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Some links between loneliness and different manifestations of suicidal conduct have been reported in variety of subgroups (e.g., college students, the elderly, psychiatric patients). We tested this hypothesis by using the results of a population-wide survey. Strong associations among suicide ideation, parasuicide and different ways of being lonely and alone, defined either subjectively (i.e., the feeling), or objectively (i.e., living alone or being without friends), were observed. Moreover, prevalence of suicide ideation and parasuicide increased with the degree of loneliness. Only minimal differences between men and women were found.

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OBJECTIVE: The primary goal of this review was to assess critically the literature concerning the ongoing search for possible biological correlates of social phobia. METHODS: In addition to manual searches, Medline, Current Contents and Psych Info databases were searched for relevant publications. RESULTS: On the evidence of an extensive body of research, so far biological correlates of social phobia remain elusive. Furthermore, the majority of studies reveal by default that the neurobiological functioning of social phobics is very much like that of normal control subjects. CONCLUSION: The conceptual and methodological foundations underpinning the current research programme are discussed critically. Its main weaknesses were found to be: lack of theory to guide research and aid the interpretation of results, static comparisons between subject groups and analysis oblivious to great individual variations. Possibilities of alternative approaches to study the neurobiology of social phobia are raised. Among others, continuous and situation-specific measurement, subjects used as their own controls and neurobiological correlates of clinical improvement following psychotherapy are considered.

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OBJECTIVE: Treatments for social phobia result typically in significant anxiety and avoidance reduction; the repercussions in terms of social functioning, however, are not clear. This controlled study compared two approaches designed to improve the social functioning of social phobics. METHOD: Sixty-eight socially phobic patients were randomly assigned to two treatments focused on improving interpersonal relationships either with or without social skills training or a waiting list; 60 completed treatment and 59 a 1-year follow-up. Treatment was administered in small groups, 14 sessions altogether. RESULTS: No clinically meaningful change was observed during the waiting period. A statistically significant and equivalent improvement obtained in both treatment conditions. CONCLUSION: Both treatments resulted in reduced anxiety, avoidance, general psychopathology and better social functioning that maintained over follow-up. Continuing improvement in remission rates was noted; fully 60% of the patients no longer fulfilled criteria for social phobia at the end of 1-year follow-up.

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Available treatments of social phobia reduce anxiety and avoidance of social situations. Social functioning however, remains relatively unaffected. This study piloted a behavioral group treatment that aimed at improving patients' individual difficulties in social functioning. Five patients fulfilling DSM-IV criteria for social phobia were selected for treatment by a 16-session behavioral group treatment focusing on improving interpersonal functioning both in specific phobic situations as well as in different spheres of social life in general. Four out of 5 patients completed treatment and showed individual patterns of clinically significant improvement. Their individual test-score results and case-histories are presented. Three patients no longer fulfilled to the diagnostic criteria at the end of treatment; the fourth--at 6 month follow-up. This was maintained at a 2 year follow-up.

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This article critically reviews the effects of psychological treatment (exposure, cognitive restructuring, social skills training) and pharmacological treatment (MAOIs, reversible MAOIs, anxiolytics and SSRIs) of social phobia. Only controlled studies have been included, and their outcomes were assessed for improvement in anxiety and avoidance, social functioning and clinical status. Both psychological and pharmacological treatments resulted in a significant and meaningful reduction in anxiety and, in most cases, a weakening of the tendency to avoid. Although useful, the effects were not of such a magnitude as to result in remission. Reduction in anxiety was long-lasting in patients treated by psychological methods. The lessening of anxiety did not necessarily lead to meaningfully improved social functioning. The combination of psychological and pharmacological treatments was disappointing, and did not exceed the effects of psychological treatments alone. However, the most promising medications were not tested. Subtype of social phobia and additional diagnoses did not determine the response to treatment.

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BACKGROUND: Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men. METHOD: Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up. RESULTS: No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up. CONCLUSIONS: Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.

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The prominence of a variety of social fears among types of phobia was examined. Responses of 80 agoraphobics, 25 social phobics and 35 specific phobics to Wolpe's (1983) Fear Survey Schedule were factor-analysed. Factors of social sensitivity (accounting for 24 out of 50 per cent of the variance), agoraphobia (7 per cent), blood injuries (5 per cent) and five other small specific phobic factors were extracted. On social sensitivity, agora- and social phobics overlapped; specific phobics were significantly lower than social phobics. On agoraphobia scores, agoraphobics scored significantly higher than social and specific phobics. A regression analysis was performed to assess the relative contribution of the diagnostic groups to each factor. Social sensitivity may be a normal evolved mechanism that is protective in social interactions.

