. The GSP group typically showed a greater percentage of persons with clinically significant impairments compared to the NGSP and healthy controls, who did not differ meaningfully from one another. In other words, although the NGSP group technically had greater social skills deficits than the healthy controls group, this difference did not reflect a clinically significant degree of impairment.

What are the clinical implications of this study?

Overall, this study provides support for considering specific subtypes of social anxiety disorder (SAD) when working with this population in order to better understand the nature of individuals’ deficits and needs for interventions. The findings of this study specifically suggest that persons with generalized social phobia likely require interventions with clear social skills training components to address the clinically significant social skills deficits often seen in this subtype. However, persons with specific, non-generalized social phobia may not require interventions with social skills training as they do not show clinically significant differences in levels of social skills deficits compared to healthy persons.

Where can professionals learn more about this study?

The study discussed here is available for free at this link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930084/

The work of Dr. Beidel discussed here can be explored further at these links:

http://anxietyclinic.cos.ucf.edu/beidel.html

http://today.ucf.edu/avatars-may-help-children-with-social-anxiety-overcome-fears/

REFERENCE

Beidel, D. C., Rao, P. A., Scharfstein, L., Wong, N., & Alfano, C. A. (2010). Social skills and social phobia: An investigation of DSM-IV subtypes. Behaviour Research and Therapy, 48, 992-1001.