Social Anxiety Disorder
Authors of a new study have found that social anxiety disorder is not just medicalized shyness. Of those youth with the disorder, only a fraction consider themselves shy, and they are not more likely to be getting treatment compared to their peers, questioning the perception that they are receiving unnecessary medications. See Triumph Over Shyness: Conquering Social Anxiety Disorder.
This study examines whether an antibiotic, d-cycloserine (DCS), boosts the effectiveness of cognitive behavior therapy (CBT) for social anxiety. CBT has been shown to be effective for the treatment of social anxiety in children and adults, but even after treatment, approximately 40% may remain diagnosable. All participants will receive 12 weekly CBT sessions. In addition to receiving the CBT, participants will be randomly assigned (similar to a coin toss) to receive either DCS or a placebo (sugar pill). The pill will be taken 1-2 hours prior to each of the 12 CBT sessions.
- Subjects between 8 yrs of age (preadolescents) and under 55 yrs of age.
- Subjects medically healthy.
- Able to give informed consent.
- Not on psychotropic meds for a minimum of 6 weeks for fluoxetine; a minimum of 1 week for PRN benzodiazepines and beta blockers, and a minimum of 3 weeks for all other psychotropic meds.
- Subjects diagnosed with DSM IV symptoms of social phobia, generalized or specific type.
- Current major depressive disorder.
- Lifetime diagnosis of psychotic disorder, bipolar disorder, eating disorder, mental retardation, substance or alcohol dependence (other than nicotine); active suicidal ideation.
- Current or lifetime history of a neurological disorder (other than tic disorders, febrile seizures of infancy), seizure disorder.
- Any unstable medical condition.
- Use of any psychoactive substance in the past 30 days.
This study uses functional magnetic resonance imaging (fMRI) to learn how the brain functions in adolescents receiving fluoxetine (Prozac) or cognitive behavioral therapy (CBT) for anxiety or depression in children/adolescents. All participants will receive interviews to assess how they are doing in general, including his or her general mood, degree of nervousness and behavior. Each participant and one of his or her parents will be interviewed separately and together.
Age: 8 - 17
Consent: can give consent/assent (Parents will provide consent; minors will provide assent)
IQ: all subjects will have IQ greater than 70 (Assessment relies on WASI)
SUBJECTS WITH AN ANXIETY DISORDER:
Diagnosis: Current Diagnosis of Social Phobia, Separation Anxiety, or Generalized Anxiety Disorder (Based on K-SADS)
Symptom Severity: Score greater than 9 on PARS (This score was used to enroll subjects in previous trial demonstrating efficacy of an SSRI in pediatric anxiety)
Clinical Impairment: CGAS less than 60
SUBJECTS WITH A MOOD DISORDER:
Diagnosis: Current Diagnosis of Major Depression (Based on K-SADS (juveniles) or SCID (adults))
Clinical Impairment: CGAS less than 60 (juveniles) GAS less than 70 (adults)
Symptom Severity: CDRS Score greater than 39 (juveniles) (This score was used to enroll subjects in previous trials demonstrating efficacy of an SSRI in pediatric depression)
Consent: can give consent/assent
IQ: all subjects will have IQ greater than 70. Assessment relies on WASI.
Any serious medical condition or condition that interferes with fMRI scanning, and for patients electing medication, any condition that increases risk of SSRI treatment. All patients will have complete physical examination. Healthy volunteer participants will be medication-free and have no current serious medical conditions, based on a review of their medical history.
Current use of any psychoactive substance; current suicidal ideation; current diagnosis of attention deficit hyperactivity disorder (ADHD) of sufficient severity to require pharmacotherapy. These factors could complicate treatment with an SSRI. No subject on medication will be accepted into the trial. Subjects will not be taken off of medications to enter the trial.
Current diagnoses Tourette's Disorder, OCD, post-traumatic distress disorder, conduct disorder. These factors may be effected by SSRI treatment, influencing ability to detect effects on anxiety/depression
Past or current history of mania, psychosis, or pervasive developmental disorder. These factors may be effected by SSRI treatment, influencing ability to detect effects on anxiety/depression
Recent use of an SSRI; all subjects must have been free of any SSRI-use for at least one month (fluoxetine six months) and must not have been treated with an SSRI for their current depressive episode. This is designed to exclude subjects who have failed a trial of an SSRI for their current episode of major depression.
HEALTHY ADULT SUBJECTS:
Any current psychiatric diagnosis. Assessment relies on SCID.
SUBJECTS WITH AN ANXIETY DISORDER:
Current Major Depressive Disorder
Psychologist John R. Walker, PhD, explains social anxiety disorder and what you can do to overcome it.
Study of training to reduce social anxiety and worry via iPhone, iPod Touch, and Android-based phones
An experimental form of attentional training has been shown in several previous studies to reduce social anxiety, generalized anxiety, and worry to a greater extent than control/placebo training. This method has a foundation in established theories of attentional processing, social anxiety, and worry.
Researchers at Harvard University are conducting a randomized controlled trial to test the training on handheld devices.
Your commitment will be to perform a simple training task on your handheld for three 2.5-minute sessions per day for 4 weeks.
- You must have your own iPhone, iPod Touch, or Android-based phone (most but not all models will work)
- You must be aged 18 or older
- You must have the English language skills to read and understand the instructions and the online consent form we will provide
- You must be willing to commit to a 4-week flexible training program
- You should have a relatively high level of social anxiety, worry, or generalized anxiety (or any combination of these), with or without any diagnosis
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