***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for generalized social phobia were assigned to cognitive therapy ( CT ) , fluoxetine plus self-exposure ( FLU + SE ) , or placebo plus self-exposure ( PLA + SE ) . At posttreatment ( 16 weeks ) , the medication blind was broken . CT and FLU + SE patients then entered a 3-month booster phase . Assessment s were at pretreatment , midtreatment , posttreatment , end of booster phase , and 12-month follow-up . Significant improvements were observed on most measures in all 3 treatments . On measures of social phobia , CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment . FLU + SE and PLA + SE  did not differ . CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up . On general mood measures , there were few differences between the Behavioral  inhibition ( BI )  and maternal over-control are early risk factors for later childhood internalizing problems , particularly  social anxiety disorder ( SAD ) . Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence . However , no prior studies have prospect ively examined observed maternal over-control as a risk factor for adolescent social anxiety ( SA ) among children initially selected for BI . The present prospect i ve longitudinal study examines the direct and indirect relations between these early risk factors and adolescent SA symptoms and SAD , using a multi- method approach . The sample consisted of 176 participants initially recruited as infants and assessed for temperamental reactivity to novel stimuli at age 4 months .  BI was measured via observations and parent-report across multiple assessment s between the ages of 14 months and 7 years . Maternal over-control was assessed observationally during parent – child interaction tasks at 7 years . Adolescents ( ages 14–17 years ) and parents provided independent reports of adolescent SA symptoms . Results indicated that higher maternal over-control at 7 years predicted higher SA symptoms and lifetime rates of SAD during adolescence . Additionally , there was a significant interaction between consistently high BI and maternal over-control , such that patterns of consistently high BI predicted higher adolescent SA symptoms in the presence of high maternal over-control . High BI across childhood was not significantly associated with adolescent SA symptoms when children experienced low maternal over-control . These findings have the potential to inform prevention and early intervention programs by indentifying particularly at-risk youth and specific targets of treatment Two experiments were conducted to examine the link between safety behaviors and social judgments in  social anxiety disorder ( SAD ) . Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction , and subsequent effects of the manipulation on the social judgments of socially anxious participants ( N = 50 , Study 1 ) and individuals meeting diagnostic criteria for generalized SAD ( N = 80 , Study 2 ) were examined . Participants were r and omly assigned to either a safety behavior reduction plus exposure condition ( SB + EXP ) or a graduated exposure ( EXP ) control condition , and then took part in a conversation with a trained experimental confederate . Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants . Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls . Moreover , reduction in safety behaviors mediated change in participant self-judgments and future social predictions . The current findings are consistent with cognitive theories of anxiety , and support the causal role of safety behaviors in the persistence of negative social judgments in SAD OBJECTIVE  Behavioral inhibition ( BI ) , a temperamental style identifiable in early childhood , is considered a risk factor for the development of anxiety disorders , particularly social anxiety disorder ( SAD ) . However , few studies examining this question have evaluated the stability of BI across multiple developmental time points and followed participants into adolescence-the developmental period during which risk for SAD onset is at its peak . The current study used a prospect i ve longitudinal design to determine whether stable early BI predicted the presence of psychiatric disorders and continuous levels of social anxiety in adolescents . It was hypothesized that stable BI would predict the presence of adolescent psychiatric diagnoses , specifically SAD . METHOD Participants included 126 adolescents aged 14 to 16 years who were first recruited at 4 months of age from hospital birth records . Temperament was measured at multiple time points between the ages of 14 months and 7 years . In adolescence , diagnostic interviews were conducted with parents and adolescents , and continuous measures of adolescent- and parent-reported social anxiety were collected . RESULTS Stable maternal-reported early BI was associated with 3.79 times increased odds of a lifetime SAD diagnosis , but not other diagnoses , during adolescence ( 95 % confidence interval 1.18 - 12.12 ) . Stable maternal-reported early BI also predicted independent adolescent and parent ratings of ongoing social anxiety symptoms . CONCLUSIONS Findings suggesting that stable maternal-reported early BI predicts lifetime SAD have important implication s for the early identification and prevention of SAD Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs . In the current study , 195 people with social phobia were r and omly allocated to 1 of 3 treatments : st and ard cognitive restructuring plus in vivo exposure , an " enhanced " treatment that augmented the st and ard program with several additional treatment techniques ( e.g. , performance feedback , attention retraining ) , and a nonspecific ( stress management ) treatment . The enhanced treatment demonstrated significantly greater effects on diagnoses , diagnostic severity , and anxiety during a speech . The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference , although they were both significantly better than the nonspecific treatment . The enhanced treatment also showed significantly greater effects than st and ard treatment on 2 putative process measures : cost of negative evaluation and negative views of one 's skills and appearance . Changes on these process variables mediated differences between the treatments on changes in diagnostic severity This study used a 2-month prospect i ve research design to examine the bi-directional interplay between  peer victimization and social anxiety among adolescents . Participants included 228 adolescents ( 58 % female ) in grade s 10–12 . Three types of peer victimization were examined : overt ( physical aggression or verbal threats ) , relational ( malicious manipulation of a relationship , such as by friendship withdrawal ) , and reputational ( damaging another ’s peer relationships , such as through rumor spreading ) . Adolescents ’ self-reported feelings of social anxiety and peer victimization experiences were assessed at two time points , in November and January of the same school year . Peer victimization was strongly related to adolescents ’ social anxiety , and relational victimization explained additional unique variance . Moreover , peer victimization was both a predictor and consequence of social anxiety over time , with the most robust results found for relational victimization . Limited support was obtained for gender as a moderating variable . Findings highlight the deleterious effects of peer victimization , especially relational victimization , and suggest avenues for future research and clinical intervention for adolescents experiencing such victimization The study investigated the relationship between self-focused attention ( SFA ) and post-event processing ( PEP ) in social anxiety . SFA is the process of directing attention to internal stimuli during a social interaction . PEP is a detailed review of performance following an interaction . Highly socially anxious students ( N = 82 ) were r and omly assigned to a high SFA ( n = 40 ) or low SFA condition ( n = 42 ) and completed baseline measures of social anxiety , depression , trait SFA , and trait rumination . After SFA was manipulated via instructions , participants engaged in a 5-min unstructured conversation with a confederate , followed by a manipulation check .  PEP was assessed the next day online . The high SFA group reported a similar amount of positive PEP but more frequent negative PEP over the 24-h period compared to the low SFA group . These results provide support for a causal relationship between SFA and PEP and have important applications for the development of effective cognitive-behavioural interventions CONTEXT Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder ( SAD ) to develop depression have been challenged by discrepant findings from prospect i ve longitudinal examinations in childhood and early adolescence . OBJECTIVES To examine patterns of SAD incidence , the consistency of associations of SAD with subsequent depression , and distal and proximal predictors for subsequent depression . DESIGN Face-to-face , 10-year prospect i ve longitudinal and family study of up to 4 waves . The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinical ly trained interviewers . SETTING Community sample in Munich . PARTICIPANTS Three thous and twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up . MAIN OUTCOME MEASURES Cumulative incidence of SAD and depression ( major depressive episode or dysthymia ) . RESULTS Cumulative incidence for SAD was 11.0 % ; for depression , 27.0 % . St and ardized person-years of incidence for SAD were highest for those aged 10 to 19 years ( 0.72 % ) and were low before ( 0.20 % ) and after ( 0.19 % ) that age range . Depression incidence was different , characterized by delayed and continued high rates . Social anxiety disorder was consistently associated with subsequent depression , independent of age at onset for SAD ( relative risk range , 1.49 - 1.85 , controlling for age and sex ) . Crude Cox regressions showed significant distal ( eg , parental anxiety or depression , behavioral inhibition ) and proximal SAD characteristics ( eg , severity measures , persistence ) as predictors . Most associations were attenuated in multiple models , leaving behavioral inhibition ( hazard ratio , 1.30 [ 95 % confidence interval , 1.04 - 1.62 ; P = .02 ] ) and , less consistently , panic ( hazard ratio , 1.85 [ 95 % confidence interval , 1.08 - 3.18 ; P = .03 ] ) as the remaining significant predictors . CONCLUSIONS Social anxiety disorder is an early , adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression . The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role . Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression , these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder ( SAD ) . Eighty individuals diagnosed with generalized SAD took part in a " getting acquainted " conversation with a trained experimental confederate . Participants were then r and omly assigned to either a safety behavior reduction plus exposure condition ( SB + EXP ) or a graduated exposure ( EXP ) control condition and completed a 2nd conversation with the same interaction partner . Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group . However , whereas the safety behavior manipulation influenced participants ' appraisal s of their partner 's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors , in reality , the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior . Thus , although both parties recognized positive changes in the social exchange following the safety behavior manipulation , different sources of social information accounted for participant versus partner interpersonal judgments . The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD The present study investigated whether post-event processing ( PEP ) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech . One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session . They were r and omly assigned to one of three manipulation conditions : post-event processing about a past speech incorporating imagery ( PEP-Imagery ) , semantic post-event processing about a past speech ( PEP-Semantic ) , or a control condition , ( n=19 per experimental group , per condition [ high vs low socially anxious ] ) . After the condition inductions , individuals ' anxiety , their predictions of performance in the anticipated speech , and their interpretations of other ambiguous social events were measured . Consistent with predictions , high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task . They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition . High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions . The impact of imagery during post-event processing in social anxiety and its implication s are discussed BACKGROUND Childhood shyness can pre date social anxiety disorder and may be associated with biased discrimination of facial expressions of emotions . OBJECTIVE To determine whether childhood shyness , or the serotonin transporter promoter polymorphism genotype , can predict participants ' visual event-related potentials in response to expressions of children of similar ages . DESIGN Study group drawn from an inception cohort of 149 subjects characterized 1 year before the present study by their degree of shyness . SETTING Third- 
    Output:
    
On balance , there is empirical evidence for the association of each of the factors in the IAM model with  social anxiety or SAD  , providing preliminary support for the model .