Abstract
Background
Individuals with social anxiety use safety behaviors to directly or indirectly avoid social situations (e.g., remaining quiet in a social setting to avoid saying anything embarrassing). Safety behaviors have been hypothesized to prevent the disconfirmation of feared occurrences while in social situations. Further, research indicates that use of safety behaviors garners negative reactions from others while in social situations, indicating a link between such behaviors and social skills deficits.
Objective
In light of the focus on addressing social skill deficits in current evidence-based treatments for adolescent social anxiety, we examined whether a measure for assessing safety behaviors in adults [Subtle Avoidance Frequency Examination (SAFE; Cuming et al. in J Anxiety Disord 23(7):879–883 2009)] could be used reliably and validly in adolescent assessments.
Methods
Participants were 40 adolescents (total sample: age range 14–17 years; 14 boys and 26 girls; M = 15.15 years; SD = 0.97) allocated into age- and gender-matched groups in terms of whether they were (n = 20) or were not (n = 20) clinic referred for a social anxiety assessment.
Results
Results demonstrate that the SAFE (a) has adequate internal consistency; (b) relates positively and uniquely to a widely used measure of adolescent social anxiety, when considering measures of other distinct psychopathology domains; and (c) differentiates clinic referred from community control adolescents.
Conclusions
These findings indicate that the SAFE can be reliably and validly administered in adolescent social anxiety assessments and thus have implications for improvements in treatment monitoring and the study of mechanisms of change for adolescent social anxiety treatments.
Similar content being viewed by others
References
Alfano, C. A., Pina, A. A., Villalta, I. K., Beidel, D. C., Ammerman, R. T., & Crosby, L. E. (2009). Mediators and moderators of outcome in the behavioral treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9), 945–953. doi:10.1097/CHI.0b013e3181af8216.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th edn). Washington, DC: American Psychiatric Association.
Anderson, E. R., Veed, G. J., Inderbitzen-Nolan, H. M., & Hansen, D. J. (2010). An evaluation of the applicability of the tripartite constructs to social anxiety in adolescents. Journal of Clinical Child and Adolescent Psychology, 39(2), 195–207. doi:10.1080/15374410903532643.
Aune, T., & Stiles, T. C. (2009). The effects of depression and stressful life events on the development and maintenance of syndromal social anxiety: Sex and age differences. Journal Of Clinical Child And Adolescent Psychology, 38(4), 501–512. doi:10.1080/15374410902976304.
Baldwin, J. S., & Dadds, M. R. (2007). Reliability and validity of parent and child versions of the Multidimensional Anxiety Scale for Children in community samples. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 252–260.
Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Hofler, M., Lieb, R., et al. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903–912. doi:10.1001/archpsyc.64.8.903.
Beidel, D. C., Turner, S. M., Sallee, F. R., Ammerman, R. T., Crosby, L. A., & Pathak, S. (2007a). SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 46(12), 1622–1632. doi:10.1097/chi.0b013e318154bb57.
Beidel, D. C., Turner, S. M., Young, B. J., Ammerman, R. T., Sallee, F. R., & Crosby, L. (2007b). Psychopathology of adolescent social phobia. Journal of Psychopathology and Behavioral Assessment, 29(1), 47–54. doi:10.1007/s10862-006-9021-1.
Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self- report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23(7), 879–883.
Dozois, D. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10(2), 83–89.
Hedtke, K. A., Kendall, P. C., & Tiwari, S. (2009). Safety-seeking and coping behavior during exposure tasks with anxious youth. Journal of Clinical Child and Adolescent Psychology, 38(1), 1–15. doi:10.1080/15374410802581055.
Hunsley, J., & Lee, C. M. (2010). Introduction to clinical psychology. Hoboken: Wiley.
IBM Corporation (2009). IBM SPSS data collection (version 5.6) [Computer Software]. Somers, NY: IBM Corporation.
Inderbitzen, H. M., & Hope, D. A. (1995). Relationship among adolescent reports of social anxiety, anxiety, and depressive symptoms. Journal of Anxiety Disorders, 9(5), 385–396. doi:10.1016/0887-6185(95)00019-k.
