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Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review

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Abstract

Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.

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Notes

  1. DSM-5 will state almost unchanged criteria.

  2. There was only a small overlap (3) with the present review regarding empirical studies [2426].

  3. As items of standardized questionnaires measuring high social anxiety and high shyness are often very similar (e.g. SASC-R [48] and RCBS [49], example item SASC-R: “I feel shy around kids I don’t know” example item RCBS: “I feel tense when I’m with people I don’t know well”), these concepts will be considered almost equivalent in this review.

  4. According to Cohen [50], d = 0.2 indicates a small effect, d = 0.5 indicates a medium effect, and d = 0.8 indicates a large effect. Regarding the effect size f, f = 0.10 indicates a small effect, f = 0.25 indicates a medium effect, and f = 0.40 indicates a large effect [50]. Regarding Pearson’s r, according to Cohen [50], r = 0.10 is a small effect, r = 0.30 is a medium effect and r = 0.50 is a large effect.

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Siess, J., Blechert, J. & Schmitz, J. Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 23, 127–142 (2014). https://doi.org/10.1007/s00787-013-0443-5

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  • DOI: https://doi.org/10.1007/s00787-013-0443-5

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