Skip to main content

What’s the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder

Abstract

Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8–12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

This is a preview of subscription content, access via your institution.

References

  1. Kashani JH, Orvaschel H (1990) A community study of anxiety in children and adolescents. Am J Psychiatry 147:313

    Article  PubMed  Google Scholar 

  2. Anderson J, Williams S, McGee R, Silva P (1989) Cognitive and social correlates of DSM-III disorders in preadolescent children. J Am Acad Child Adolesc Psychiatry 28:842–846

    Article  PubMed  Google Scholar 

  3. Fichter MM, Kohlboeck G, Quadflieg N, Wyschkon A, Esser G (2009) From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Soc Psychiatry Psychiatr Epidemiol 44:792–803

    Article  PubMed  Google Scholar 

  4. Schneier FR (2006) Social anxiety disorder. N Engl J Med 355:1029–1036

    Article  PubMed  Google Scholar 

  5. Beesdo K et al (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64:903–912

    Article  PubMed  Google Scholar 

  6. Wittchen HU, Stein MB, Kessler RC (1999) Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med 29:309–323

    Article  PubMed  Google Scholar 

  7. Spence SH, Rapee RM, McDonald C, Ingram M (2001) The structure of anxiety symptoms among preschoolers. Behav Res Ther 39:1293–1316

    Article  PubMed  Google Scholar 

  8. Rapee RM, Kennedy S, Ingram M, Edwards S, Sweeney L (2005) Prevention and early intervention of anxiety disorders in inhibited preschool children. J Consult Clin Psychol 73:488–497

    Article  PubMed  Google Scholar 

  9. Davidson JR, Hughes DL, George LK, Blazer DG (1993) The epidemiology of social phobia: findings from the Duke epidemiological catchment area study. Psychol Med 23:709–718

    Article  PubMed  Google Scholar 

  10. Beidel DC & Turner SM (1998) Shy children, phobic adults: Nature and treatment of social phobia. American Psychological Association, Washington, DC.

    Book  Google Scholar 

  11. Walkup JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766

    Article  PubMed  PubMed Central  Google Scholar 

  12. Verduin TL, Kendall PC (2003) Differential occurrence of comorbidity within childhood anxiety disorders. J Clin Child Adolesc Psychol 32:290–295

    Article  PubMed  Google Scholar 

  13. Holmes M, Donovan CL, Farrell LJ, March S (2014) The efficacy of a group-based, disorder-specific treatment program for childhood GAD–A randomized controlled trial. Behav Res Ther 61:122–135

    Article  PubMed  Google Scholar 

  14. Sterba SK et al (2010) Longitudinal dimensionality of adolescent psychopathology: testing the differentiation hypothesis. J Child Psychol Psychiatry 51:871–884

    Article  PubMed  PubMed Central  Google Scholar 

  15. Spence SH, Rapee RM (2016) The etiology of social anxiety disorder: an evidence-based model. Behav Res Ther

  16. Borkovec TD, Robinson E, Pruzinsky T, DePree JA (1983) Preliminary exploration of worry: some characteristics and processes. Behav Res Ther 21:9–16

    Article  PubMed  Google Scholar 

  17. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: version 5 (DSM-5). American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  18. Perrin S, Last CG (1997) Worrisome thoughts in children clinically referred for anxiety disorder. J Clin Child Psychol 26:181–189

    Article  PubMed  Google Scholar 

  19. Weems CF, Silverman WK, La Greca AM (2000) What do youth referred for anxiety problems worry about? Worry and its relation to anxiety and anxiety disorders in children and adolescents. J Abnorm Child Psychol 28:63–72

    Article  PubMed  Google Scholar 

  20. Whitmore MJ, Kim-Spoon J, & Ollendick TH (2013) Generalized anxiety disorder and social anxiety disorder in youth: are they distinguishable? Child Psychiatry Hum Dev :1–8

  21. Boelen PA, Vrinssen I, van Tulder F (2010) Intolerance of uncertainty in adolescents: correlations with worry, social anxiety, and depression. J Nerv Ment Dis 198:194–200

    Article  PubMed  Google Scholar 

  22. Ellis DM, Hudson JL (2010) The metacognitive model of generalized anxiety disorder in children and adolescents. Clin Child Fam Psychol Rev 13:151–163

    Article  PubMed  Google Scholar 

  23. Clark DM, Wells A (1995) A cognitive model of social phobia. In: Heimberg RG, Leibowitz MR, Hope DA, & Schneier FR (eds) Social phobia: Diagnosis, assessment and treatment. Guilfrod Press, New York, p 69–93

