DESCRIPTION

The LSAS was published by Liewobitz in 1987 and subsequently modified.

in 1992 by the same author1-2In our country, it has been translated, adapted to
Spanish and validated by J. Bobes et al. in 19993.

It is a hetero-evaluated scale, which, interestingly, has been

applied in a study through a computerized version, obtaining a
high degree of correlation with the version managed by the clinicians and even a
higher degree of acceptance by patients4-5In the study of
Spanish validation was administered through clinical interview.

The questionnaire consists of 24 items that refer to situations

social or acting problems, frequently problematic, in patients with
social phobia disorder. The items are grouped into two subscales:

- performance or execution anxiety (13 items) (marked with P of

performance).

- of social anxiety (11 items) (marked with S for social).

Each of the two subscales explores the two characteristic aspects of

this type of process: the degree of fear or anxiety towards certain
situations and the degree of avoidance that they trigger.

Each item is scored according to a 4-point Likert scale, which in the

In the case of the anxiety dimension, it refers to intensity:

0 = no anxiety
1 = mild anxiety
2 = moderate anxiety
3 = severe anxiety

and in the case of the avoidance dimension, it refers to frequency of

appearance

0 = never (0% of the time)

1 = occasionally (1-33%)
2 = frequently (33-67%)
3 = usually (67-100%)

It is possible to obtain two total scores from 0 to 72 points for each

one of the mentioned aspects (level of anxiety and level of avoidance), where 0
0 represents the null degree of anxiety and avoidance, and 72 represents the maximum degree.
 INTERPRETATION

It is one of the most cited questionnaires in the literature on clinical trials.

in patients with a diagnosis of social phobia. Provide an approach
appropriate to the severity of the symptoms and is sensitive to the changes produced
for the treatment.

The proposed cutoff points by some authors for the scoring

total son:

Less than or equal to 51: mild social phobia.

From 52 to 81: moderate social phobia.
Greater than or equal to 82: severe social phobia.

In the Spanish validation of Bobes et al., the proposed cut-off points

son

From 19.6 to 32.7 (range 0-72) in the total anxiety questionnaire

From 19.6 to 26.1 (range 0-72) in the total avoidance questionnaire.

As we can see, the cutoff points are very broad and are left to the discretion of the
examiner, the very conservative ones are used (higher specificity and lower
sensitivity) (19.6 in both subscales) to provide additional information in
differential diagnoses and the more liberal ones (greater sensitivity and lower
specificity) (32.7 and 26.1 in each subscale) to use them in the screening of
possible cases of social phobia.

As a drawback, it is probably not a good instrument for

diagnosis, and emphasize that it does not contain any item that explores symptoms
physiological factors that often are part of the symptomatic courtship of this type of
disorder. For some authors6a more in-depth study of the
psychometric properties of the LSAS.

Psychometric properties

In the work of Bobes et al., 57 patients were included with

diagnosis of social phobia and 57 healthy subjects.

Reliability:
Regarding reliability, the coefficients of internal consistency (alpha of
Cronbach's alpha obtained in the sample was above 0.73 in all
subscales of the LSAS. The intraclass correlation coefficients (ICCs) obtained
in the test-retest, administered with a 14.4-day difference, were
greater than 0.82 in all subscales of the LSAS.

Validity:
The Pearson correlation coefficients obtained in the test of
convergent validity with other scales (subjective Hamilton and total) were
moderate (0.44 in total social anxiety and 0.38 in total avoidance).
The correlation coefficients obtained in the comparison with the Questionnaire
of Global Activity Assessment (EEAG) and the Visual Analog Scale (EVA)
of EuroQol were low. The correlation coefficients obtained between the
LSAS and the Social Anxiety and Distress Scale (SADS) were above
0.7 on all subscales. The questionnaire showed adequate power
discriminant, statistically significant, between patients with social phobia and
healthy subjects and among groups of patients with different severity of the process.
Although the work investigated predictive validity, the only data that
they communicate in the publication, it is an area under the ROC curve of 0.98 for the
anxiety subscale of 0.95 for the avoidance subscale.

Other studies have confirmed the reliability, validity, and sensitivity to

change of the LSAS7-8.

