Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-23T19:57:13.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions

Published online by Cambridge University Press:  28 July 2020

Barbara Hoff Esbjørn Open the ORCID record for Barbara Hoff Esbjørn [Opens in a new window] ,
Anette Falch ,
Monika Anna Walczak ,
Nicoline Normann Open the ORCID record for Nicoline Normann [Opens in a new window]  and
Sonja Breinholst
Barbara Hoff Esbjørn
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Anette Falch
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Monika Anna Walczak*
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Nicoline Normann
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Sonja Breinholst
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD.

Aim:

The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children.

Method:

We enrolled 122 clinically anxious children aged 7–13 years; of these, 33 had an SAD diagnosis.

Results:

SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis.

Conclusions:

Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Keywords

automatic thoughtschildmetacognitionrepetitive negative thinkingsocial anxiety disorder
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 2 , March 2021 , pp. 159 - 171
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: the generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24.CrossRefGoogle ScholarPubMed
Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H.-U. (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, 903–912. https://doi.org/10.1001/archpsyc.64.8.903 CrossRefGoogle ScholarPubMed
Bijttebier, P., Raes, F., Vasey, M. W., Bastin, M., & Ehring, T. W. (2015). Assessment of repetitive negative thinking in children: the Perseverative Thinking Questionnaire – Child Version (PTQ-C). Journal of Psychopathology and Behavioral Assessment, 37, 164–170. https://doi.org/10.1007/s10862-014-9446-x CrossRefGoogle Scholar
Calvete, E., Orue, I., & Hankin, B. L. (2013). Early maladaptive schemas and social anxiety in adolescents: the mediating role of anxious automatic thoughts. Journal of Anxiety Disorders, 27, 278–288. https://doi.org/10.1016/j.janxdis.2013.02.011 CrossRefGoogle ScholarPubMed
Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusion: the Meta-Cognitions Questionnaire and its correlates, 11, 279–296.CrossRefGoogle Scholar
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835–855. https://doi.org/10.1016/S0005-7967(99)00130-8 CrossRefGoogle ScholarPubMed
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (eds), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69–93). New York, USA: Guilford Press.Google Scholar
Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42, 225–232. https://doi.org/10.1016/j.jbtep.2010.12.003 CrossRefGoogle ScholarPubMed
Ellis, D. M., & Hudson, J. L. (2010). The metacognitive model of generalized anxiety disorder in children and adolescents. Clinical Child and Family Psychology Review, 13, 151–163.CrossRefGoogle ScholarPubMed
Ellis, D., & Hudson, J. (2011). Test of the metacognitive model of generalized anxiety disorder in anxiety-disordered adolescents. Journal of Experimental Psychopathology, 2, 28–43. https://doi.org/10.5127/jep.011910 CrossRefGoogle Scholar
Esbjørn, B. H., Lønfeldt, N. N., Nielsen, S. K., Reinholdt-Dunne, M. L., Sømhovd, M. J., & Cartwright-Hatton, S. (2015). Meta-worry, worry, and anxiety in children and adolescents: relationships and interactions. Journal of Clinical Child & Adolescent Psychology, 44, 145–156.CrossRefGoogle ScholarPubMed
Esbjørn, B. H., Sømhovd, M. J., Turnstedt, C., & Reinholdt-Dunne, M. L. (2012). Assessing the Revised Child Anxiety and Depression Scale (RCADS) in a national sample of Danish youth aged 8–16 Years. PLoS ONE, 7, e37339. https://doi.org/10.1371/journal.pone.0037339 CrossRefGoogle Scholar
Esbjørn, , Sømhovd, M. J., Holm, J. M., Lønfeldt, N. N., Bender, P. K., Nielsen, S. K., & Reinholdt-Dunne, M. L. (2013). A structural assessment of the 30-item Metacognitions Questionnaire for Children and its relations to anxiety symptoms. Psychological Assessment, 25, 1211–1219. https://doi.org/10.1037/a0033793 CrossRefGoogle ScholarPubMed