    Google Scholar 

  24. Rachman S, Grüter-Andrew J, Shafran R (2000) Post-event processing in social anxiety. Behav Res Ther 38:611–617

    Article  PubMed  Google Scholar 

  25. Abbott MJ, Rapee RM (2004) Post-event rumination and negative self-appraisal in social phobia before and after treatment. J Abnorm Psychol 113:136–144

    Article  PubMed  Google Scholar 

  26. Dugas MJ, Robichaud M (2007) Cognitive-behavioural treatment for generalized anxiety disorder: from science to practice. Routledge, New York

    Google Scholar 

  27. Dugas MJ et al (2007) Can the components of a cognitive model predict the severity of generalized anxiety disorder? Behav Ther 38:169–178

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dugas MJ, Gagnon F, Ladouceur R, Freeston MH (1998) Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther 36:215–226

    Article  PubMed  Google Scholar 

  29. Wells A (1995) Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cogn Psychother 23:301–320

    Article  Google Scholar 

  30. Barlow DH (1988) Anxiety and its disorders. Guilford Press, New York

    Google Scholar 

  31. Starcevic V, Berle D (2006) Cognitive specificity of anxiety disorders: a review of selected key constructs. Depress Anxiety 23:51–61

    Article  PubMed  Google Scholar 

  32. Pierce Keeton C, Kolos AC, Walkup JT (2009) Pediatric generalized anxiety disorder: epidemiology, diagnosis and management. Paediatr Drugs 11:171–184

    Article  Google Scholar 

  33. Comer JS et al (2009) The intolerance of uncertainty scale for children: a psychometric evaluation. Psychol Assess 21:402–411

    Article  PubMed  PubMed Central  Google Scholar 

  34. Laugesen N, Dugas MJ, Bukowski WM (2003) Understanding adolescent worry: the application of a cognitive model. J Abnorm Child Psychol 31:55–64

    Article  PubMed  Google Scholar 

  35. Fialko L, Bolton D, Perrin S (2012) Applicability of a cognitive model of worry to children and adolescents. Behav Res Ther 50:341–349

    Article  PubMed  Google Scholar 

  36. Read KL, Comer JS, Kendall PC (2013) The intolerance of uncertainty scale for children (IUSC): discriminating principal anxiety diagnoses and severity. Psychol Assess 25:722–729

    Article  PubMed  Google Scholar 

  37. Carleton RN, Collimore KC, Asmundson GJ (2010) “It’s not just the judgements—It’s that I don’t know”: intolerance of uncertainty as a predictor of social anxiety. J Anxiety Disord 24:189–195

    Article  PubMed  Google Scholar 

  38. Mahoney AE, McEvoy PM (2012) A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cogn Behav Ther 41:212–222

    Article  PubMed  Google Scholar 

  39. Cartwright-Hatton S, Wells A (1997) Beliefs about worry and intrusions: the meta-cognitions questionnaire and its correlates. J Anxiety Disord 11:279–296

    Article  PubMed  Google Scholar 

  40. Wells A (1994) Attention and the control of worry. In: Davey GCL, Tallis F (eds) Worrying: perspectives on theory, assessment and treatment. Wiley, Oxford, England, pp 91–114

  41. Wells A (ed) (2006) The metacognitive model of worry and generalised anxiety disorder. John Wiley and Sons, Chichester, p 179–199

    Google Scholar 

  42. Borkovec TD, Roemer L (1995) Perceived functions of worry among generalized anxiety disorder subjects: distraction from more emotionally distressing topics? J Behav Ther Exp Psychiatry 26:25–30

    Article  PubMed  Google Scholar 

  43. Wells A, Carter K (2002) Further tests of a cognitive model of generalized anxiety disorder: metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behav Ther 32:85–102

    Article  Google Scholar 

  44. Cartwright-Hatton S, Roberts C, Chitsabesan P, Fothergill C, Harrington R (2004) Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. Br J Clin Psychol 43:421–436

    Article  PubMed  Google Scholar 

  45. Smith KE & Hudson JL (2013) Metacognitive beliefs and processes in clinical anxiety in children. J Clin Child Adolesc Psychol :1–13

  46. Muris P et al (1998) The screen for child anxiety related emotional disorders (SCARED) and traditional childhood anxiety measures. J Behav Ther Exp Psychiatry 29:327–339

