The Liebowitz Social Anxiety Scale: A useful tool for clinicians working with those struggling with Social Anxiety Disorder

Article summary provided by Kathryn Zumberg

 

THE MAIN POINT:

The Liebowitz Social Anxiety Scale is a well-validated measure that can be used to screen clients for social anxiety disorder and measure their progress while in treatment. Details about the measure and uses are discussed below. As a reminder, always remember to interpret clinical measures in context.

THE DETAILS:

What is the scale like?

The Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987) is a 24-item measure designed to assess both fear and avoidance of social (e.g., going to a party, meeting strangers) and performance situations (e.g., taking a test, giving a report to a group) occurring in the last week. Each of the items is rated from 0-4, with high scores representing more fear and/or avoidance. The scale provides clinicians and clients with six scores representing the following: total fear, total avoidance, fear of social situations, fear of performance situations, avoidance of social situations and avoidance of performance situations. A total score can also be obtained by summing the total fear and total avoidance subscales.

What versions of the scale are available? 

The original scale was created as a clinician-rated measure. Administration involves the clinician asking clients to rate their fear and avoidance (from 0-3) for each of the social and performance situations listed. Although client provides the initial rating, the clinician may adjust these scores based upon clinical judgment. Recently, the scale has used as a self-report measure, which allows for quicker and less costly administration. Additionally, a children’s version of the scale is also available (Masia-Warner et al., 2003).

 What has research found about the reliability and validity of the scale?

Several studies have been conducted to examine the reliability and validity of the scale. Overall, researchers have found that all versions of the scale have excellent internal consistency (Fresco et al., 2001; Heimberg et al., 1999; Masia-Warner et al., 2003), or reliability. With regards to validity, the measure has also been found to be associated with other current measures of social anxiety, indicating that it has good convergent validity (Fresco et al., 2001; Heimberg et al., 1999; Masia-Warner et al., 2003).

What are potential uses of the scale?

Given its ease of administration and good reliability and validity, the LSAS can be a very useful tool to use when working with individuals who may be struggling with social anxiety disorder.

• Screening— Rytwinski et al. (2009) found that the self-report version of the scale can aid in screening individuals for social anxiety disorder. These authors found that a cut-off total LSAS score of 30, accurately identified more than 90% of the individuals with social anxiety disorder studied.

• Change—The scale has commonly been used in studies examining the efficacy of psychotropic medications for social anxiety disorder because it is sensitive to change (Heimberg et al., 1999). Therefore, this measure can be used throughout treatment in order to better monitor changes in social anxiety, as well as treatment success. However, it is important to remember that measures should always be interpreted within context and that scores changing on a measure may reflect ‘real’ change, or could reflect changes in how willing an individual is to disclose their distress. For example, Youn, Kraus, and Castonguay (2012) note that individuals can sometimes look more distressed on clinical assessments after a few sessions because they feel more comfortable sharing their struggles after getting to know the professional.

How can I learn more about the measure?

If you would like to learn more about the measure, please see the following references. In addition, you can print out a copy of the adult version by following the link, below.

http://healthnet.umassmed.edu/mhealth/LiebowitzSocialAnxietyScale.pdf

To obtain a copy of the child version, please contact Dr. Masia-Warner: http://www.aboutourkids.org/about_us/staff/research_faculty/carrie_masiawarner?CSRT=2790883108876939579

 

References

Fresco, D. M., Coles, M. E., Heimberg, R. G., Leibowitz, M. R., Hami, S., Stein, M. B., & Goetz, D. (2001). The Liebowitz Social Anxiety Scale: A comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31(6), 1025-1035. doi: 10.1017/S0033291701004056

Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 29(1), 199-212. doi: 10.1017/S0033291798007879

Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141-173.

Masia-Warner, C., Storch, E. A., Pincus, D. B., Klein, R. G., Heimberg, R. G., & Liebowitz, M. R. (2003). The Liebowitz Social Anxiety Scale for Children and Adolescents: An Initial Psychometric Investigation. Journal of the American Academy of Child & Adolescent Psychiatry, 42(9), 1076-1084. doi: 10.1097/01.CHI.0000070249.24125.89

Rytwinski, N. K., Fresco, D. M., Heimberg, R. G., Coles, M. E., Liebowitz, M. R., Cissell, S., . . . Hofmann, S. G. (2009). Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale. Depression and Anxiety, 26(1), 34-38. doi: 10.1002/da.20503

Youn, S. J., Kraus, D. R., & Castonguay, L. G. (2012). The treatment outcome package: Facilitating practice and clinically relevant research. Psychotherapy, 49(2), 115-122. doi: 10.1037/a0027932