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Twenty patients diagnosed major depression and 20 matched normal control subjects were compared in terms of marital adjustment and other related features. Marital adjustment reported by the depressed group was significantly worse than that of the normal group. Both groups, however, had adjustment scores above the cut-off point for maladjustment. These results question the causal role ascribed to marital maladjustment in the genesis of depression.

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Twenty-eight outpatients who met DSM-III diagnostic criteria for avoidant personality disorder completed 14 one and a half hour sessions of social skills training in the clinic only or a combination of four sessions in the clinic, four sessions in real-life and six follow-up sessions in the clinic. Subjects were assessed before treatment began, after four sessions, at the end of treatment and at three month follow-up points. Training in real-life did not enhance social skills training; no significant difference between the groups at any assessment points was found. In both groups improvement in time was significant and clinically worthwhile. The treatment effects were maintained up to the three month follow-up, where available. Social skills training appears to be a useful and promising intervention for avoidant personality disorder but its long term impact remains to be investigated.

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Twenty-four outpatients meeting DSM-III-R criteria for major depression were assigned to group behavioral-cognitive therapy either with or without antidepressant medication (imipramine). Eighteen patients completed 15 weekly sessions of treatment. Equivalent improvement was observed in both regimens after treatment. The results essentially maintained at six months follow-up. This suggests that a group format of behavioural-cognitive therapy is a viable therapeutic intervention for outpatients diagnosed as suffering from major depression. However, the addition of imipramine to group behavioural-cognitive therapy did not enhance the outcome.

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This article reviews the effects of psychological treatments specifically developed for depression. Promising and durable results have been reported for cognitive and interpersonal psychotherapies but also for behavioral psychotherapy, which has generated less research interest so far. The therapeutic effects seem to be equivalent and at least comparable to pharmacotherapy in mild to moderate depression.

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This retrospective study investigated experiences of separation and perceptions of early relations with parents and peers by patients diagnosed as having avoidant personality disorder. The main hypothesis of our study was that patients diagnosed as having avoidant personality disorder would report more actual separations and more pathogenic parenting than normal control subjects. This hypothesis was not supported. The main features differentiating patients from normals were: perceptions of a encouraging home climate, and less demonstrations of love and pride in the child on the part of the parents.

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Twenty-eight patients meeting the criteria for DSM-III avoidant personality disorder were randomly assigned to two treatment groups consisting each of five sessions of social skills training plus homework and five sessions of group discussion plus homework administered in different order in accordance with a latin-square (crossover) design. Twenty-one subjects completed the study. No significant differences between the treatment groups or treatment modalities (i.e., social skills training and group discussion combined with homework each) were found. Significant improvements in time on most measures were found when data from both groups were amalgamated.

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The perceptions of their parents by patients diagnosed avoidant personality disorder (DSM-III) and matched normal subjects were compared. The overprotection hypothesis proposed by Parker was not found to predict the perceptions of patients diagnosed avoidant personality disorder. Social introversion in patients was found to be related to perceptions of their parents as shaming, guilt-engendering and intolerant.

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One hundred seventy-three abstinent patients were screened for phobias and avoidant personality disorder. Ninety-six patients were interviewed and diagnosed by two independent assessors who were in agreement on 74% of the diagnoses. In DSM-III terms, over half of the sample (51.4%) met criteria for agoraphobia (8.5%), social phobia (7.8%) and avoidant personality disorder (35.1%). More than 70% of the patients in each diagnostic category were men. For the vast majority of the patients in the sample the disorder preceded the abuse of alcohol which was used by at least 40% of them to relieve their distress in the past. For many it had still a moderating effect on distress at the present but appeared to be mainly used out of "psychological dependence".

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Premature ejaculation and erectile failure in a 54-year-old man were treated by a combination of exposure in vivo and social skills training. The intervention was not aimed directly at the dysfunctional sexual response but at features of the patient's interpersonal behavior hypothesized to be instrumental in maintaining it. Change was assessed on the basis of the patient's records of weekly rate of successful intercourse, performance of target behaviors, and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out the effect of mere therapeutic contact or passage of time. The intervention resulted in an increased rate of performance of adaptive social targets in real life, a decrease in associated anxiety, and eventually a correlated moderate increase in the rate of successful intercourse. The outcome maintained for 1-year follow-up. Systematic data collection was discontinued after 6 months.

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Patients attending a clinic for behavioral psychotherapy included 46 whose main complaint was social dysfunction. Certain demographic variables and clinical features were found to predominate in this sub-group who meet all the criteria for avoidant personality disorder in the DSM-III. The significance of these findings is discussed, including their implications for diagnosis and management.

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