    Article  PubMed  Google Scholar 

  47. Kertz S, Woodruff-Borden J (2013) The role of metacognition, intolerance of uncertainty, and negative problem orientation in children’s worry. Behav Cogn Psychother 41:243–248

    Article  PubMed  Google Scholar 

  48. Wilson C, Hughes C (2011) Worry, beliefs about worry and problem solving in young children. Behav Cogn Psychother 39:507–521

    Article  PubMed  Google Scholar 

  49. Bacow TL, Pincus DB, Ehrenreich JT, Brody LR (2009) The metacognitions questionnaire for children: development and validation in a clinical sample of children and adolescents with anxiety disorders. J Anxiety Disord 23:727–736

    Article  PubMed  Google Scholar 

  50. D’Zurilla TJ, Nezu AM, Maydeu-Olivares A (2001) Manual for the social problem-solving inventory—revised (SPSI-R). Multi-Health Systems, North Tonawanda

    Google Scholar 

  51. Lavy EH, van den Hout MA (1990) Thought suppression induces intrusions. Behav Cogn Psychother 18:251–258

    Article  Google Scholar 

  52. Wegner DM, Zanakos S (1994) Chronic thought suppression. J Pers 62:615–640

    Article  Google Scholar 

  53. Robichaud M, Dugas MJ, Conway M (2003) Gender differences in worry and associated cognitive-behavioral variables. J Anxiety Disord 17:501–516

    Article  PubMed  Google Scholar 

  54. Gosselin P et al (2007) Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry. Behav Res Ther 45:225–233

    Article  PubMed  Google Scholar 

  55. Wong Q, Moulds M (2011) The relationship between the maladaptive self-beliefs characteristic of social anxiety and avoidance. J Behav Ther Exp Psychiatry 42:171–178

    Article  PubMed  Google Scholar 

  56. Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV—child version: parent interview schedule. The Psychological Corporation, San Antonio, TX

    Google Scholar 

  57. Lyneham HJ, Rapee RM (2005) Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. J Am Acad Child Adolesc Psychiatry 44:274–282

    Article  PubMed  Google Scholar 

  58. Shaffer D et al (1983) A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 40:1228–1231

    Article  PubMed  Google Scholar 

  59. Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36:545–566

    Article  PubMed  Google Scholar 

  60. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: text revision, 4th Edn, Text Revision Ed. American Psychiatric Association, Washington, DC

    Google Scholar 

  61. Spence SH, Barrett PM, Turner CM (2003) Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. J Anxiety Disord 17:605–625

    Article  PubMed  Google Scholar 

  62. Muris P, Meesters C, Gobel M (2001) Reliability, validity, and normative data of the Penn State Worry Questionnaire in 8-12-yr-old children. J Behav Ther Exp Psychiatry 32:63–72

    Article  PubMed  Google Scholar 

  63. Carleton RN, Norton MAPJ, Asmundson GJG (2007) Fearing the unknown: a short version of the intolerance of uncertainty Scale. J Anxiety Disord 21:105–117

    Article  PubMed  Google Scholar 

  64. Hearn CS, Donovan CL, & Holmes M (In preparation) Cognitive components of worry in children. In preparation

  65. Hawkins D, Sofronoff K, Sheffield J (2009) Psychometric properties of the social problem solving inventory-revised short-form: is the short form a valid and reliable measure for young adults? Cognit Ther Res 33:462–470

    Article  Google Scholar 

  66. Farrell L, Barrett PM (2006) Obsessive–compulsive disorder across developmental trajectory: cognitive processing of threat in children, adolescents and adults. Br J Psychol 97:95–114

    Article  PubMed  Google Scholar 

  67. Kocovski NL, Endler NS, Rector NA, Flett GL (2005) Ruminative coping and post-event processing in social anxiety. Behav Res Ther 43:971–984

    Article  PubMed  Google Scholar 

  68. Chorpita BF, Tracey SA, Brown TA, Collica TJ, Barlow DH (1997) Assessment of worry in children and adolescents: An adaptation of the Penn State Worry Questionnaire. Behav Res Ther 35:569–581

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cate S. Hearn.

Ethics declarations

Conflict of interest

The authors have no conflict of interest with respect to this publication.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hearn, C.S., Donovan, C.L., Spence, S.H. et al. What’s the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder. Child Psychiatry Hum Dev 48, 786–795 (2017). https://doi.org/10.1007/s10578-016-0703-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-016-0703-y

Keywords

  • Social anxiety disorder
  • Social phobia
  • Child anxiety
  • Worry
  • Generalized anxiety disorder