In the work of Safren SA et al7the authors conduct a factor analysis

from the questionnaire and suggest that there are 4 types of fear factors or categories
social explored by the LSAS social interaction, public speaking, being
observed by others and eating and drinking in public and that while the anxiety of
social interaction seems to be unifactorial, the situations of fear of
Execution/observation are likely multifactorial.

BIBLIOGRAPHY

translatedText

Liebowitz MR. Social phobia. Mod Probl Pharmacopsychiatry 1987; 22: 141-173.

Liebowitz MR, Schneier FR, Campeas R, et al. Phenelzine versus atenolol in

social phobia: a placebo controlled comparison. Arch Gen Psychiatry 1992;
49:290-300.

Validation:

Bobes J, Badía X, Luque A, García M, González MP, Dal-Re R. Documentation of

the Spanish versions of the Liebowitz Social Anxiety Scale questionnaires,
Social Anxiety and Distress Scale and Seehan Disability Inventory for the
evaluation of social phobia. Clinical Medicine 1999; 112:530-538.

Documentation:

Cervera S, Roca M, Bobes J. Social Phobia. Barcelona, Masson, 1998.

Heimberg RG, Liebowitz MR, Hope DA, Schneier FR. Social Phobia. Diagnosis,
Assessment and Treatment. New York, The Guilford Press, 1995.

Clark DB, Feske U, Masia CL. et al. Systematic assessment of social phobia in
clinical practice. Depression and Anxiety 1997; 6:47-61.
Rush AJ, Pincus HA, First MB, Blacker D, Endicott J, Keith SJ, Phillips KA, Ryan
ND, Smith GR, Tsuang MT, Widiger JA, Zarin DA (Task Force for the Handbook
Psychiatric Measures). Handbook of Psychiatric Measures. Washington DC,
American Psychiatric Association, 2000.

Additional:

1.- Liebowitz MR. Social phobia. Mod Probl Pharmacopsychiatry 1987; 22: 141-
173.

2.- Liebowitz MR, Schneier FR, Campeas R, et al. Phenelzine versus atenolol in
social phobia: a placebo controlled comparison. Arch Gen Psychiatry 1992;
49:290-300.

3.- Bobes J, Badía X, Luque A, García M, González MP, Dal-Re R. Validation of

the Spanish versions of the Liebowitz Social Anxiety Scale questionnaires,
Social Anxiety and Distress Scale and Seehan Disability Inventory for the
Evaluation of social phobia. Clinical Medicine 1999; 112:530-538.

4.- Kobak KA, Schaettle SC, Greist JH, Jefferson JW, Katzelnick DJ, Dotti SL.
Computer-administered rating scales for social anxiety in a clinical drug trial.
Depress Anxiety 1998; 7:3 97-104.

5.- Katzelnick DJ, Kobak KA, Greist JH, Jefferson JW, Mantle JM, Serlin RC.
Sertraline for social phobia: a double-blind, placebo-controlled crossover study.
Am J Psychiatry 1995; Sep 152:9 1368-71.

6.- Connor KM, Davidson JR, Sutherland S, Weisler R. Social Phobia: Issues in
Assessment and Management. Epilepsia 1999; 40 (Suppl 6): S60-S65.

7.- Safren SA, Heimberg RG, Horner KJ, Juster HR, Schneier FR, Liebowitz MR.
Factor structure of social fears: The Liebowitz Social Anxiety Scale. J Anxiety
Disord 1999; May-Jun 13:3 253-270.

8.- Heimberg RG, Horner KJ, Juster HR, Safren SA, Brown EJ, Schneier FR,
Liebowitz MR. Psychometric properties of the Liebowitz Social Anxiety Scale.
Psychol Med 1999; Jan 29:1 199-212.

9.- Schneier FR. Johnson J, Hornig CD, Liebowitz MR, Weismann MM. Social
phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen
Psychiatry 1992; 49: 282-288.

10.- Montgomery SA. Implications of the severity of social phobia. J Affect Disord
1998; Sep 50 Suppl 1 S17-22.

11.- Wittchen HU, Fuetsch M, Sonntag H, Müller N, Liebowitz MR. Disability and
quality of life in pure and comorbid social phobia. Findings from a controlled
study. Eur Psychiatry 2000; Feb 15:1 146-58.