Articles

Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64(2), 333-342. doi:10.1037/0022-006X.64.2.333

Brook, C. A., & Schmidt, L. A. (2008). Social anxiety disorder: A review of environmental risk factors. Neuropsychiatric Disease and Treatment, 4(1), 123-143.

Caballo, V. E., Arias, B., Salazar, I. C., Calderero, M., Irurtia, M. J., & Ollendick, T. H. (2012). A new selfreport assessment measure of social phobia/anxiety in children: The social anxiety questionnaire for children. Psicología Conductual, 20(3), 485.

Ginsburg, G. S., Siqueland, L., Masia-Warner, C., & Hedtke, K. A. (2004). Anxiety disorders in children: Family matters. Cognitive and Behavioral Practice, 11(1), 28-43. doi:10.1016/S1077-7229(04)80005-1

Ginsburg, G. S., & Schlossberg, M. C. (2002). Family-based treatment of childhood anxiety disorders. International Review of Psychiatry, 14(2), 143-154. doi:10.1080/09540260220132662

Ginsburg, G. S., La Greca, A. M., & Silverman, W. K. (1998). Social anxiety in children with anxiety disorders: Relation with social and emotional functioning. Journal of Abnormal Child Psychology, 26(3), 175-185. doi:10.1023/A:1022668101048

Ginsburg, G. S., Silverman, W. K., & Kurtines, W. K. (1995). Family involvement in treating children with phobic and anxiety disorders: A look ahead. Clinical Psychology Review, 15(5), 457-473. doi:10.1016/0272-7358(95)00026-L

Goldin, P. R., Morrison, A. S., Jazaieri, H., Heimberg, R. G., & Gross, J. J. (2017). Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behaviour Research and Therapy, 97, 1-13. doi:10.1016/j.brat.2017.06.001

Goldin, P. R., Ziv, M., Jazaieri, H., Weeks, J., Heimberg, R. G., & Gross, J. J. (2014). Impact of cognitive behavioral therapy for social anxiety disorder on the neural bases of emotional reactivity to and regulation of social evaluation. Behaviour Research and Therapy, 62, 97-106. doi:10.1016/j.brat.2014.08.005

Lee, S., Palmer, S. B., Turnbull, A. P., & Wehmeyer, M. L. (2006). A model for parent-teacher collaboration to promote self-determination in young children with disabilities. TEACHING Exceptional Children, 38(3), 36-41.

Morris, T. L., & Oosterhoff, B. (2016). Observed mother and father rejection and control: Association with child social anxiety, general anxiety, and depression. Journal of Child and Family Studies, 25(9), 2904-2914. doi:10.1007/s10826-016-0448-z

Thompson, B. L., & Waltz, J. A. (2007;2008;). Mindfulness, self-esteem, and unconditional selfacceptance. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 26(2), 119-126. doi:10.1007/s10942-007-0059-0

Apps and activities

Social anxiety self-check:

this is a useful tool to identify social anxiety.

Camp Cope A-Lot: 

based on cognitive behaviour therapy, Camp Cope-A-Lot offers an online program for children with social anxiety disorders.

visual schedules:

The visual schedules help children with social anxiety by making daily events predictable and structured. Therefore, their anxiety will reduced due to predictability and a sense of controlling over the situations.

Free download

Activities:

These are 10 activities to support kids with anxiety disorders.

kit:

This Resilience Kit is a collection of printable worksheets, posters activities, and coloring pages designed to help children develop grit, resilience, and perseverance.

Mindfulness

Mindfulness is a type of meditation that can help decreasing stress and anxiety. mindfulness, in fact, is a practice of being at the moment and focused on your breathing, and using imagery to relax both body and mind. Social anxiety is a fear of being in a social situation and being negatively judged. Indeed, in a social situation, children with SAD might experience physical and emotional symptoms which has a negative effect on their mental and physical wellbeing such as Shaking, sweating, upset stomach, rapid heartbeats, and being stressed and anxious. Mental and emotional training. Therefore, can be useful for children with SAD. Jozsef, (2020) notes that mindfulness is in fact a sense of acceptance and paying attention to feelings without judging them or without considering right or wrong. In other words, we can increase self-esteem by the use of mindfulness practices which play an important role in supporting SAD.

