Liebowitz Social Anxiety Scale LSAS
Liebowitz Social Anxiety Scale LSAS overview
Creator and Context
The Liebowitz Social Anxiety Scale (LSAS) is the most detailed measure of social anxiety in common use.
It was developed by Michael Liebowitz and published in 1987. A self report version, the LSAS-SR, was validated by Fresco and colleagues in 2001 and shown to be psychometrically equivalent to the clinician administered original. A child and adolescent version, the LSAS-CA, also exists.
Presenting Conditions
The LSAS presents 24 social and performance situations. Each is rated twice, once for fear or anxiety and once for avoidance, producing four subscores plus a total:
Performance situations (13 items), fear and avoidance
Social interaction situations (11 items), fear and avoidance
Administration
Originally clinician administered, and now widely used as a self report. The person rates fear from None (0) to Severe (3) and avoidance from Never (0) to Usually (3), based on the past week. That gives 48 ratings in total.
Desired Audience
Adults with social anxiety disorder. The LSAS-CA is the appropriate version for children and adolescents.
Rating fear and avoidance separately across 24 named situations is what makes the LSAS worth its length. It produces something close to a ready made exposure hierarchy, which is exactly what the treatment needs.
Considerations
48 ratings is a real completion burden. It is not a measure for every session.
It is a severity measure, not a diagnostic instrument.
Fine grained severity band tables circulate widely but are not traceable to a peer reviewed source. The defensible thresholds are 30 and 60.
Licensing status for commercial embedding is not clearly documented. Confirm permission before deployment.
How to score the Liebowitz Social Anxiety Scale LSAS
Conducting the assessment
The person rates each of the 24 situations twice, once for fear and once for avoidance, each on a 0 to 3 scale for the past week.
Interpretation
All fear and avoidance ratings are summed to give a total from 0 to 144.
A total of 30 or above indicates social anxiety disorder. At that threshold, sensitivity was 93.3 percent and specificity 91.6 percent.
A total of 60 or above indicates the generalised subtype.
These two thresholds are the numbers supported by the validation literature.
Clinical Considerations
Read the fear and avoidance subscores separately. Avoidance that outstrips fear usually means the person has stopped testing their predictions, which is the target of treatment.
Use the item level ratings to build the exposure hierarchy rather than starting from scratch.
Reserve it for assessment and review rather than routine session by session monitoring.
Liebowitz Social Anxiety Scale LSAS use cases
Detailed assessment of social anxiety severity
Distinguishing generalised from non generalised social anxiety
Building an exposure hierarchy from the situation level ratings
Measuring treatment response, where it is the standard outcome measure in trials
Category
Anxiety
Research Summary
Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141 to 173.
Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., et al. (2001). The Liebowitz Social Anxiety Scale: A comparison of the psychometric properties of self report and clinician administered formats. Psychological Medicine, 31(6), 1025 to 1035.
Rytwinski, N. K., Fresco, D. M., Heimberg, R. G., et al. (2009). Screening for social anxiety disorder with the self report version of the Liebowitz Social Anxiety Scale. Depression and Anxiety, 26(1), 34 to 38.
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