Specificity of Dysfunctional Beliefs in Children with Social Anxiety Disorder: Effects of Comorbidity

ABSTRACT

Objective: This study examined the content-specificity of dysfunctional social beliefs to Social Anxiety Disorder (SoAD) in a large, clinically referred sample of children with a variety of anxiety, mood and externalizing disorders. The effects of comorbidity on the content-specificity of dysfunctional social beliefs were examined.

Method: Participants included 912 children aged 7–12 years (M_age = 9.15; 45.5% female) who presented at a specialized clinic for assessment and treatment of anxiety disorders. Children with SoAD were compared to children with nonsocial anxiety disorders, children with SoAD and mood disorders, and children with SoAD and externalizing disorders, on self-reported dysfunctional social threat beliefs, physical threat, hostility, and personal failure beliefs.

Results: Children with SoAD endorsed significantly higher levels of dysfunctional social threat beliefs when compared to children with nonsocial anxiety disorders. However, children with SoAD and mood comorbidity scored significantly higher on dysfunctional social beliefs than all other groups.

Conclusions: Results suggest that within childhood anxiety disorders, dysfunctional social beliefs are content-specific for SoAD. Externalizing comorbidity does not seem to change the level of dysfunctional social beliefs in this group. However, mood comorbidity leads to endorsement of higher levels of dysfunctional social beliefs. These results provide support for, and refine, the content-specificity hypothesis and highlight the importance of taking comorbidity into account when examining and treating dysfunctional beliefs in youth.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary Material

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2019.1697930

Notes

¹ Originally, it was planned to divide the sample into four groups to be able to compare children with SoAD in their profile (but without any comorbidity) to children with SoAD in their profile, but with either (1) nonsocial anxiety comorbidity, (2) mood comorbidity, or (3) externalizing comorbidity. However, the number of children with no comorbidity or purely mood or externalizing comorbidity turned out to be too small for meaningful analysis. Instead, a hierarchical approach was used to create groups.

² Some of the children in the current sample have also participated in one of the following randomized controlled trials: (1) comparing the use of a bibliotherapy version of treatment to treatment as usual, (2) CBT versus an active control, and (3) CBT versus CBT enhanced with parent anxiety management (Hudson et al., 2013, 2009; Rapee, Abbott, & Lyneham, 2006), or were part of a non-research group or RCT that has not been published yet.

³ As our main goal was to study the specificity of social threat thoughts within anxiety disorders and a secondary goal was to see how the presence of specific disorder groups (depressive disorders and externalizing disorders) would influence the presence of these social dysfunctional beliefs, children with disorders in their diagnostic profile belonging to different disorder groups, were excluded. This included selective mutism as it has a large overlap with SoAD and is often considered to be a developmental variant or a symptom of SoAD (e.g., Bögels et al., 2010).

⁴ Effect sizes were approximately the same size and in the same direction for all imputed datasets, but due to the small effect size, some were not significant. However, the majority was significant or marginally significant.

Additional information

Funding

This work was supported by the Australian National Health & Medical Research Council (NHMRC) under Grant [1027556] & [488505] & [382008]; and by the Australian Research Council (ARC) under [DP0878609]; and by the Macquarie University (MRTP).