In order to gain a better result in Self-determination through Cognitive Behavoiur Therapy (CBT) and Self-Determined Learning Model of intervention (SDLMI), mindfulness-based stress reduction MBSR is an effective way implemented along with the interventions offered in my study both for parents at home and teachers at school. On the one hand, Through CBT, the child with SAD learns that social situations are not threatening and we should face our fear and train our minds on how to confront the fears. Therefore, as we can see in the study conducted by Goldin, et al. (2017), mindfulness-based stress reduction MBSR and cognitive behaviour therapy CBT are complementary in a way that they both decrease social anxiety and increase reappraisal (changing the way of thinking) and mindfulness (mindful attitude). CBT helps SAD by disputing anxious thoughts/feelings and reappraisal success and, MBSR produces greater acceptance of anxiety and acceptance success. On the other hand, Social exposures must be arranged to provide evidence to violate the assumptions that the social situation is socially or emotionally dangerous. This is achieved by helping children think through, define, and discover what constitutes adequate social performance while having adequate practice in social situations to allow anxiety to dissipate. Elements of exposure also help to realize how their anxiety changes as their attentional focus shifts and as they persist in once avoided social situations. Hejeltness, et al. (2019) stated that MBRS can help children with SAD in a way that it increases awareness and acceptance of sensations, thoughts, and feelings, as well as greater self-acceptance and improved interpersonal relationships (p.35).  Besides, the aim of CBT and SDLMI is to increase self-esteem in children with SAD. Thompson, and Waltz, (2007;2008;) realized a significant relationship between MBRS and increased self-esteem and self-acceptance in their study as mindfulness helps to develop a less ego-centered approach to one’s experience and cultivate higher acceptance of the present moment and consequently increases self-acceptance.

There are three aspects in MBRS:

1.Intension: what is the goal for using mindfulness? Is it to decrease stress, anxiety or for emotional balance.

2. Attention: paying attention to your inner and outer experience and practice mindfulness constantly.

3. Attitude: paying attention to some attitudes such as acceptance.

There are different types of mindfulness practices:

Brain Training:

Train to brain to be focused and stay in present

Breathing:

focus on natural flow of your breath

Body Scan:

pay attention to all your body parts and connect to the body and the feelings without judgment.

Nature:

pay attention to the features of the nature such as sounds, smells, and colors

Gratitude:

appreciate all blessings we have and stay away from misfortunes we face

MBSR is an easy intervention that can be implemented both at home by parents and at school by teachers in order to have a better result. Parents and teachers, also, can benefit from mindfulness practice to cope with their own stress and anxiety. providing a safe and relaxing home environment and a fun and relaxing classroom environment motivate children to have a better function in their studies and lifelong skills such as coping skills and communication. As we can see in parents.com, practicing mindfulness increase attention and reduce stress and helps students to regulate their emotion and feel empathy. There is a science-based mindfulness curriculum that can be used at schools. visit MindUp.

Parents also can use some of the same lessons teachers use in the classroom at home such as breathing practices (blowing bubbles) or going to nature and ask the child to pay attention to nature, sounds, smells, textures, and explore nature.

Parent’ Involvement

Parent involvement in treatment can enhance treatment effects and help parents to change dysfunctional parent-child interactions when the children face social situations. Garcia-Lopez et al.’s (2014) study was a quantitative study that showed interventions, post-treatment, and follow-up for children’s SAD. The anxiety and expressed emotion in children and parents were measured through semi-structured audiotaped interviews, which increased the validity of the method. The participants of Garcia-Lopez et al.’s study were comprised of 52 adolescents with SAD aged 13-18, all with social phobia. Garcia-Lopez et al. chose two groups: one group with parents’ training and intervention for parents, and the other group without parents’ training and intervention for parents. Garcia-Lopez et al. used semi-structured interviews for the diagnostic measures before and after treatment. The study includes four stages: screening, pre-treatment, post-treatment, and a 12-month follow-up assessment in the school environment. Finally, Garcia-Lopez et al. compared two groups with each other. Data revealed that children with parents’ training reported greater improvement in SAD. Parents’ training not only resulted in reductions in Social Anxiety symptomatology but also resulted in a similar decrease in depression symptomatology.

When the main reason for social anxiety in children is their parents’ behavior, it is obvious that parents need supports and interventions to help their children with SAD. Garcia-Lopez et al. used post-treatment and 12-month follow-up, which could help them to draw more consistent conclusions according to follow-up results. One of the most important weaknesses in Garcia-Lopez et al.’s work was that only child measures were used to evaluate treatment outcomes and they did not measure parents’ EE levels again. As children with Social Anxiety present substantially increased risks of depression, suicide attempts, substance abuse, severe social restriction, and lower educational attainment, Garcia-Lopez et al. suggested that high EE-parents of children with Social Anxiety need to be involved in their child’s therapy.

parents with a high level of Expressed Emotion

Parents with a high level of Expressed Emotion (EE) such as criticism and/or hostility need training to improve the outcome for alleviating their children’s social anxiety.

