Skip to main content
Log in

Using the Subtle Avoidance Frequency Examination in Adolescent Social Anxiety Assessments

  • Original Paper
  • Published:
Child & Youth Care Forum Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Hunsley, J., & Lee, C. M. (2010). Introduction to clinical psychology. Hoboken: Wiley.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  Google Scholar 

  • March, J. S. (1997). Manual for the Multidimensional Anxiety Scale for Children (MASC). Toronto: Multi-Health Systems.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Andres De Los Reyes.

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10566-012-9181-y

Keywords

Navigation