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160. https://doi.org/10.3758/BRM.41.4.1149 CrossRefGoogle ScholarPubMed
Fields, A. (2015). Discovering Statistics Using IBM Spss Statistics + Sage IBM SPSS Statistics V 23.0, Student Version (4th edn). Sage Publications.Google Scholar
Fisak, B., & Hammond, A. N. (2013). Are positive beliefs about post-event processing related to social anxiety? Behaviour Change, 30, 36–47. https://doi.org/10.1017/bec.2013.4 CrossRefGoogle Scholar
Halldorsson, B., & Creswell, C. (2017). Social anxiety in pre-adolescent children: what do we know about maintenance? Behaviour Research and Therapy, 99, 19–36. https://doi.org/10.1016/j.brat.2017.08.013 CrossRefGoogle ScholarPubMed
Hearn, C. S., Donovan, C. L., Spence, S. H., March, S., & Holmes, M. C. (2017). What’s the worry with social anxiety? Comparing cognitive processes in children with generalized anxiety disorder and social anxiety disorder. Child Psychiatry & Human Development, 48, 786–795. https://doi.org/10.1007/s10578-016-0703-y CrossRefGoogle ScholarPubMed
Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2018). Do worry and its associated cognitive variables alter following CBT treatment in a youth population with social anxiety disorder? Results from a randomized controlled trial. Journal of Anxiety Disorders, 53, 46–57.CrossRefGoogle Scholar
Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder. In Social Anxiety (pp. 395–422). Elsevier. https://doi.org/10.1016/B978-0-12-375096-9.00015-8 CrossRefGoogle Scholar
Hodson, K. J., McManus, F. V, Clark, D. M., & Doll, H. (2008). Can Clark and Wells’ (1995) cognitive model of social phobia be applied to young people. Behavioural and Cognitive Psychotherapy, 36, 449–461. https://doi.org/10.1017/S1352465808004487 CrossRefGoogle Scholar
Hogendoorn, S. M., Prins, P. J. M., Boer, F., Vervoort, L., Wolters, L. H., Moorlag, H., … & de Haan, E. (2014). Mediators of cognitive behavioral therapy for anxiety-disordered children and adolescents: cognition, perceived control, and coping. Journal of Clinical Child & Adolescent Psychology, 43, 486–500. https://doi.org/10.1080/15374416.2013.807736 CrossRefGoogle Scholar
Hogendoorn, S. M., Prins, P. J. M., Vervoort, L., Wolters, L. H., Nauta, M. H., Hartman, C. A., … & Boer, F. (2012). Positive thinking in anxiety disordered children reconsidered. Journal of Anxiety Disorders, 26, 71–78. https://doi.org/10.1016/j.janxdis.2011.09.003 CrossRefGoogle ScholarPubMed
Hogendoorn, S. M., Wolters, L. H., Vervoort, L., Prins, P. J. M., Boer, F., Kooij, E., & de Haan, E. (2010). Measuring negative and positive thoughts in children: an adaptation of the Children’s Automatic Thoughts Scale (CATS). Cognitive Therapy and Research, 34, 467–478. https://doi.org/10.1007/s10608-010-9306-2 CrossRefGoogle Scholar
IBM Corporation (2017). IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY,USA: IBM Corporation.Google Scholar
Kessler, R. C. (2003). The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatrica Scandinavica, 108, 19–27. https://doi.org/10.1034/j.1600-0447.108.s417.2.x CrossRefGoogle Scholar
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21, 169–184. https://doi.org/10.1002/mpr.1359 CrossRefGoogle ScholarPubMed
Klemanski, D. H., Curtiss, J., McLaughlin, K. A., & Nolen-Hoeksema, S. (2017). Emotion regulation and the transdiagnostic role of repetetive negative thinking in adolescents with social anxiety and depression. Cognitive Therapy Research, 41, 206–219.CrossRefGoogle Scholar
Kodal, A., Fjermestad, K., Bjelland, I., Gjestad, R., Öst, L.-G., Bjaastad, J. F., … & Wergeland, G. J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders, 53, 58–67. https://doi.org/10.1016/j.janxdis.2017.11.003 CrossRefGoogle ScholarPubMed
Lamberton, A., & Oei, T. P. S. (2008). A test of the cognitive content specificity hypothesis in depression and anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 39, 23–31. https://doi.org/10.1016/j.jbtep.2006.11.001 CrossRefGoogle ScholarPubMed