Garcia-Lopez, Díaz-Castela, Muela-Martinez, and Espinosa-Fernandez’s (2014) findings revealed that parents’ high level of EE was significantly associated with their children’s poor treatment outcomes. Indeed, it is important to identify the parents with behaviours that affect their children’s SAD and to help the parents to eliminate the problem related to their behaviours. Because parental high EE has been found to be related to the treatment outcome in socially anxious children, Garcia-Lopez et al.’s research aim to examine whether adding a parent training intervention to decrease high levels of parental EE would improve the treatment outcome for children with SAD. Garcia-Lopez et al.’s research was a call to action for the parents with EE to receive training and interventions in order to support the improvement of their children’s social anxiety. Garcia-Lopez et al.’s study hypothesized that parents’ involvement may play important roles in improving children’s social anxiety.

The Positive Effects of Parents’ Training on Lessening their Children’s Social Anxiety

Research showed that family-based intervention is an effective way to increase the positive results from treatments of children with SAD (Barrett et al., 1996; Ginsburg et al., 1995). When parents’ behaviour is considered a risk factor for their children’s SAD, the most effective alternative for supporting children with SAD is to train their parents (Garcial-Lopez et al., 2014). Parents might not be aware of the consequences of their behaviours, or they might not have sufficient knowledge or experience of identifying and implementing an effective strategy to support their children with SAD. Therefore, parents need either different types of resources, such as media, websites, blogs, books, or implementing a collaborative relationship with teachers to increase their knowledge about how to support their children with SAD.

Brendel and Maynard (2014) illustrated that parent-child interventions seem to be more effective than implementing interventions for only children. In other words, integrating parents into child therapy is considered as a means to generalize interventions to the home environment and for both the children and the parents to learn and practice better methods to cope with children’s SAD.

 

Parents’ Behaviour

The parent-child relationship may be a primarily important context for the development and health of children. Parents are thought to participate in behaviours that influence children’s social and emotional regulation skills, self-efficacy, self-determination, and mastery, which in turn may contribute to children’s SAD. Morris and Oosterhoff (2016) conducted a subjective study based on an observation of different families with different educational levels to identify the relationship between parents’ behavior and children’s Social Anxiety. Morris and Oosterhoff stated two main purposes for their study. The first aim was to comprehensively examine whether specific types of mothers’ and fathers’ rejecting or controlling behavior were associated with child social anxiety. The second aim was to explore whether the association among observed mothers’ and fathers’ rejecting and controlling behaviors and children’s Social Anxiety varied by the gender of the child.

Examining specific parenting behaviors that are linked with children’s internalizing symptoms may help parents further elucidate how parent-child interactions contribute to the development of child anxiety and depression. The article by Morris and Oosterhoff hypothesized that mothers’ and fathers’ specific parenting behaviors are associated with children’s Social Anxiety. Parenting styles are thought to play an important role in the development of important life skills and competencies necessary for healthy emotional adjustment and wellbeing throughout one’s life. Morris and Oosterhoff used semi-structured interviews and observed parent-child interaction tasks. This method allowed Morris and Oosterhoff to observe a diverse range of behaviors, including the possibility for supportive or critical communication between family members. The participants were a sample of 90 children who had two-parent’s family and whose fathers and mothers were biological parents. The study of Morris and Oosterhoff illustrated that mothers’ and fathers’ verbal and nonverbal control and rejection behaviors were associated with child anxiety, and these associations differed between the boys and girls. Mothers’ and fathers’ behaviors, such as rejection and control played an important role in children’s social anxiety. Identifying parents’ behavior as a risk factor for SAD in children is an opportunity to support children with SAD with effective interventions and training for both parents and children. Parents’ rejection or controlling behaviors play different roles in various family environments. As anxiety and depression are among the most common forms of psychopathology and might have developmental roots in late childhood, the findings from Morris and Oosterhoff’s article suggested that specific mothers’ and fathers’ parenting behaviors are associated with children’s social anxiety.