Kessler, R. C. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica, 108(Suppl417), 19–27. doi:10.1034/j.1600-0447.108.s417.2.x.
Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16, 52–65.
Kessler, R. C., Stang, P. P., Wittchen, H. U., Stein, M. M., & Walters, E. E. (1999). Lifetime comorbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological Medicine: A Journal of Research In Psychiatry And The Allied Sciences, 29(3), 555–567. doi:10.1017/S0033291799008375.
Kim, E. (2005). The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics. Journal of Anxiety Disorders, 19(1), 69–86. doi:10.1016/j.janxdis.2003.11.002.
Kim, K. L., Parr, A. F., & Alfano, C. A. (2011). Behavioral and cognitive behavioral treatments for social anxiety disorder in adolescents and young adults. In C. A. Alfano, & D. C. Beidel (Eds.), Social anxiety in adolescents and young adults: Translating developmental science into practice (pp. 245–264). Washington, DC: American Psychological Association.
Loeber, R., Dishion, T. J., & Patterson, G. R. (1984). Multiple gating: A multistage assessment procedure for identifying youths at risk for delinquency. Journal of Research in Crime & Delinquency, 21(1), 7–32.
March, J. S. (1997). Manual for the Multidimensional Anxiety Scale for Children (MASC). Toronto: Multi-Health Systems.
McManus, F., Clark, D. M., Grey, N., Wild, J., Hirsch, C., Fennell, M., et al. (2009). A demonstration of the efficacy of two of the components of cognitive therapy for social phobia. Journal of Anxiety Disorders, 23(4), 496–503. doi:10.1016/j.janxdis.2008.10.010.
McManus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39(2), 147–161. doi:10.1016/j.jbtep.2006.12.002.
Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77(2), 317–327.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6–19. doi:10.1017/S0141347300011472.
Scharfstein, L. A., Beidel, D. C., Finnell, L. R., Distler, A., & Carter, N. T. (2011). Do pharmacological and behavioral interventions differentially affect treatment outcome for children with social phobia? Behavior Modification, 35(5), 451–467. doi:10.1177/0145445511408590.
Silverman, W. K., & Albano, A. M. (1996). The Anxiety Disorders Interview Schedule for Children for DSM-IV: (Child and Parent Versions). San Antonio, TX: Psychological Corporation.
Silverman, W. K., & Ollendick, T. H. (2005). Evidence-based assessment of anxiety and its disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 380–411.
Stein, M. B., Fuetsch, M., Müller, N., Höfler, M., Lieb, R., & Wittchen, H. (2001). Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry, 58(3), 251–256. doi:10.1001/archpsyc.58.3.251.
Taylor, C. T., & Alden, L. E. (2010). Safety behaviors and judgmental biases in social anxiety disorder. Behaviour Research and Therapy, 48(3), 226–237. doi:10.1016/j.brat.2009.11.005.
Taylor, C. T., & Alden, L. E. (2011). To see ourselves as others see us: An experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder. Journal of Abnormal Psychology, 120(1), 129–141. doi:10.1037/a0022127.
Wells, A., Clark, D. M., Salkovskis, P., & Ludgate, J. (1995). Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26(1), 153–161. doi:10.1016/S0005-7894(05)80088-7.
Wood, J. J., Piacentini, J. C., Bergman, R., McCracken, J., & Barrios, V. (2002). Concurrent validity of the Anxiety Disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. Journal of Clinical Child and Adolescent Psychology, 31(3), 335–342. doi:10.1207/S15374424JCCP3103_05.
Acknowledgments
This work was supported, in part, by an internal grant from the University of Maryland (College of Behavioral and Social Sciences Dean’s Research Initiative) awarded to Andres De Los Reyes. We are grateful to Amelia Aldao, William Lechner, Anna Swan, Michael Van Wie, and Ho-Man Yeung for their assistance with data collection and administration of study training protocols.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thomas, S.A., Daruwala, S.E., Goepel, K.A. et al. Using the Subtle Avoidance Frequency Examination in Adolescent Social Anxiety Assessments. Child Youth Care Forum 41, 547–559 (2012). https://doi.org/10.1007/s10566-012-9181-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-012-9181-y