Lønfeldt, N. N., Silverman, W., & Esbjørn, B. H. (2017). A systematic review and meta-analysis of the association between third-wave cognitive constructs and youth anxiety. International Journal of Cognitive Therapy, 10, 115–137.CrossRefGoogle 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, 147–161. https://doi.org/10.1016/j.jbtep.2006.12.002 CrossRefGoogle ScholarPubMed
Micco, J. A., & Ehrenreich, J. T. (2009). Validity and specificity of the children’s automatic thoughts scale in clinically anxious and non-clinical children. Cognitive Therapy and Research, 33, 532–536. https://doi.org/10.1007/s10608-009-9230-5 CrossRefGoogle Scholar
Muris, P., Meesters, C., & Gobel, M. (2001). Reliability, validity, and normative data of the Penn State Worry Questionnaire in 8–12-yr-old children. Journal of Behavior Therapy and Experimental Psychiatry, 32, 63–72. https://doi.org/10.1016/S0005-7916(01)00022-2 CrossRefGoogle ScholarPubMed
Muris, P., Merckelbach, H., & Damsma, E. (2000). Threat perception bias in nonreferred, socially anxious children. Journal of Clinical Child Psychology, 29, 348–359. https://doi.org/10.1207/S15374424JCCP2903_6 CrossRefGoogle ScholarPubMed
Niekerk, R. E. van, Klein, A. M., Dam, E. A., Hudson, J. L., Rinck, M., Hutschemaekers, G. J. M., & Becker, E. S. (2017). The role of cognitive factors in childhood social anxiety: social threat thoughts and social skills perception. Cognitive Therapy and Research, 41, 489–497. https://doi.org/10.1007/s10608-016-9821-x CrossRefGoogle ScholarPubMed
Nordahl, H., & Wells, A. (2017). Testing the metacognitive model against the benchmark CBT model of social anxiety disorder: is it time to move beyond cognition? PLOS One, 12, 1–11. https://doi.org/10.1371/journal.pone.0177109 CrossRefGoogle ScholarPubMed
Normann, N., & Morina, N. (2018). The efficacy of metacognitive therapy: a systematic review and meta-analysis. Frontiers in Psychology, 9, 2211.CrossRefGoogle ScholarPubMed
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. https://doi.org/10.1016/S0005-7967(97)00022-3 CrossRefGoogle ScholarPubMed
Schmitz, J., Krämer, M., Blechert, J., & Tuschen-Caffier, B. (2010). Post-event processing in children with social phobia. Journal of Abnormal Child Psychology, 38, 911–919. https://doi.org/10.1007/s10802-010-9421-2 CrossRefGoogle ScholarPubMed
Schmitz, J., Krämer, M., & Tuschen-Caffier, B. (2011). Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: an experimental study. Behaviour Research and Therapy, 49, 789–795. https://doi.org/10.1016/j.brat.2011.09.001 CrossRefGoogle ScholarPubMed
Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV. Oxford, UK: Oxford University Press.Google Scholar
Spada, M. M., Caselli, G., Manfredi, C., Rebecchi, D., Rovetto, F., Ruggiero, G. M., … & Sassaroli, S. (2012). Parental overprotection and metacognitions as predictors of worry and anxiety. Behavioural and Cognitive Psychotherapy, 40, 287–296.CrossRefGoogle ScholarPubMed
Stallard, P. (2014). Anxiety: Cognitive Behaviour Therapy with Children and Young People. Routledge.CrossRefGoogle Scholar
Vassilopoulos, S. P., Brouzos, A., Moberly, N. J., Tsorbatzoudis, H., & Tziouma, O. (2017a). Generalisation of the Clark and Wells cognitive model of social anxiety to children’s athletic and sporting situations. British Journal of Guidance & Counselling, 45, 1–15. https://doi.org/10.1080/03069885.2015.1057474 CrossRefGoogle Scholar
Vassilopoulos, S. P., Brouzos, A., Tsorbatzoudis, H., & Tziouma, O. (2017b). Is positive thinking in anticipation of a performance situation better than distraction? An experimental study in preadolescents. Scandinavian Journal of Psychology, 58, 142–149. https://doi.org/10.1111/sjop.12355 CrossRefGoogle ScholarPubMed
Vassilopoulos, S. P., Moberly, N. J., & Tsoumanis, P. (2014). Social anxiety, anticipatory processing and negative expectancies for an interpersonal task in middle childhood. Journal of Experimental Psychopathology, 5, 151–167. https://doi.org/10.5127/jep.032412 CrossRefGoogle Scholar
Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320. https://doi.org/10.1017/S1352465800015897 CrossRefGoogle Scholar
Wells, A. (2011). Metacognitive Therapy for Anxiety and Depression. New York, USA: Guilford Press.Google Scholar
Submit a response

Comments

No Comments have been published for this article.