Interventions for Social Anxiety Disorders

Medication: Medication

according to Fader (2018), if your anxiety stops you from normal functioning during the day, your doctor may prescribe you anti-anxiety medications. When you can’t take care of your basic needs, like going to work, or interacting with other people, medications for anxiety can be a help to everyday functioning. There are many different medications for social anxiety. However, certain ones are considered the most common medications for social anxiety. Preferred social anxiety medication options include:

  • Luvox CR
  • Paxil
  • Inderal
  • Zoloft
  • Effexor XR
  • Sertraline

Psycho-Therapy: Psycho- therapy

According to McEvoy et al. (2017), Negative, distorted self-images are the important features of social anxiety disorder, and working with imagery can make cognitive-behavioral therapy (CBT) more effective for those who struggle with social anxiety. CBT focuses on beliefs and attitudes that are related to a person’s behaviour and emotional problems. CBT can fine unhealthy beliefs and behaviours in people with social anxiety by applying strategies and interventions and helps developing alternative positive attitudes.

Strategies

https://education.jhu.edu/2018/03/strong-curricula-an-intervention-that-works/

Now there is a question. Why early intervention is so important?  

In a study by Nores and Barnett (2010), A total of 56 studies reporting the effects of 30 interventions (and 38 contrasts) in 23 countries in Europe, Asia, Africa, Central, and South America are analyzed. they coded studies on the type of intervention (cash transfer, nutritional, educational or mixed), the sample size of the control and treatment group, the study design, the country of intervention, subpopulations of interventions, follow-ups, whether it targeted infants, pre-K age children or both, and dosage. they find children from different contexts and countries receive substantive benefits across all dimensions, and that interventions providing direct care or education to be more effective particularly in terms of cognition. The results of the study show the importance of early intervention in children.

Children with social anxiety need further supports and interventions implemented at both school and home. There are different kinds of interventions that we can use for supporting children. Based on each child’s need, the type of interventions we might implement differs.

Self-Determined Learning Model of Intervention (SDLMI)

https://www.semanticscholar.org/paper/The-Self-Determined-Learning-Model-of-Instruction-Raley-Burke/9746a0dc1a97009e1dfba1a4fc80d0094933ff89

 Lee et al. (2006) introduced the self-determined learning model of support which parents can use to promote self-determination in young children. The model also offered teachers the opportunity to build a collaborative partnership with parents. The article illustrated the effectiveness of the Self-Determine Learning Model of Intervention (SDLMI) from nominalists’ and post-positivists’ points of view according to the experience and observations of the model. The purpose of Lee et al.’s study was to offer a model for parent-teacher collaboration to promote self-determination in young children with disabilities. Lee et al. hypothesized that the efforts to promote self-determination are more likely to be successful when there is a collaboration between parents and teachers. Home offers children the earliest opportunity to make choices, exercise control, and exhibit competence. Many parents want their children to become more self-determined, so teachers must consider this when working with children with disabilities.

https://selfdetermination.ku.edu/homepage/intervention/

Using qualitative methods, Lee et al. illustrated a family’s experience of implementing the SDLMI model. The participant’s name was Young, an 8-year-old boy with down syndrome who does not have many friends, and the boy’s mother had to spend time with the boy’s brother as well. SDLMI is in form of questions to identify the problem, identify potential solutions to the problem, identify the barriers to solve the problem and identify consequences to each solution. If a teacher is using SDLMI in the classroom, parents should work on a complementary process at home. The schoolteacher suggested SDLMI support Young’s goals at school and recommended that his mother implement the model at home as a way to encourage Young’s self-determination. SDLMI consists of three phases. Students are supposed to ask specific questions from themselves in each phase and find a solution by the answer to the questions. The question at phase one is “What is my goal?”. The goal for Young was to have an after-school social activity with friends. Phase two is taking action, and the question is “What is my plan?”. Young decided to invite a neighborhood friend to play with. “What have I learned?” is in Phase Three, which is adjusting the goal or plan. Three months later, Young became better at playing basketball with friends. The positive outcomes of the plan were: (a) Young now plays and practices basketball with friends, and (b) his mom now has more time to work with Young’s brother. The SDLMI model is equally appropriate for children with and without disabilities across a wide range of goal content areas, from academic to family decision making. The general process embedded in the model was equally applicable for use by parents at home and by teachers in an educational context. Lee et al. described the model with a successful example of a family which made the model more comprehensive for the readers. However, Lee et al.’s article could illustrate an example of the SDLMI model implemented for a child without disabilities and make comparisons in the effectiveness of the model for children with or without disabilities. Enhanced self-determination contributes to positive individual quality of life outcomes. Promoting self-determination in young children with disabilities may affect not only the children’s quality of life but also the quality of life for their families. According to Lee et al., the SDLMI is an effective method for children with disabilities and it can be implemented by both parents at home and teachers at school.