Targeting the probability versus cost of feared outcomes in public speaking anxiety

Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed.     

Modelling relationships between cognitive variables during and following public speaking in participants with social phobia

Cognitive models of social phobia predict that several cognitive processes will mediate the relationship between trait levels of social anxiety and the extent of anxiety experienced in a specific social-evaluative situation. The current study aimed to provide a test of these relationships. Over 200 clinical participants with social phobia completed measures of their general social anxiety and a week later performed a brief impromptu speech. They completed a measure of state anxiety in response to the speech as well as questionnaires assessing several cognitive constructs including focus of perceived attention, perceived performance, and probability and cost of negative evaluation. A week later, they completed measures of negative rumination experienced over the week, as well as a measure of the recollection of their perceived performance. Path analysis provided support for a model in which the cognitive factors mediated between general social anxiety and the degree of anxiety experienced in response to the speech. A second model supported the theory that negative rumination mediated between characteristic social anxiety and negative bias in the recollection of performance.     

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that "costly" social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.     

Cognitions in generalized anxiety disorder and panic disorder patients. A prospective approach.

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had significantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had significantly more cognitions in the physical catastrophe category. Furthermore, GAD-patients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive specificity of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.     

Social anxiety and interpersonal perception: a social relations model analysis

Cognitive models of social phobia posit that an individual's negative beliefs about the way he or she is perceived by others (metaperceptions) are a core feature of the disorder. The social relations model () was used to analyze interpersonal perception data collected following unstructured social interactions in 62 socially anxious (SA) and 62 not socially anxious (NSA) individuals. Using this model, the interpersonal perceptions were analyzed to evaluate whether pathological levels of social anxiety are associated with self-perceptions, metaperceptions, and perceptions from others. SA participants saw themselves negatively and believed others saw them negatively. Although seen as more nervous by others, SA participants were not seen as less likeable. A mediational model demonstrated that the negative metaperceptions of SA individuals were more a function of their own self-perceptions than the negative perceptions of others. These findings were not attributable to depressive symptoms. Implications for theory and treatment of social phobia are discussed.     

To see ourselves as others see us: an experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder

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 randomly 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' appraisals 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.     

Group Guidance: Principles and Practices by Jane Warters

Abstract

A longitudinal study of 80 participants in cognitive and interpersonal group therapy for social phobia was conducted. The aim was to investigate the relationship between group climate and patients’ short-term and long-term outcome. Group climate data was collected every other week during treatment, whereas social phobia symptoms were assessed at admission, discharge, and one year follow-up. Abbreviated symptom assessments were performed weekly. Regression analyses and mixed models were used in the analyses. Engagement predicted symptom reduction during treatment, from pretreatment to follow-up, and from posttreatment to follow-up. During treatment, avoidance predicted higher symptomatic distress. The results imply that group engagement should be emphasized for patients with social phobia. Avoidance, on the other hand, should be addressed as a process that interferes with treatment progress.     

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.     

Interpersonal cognitive self-focus as a function of neuroticism: Basal tendencies and priming effects

Self-focus is one mechanism that may account for the social-evaluative anxiety of individuals high in neuroticism. The present two studies (total N = 183) sought to cognitively model interpersonal self-focus. The cognitive task was a simple one in which participants simply categorized dyadic interpersonal pronouns, with reaction times as the dependent measure. When others engage us, the pronoun “me” refers to the other and the pronoun “you” refers to the self. Study 1 found a neuroticism by pronoun interaction on categorization time consistent with implicit interpersonal self-focus at high (but not low) levels of neuroticism establishing a basal tendency. Study 2 examined boundary conditions. Individuals high in neuroticism exhibited implicit self-focus particularly to the extent that they had been primed to think of themselves as submissive rather than dominant in their interpersonal interactions. Implications for understanding neuroticism, self-focus, and relationship functioning are discussed.     

The effects of dropping in‐situation safety behaviors in the treatment of social phobia

Over the past years, important advances in the cognitive–behavioral treatment of social phobia have taken place. There is wide evidence that demonstrates exposure is an effective treatment for social phobia. However, some research has noticed that exposure has limitations in treating this disorder. In clinical practice we find patients who do not achieve marked reductions in anxiety using this technique. One of the mechanisms that can be involved is the use of in‐situation safety behaviors, which patients use to prevent the feared consequences in social situations. The aim of this study is to present a single case study where we compare the improvement achieved using exposure alone versus exposure dropping in‐situation safety behaviors. The social phobic patient improved significantly when exposure was combined with the drop of in‐situation safety behaviors. Copyright © 2003 John Wiley & Sons, Ltd.     

Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants

This study investigated self-reported state (anxiety, physical symptoms, cognitions, internally focused attention, safety behaviors, social performance) and trait (social anxiety, depressive symptoms, dysfunctional self-consciousness) predictors of post-event processing (PEP) subsequent to two social situations (interaction, speech) in participants with a primary diagnosis of social anxiety disorder (SAD) and healthy controls (HC). The speech triggered significantly more intense PEP, especially in SAD. Regardless of the type of social situation, PEP was best predicted by situational anxiety and dysfunctional cognitions among the state variables. If only trait variables were considered, PEP following both situations was accounted for by trait social anxiety. In addition, dysfunctional self-consciousness contributed to PEP-speech. If state and trait variables were jointly considered, for both situations, situational anxiety and dysfunctional cognitions were confirmed as the most powerful PEP predictors above and beyond trait social anxiety (interaction) and dysfunctional self-consciousness (speech). Hence, PEP as assessed on the day after a social situation seems to be mainly determined by state variables. Trait social anxiety and dysfunctional self-consciousness also significantly contribute to PEP depending on the type of social situation. The present findings support dysfunctional cognitions as a core cognitive mechanism for the maintenance of SAD. Implications for treatment are discussed.     

Depression as a predictor of perceived social support and demand: a componential approach using a prospective sample of older adults

This study examined the relationship of the cognitive, mood, and somatic components of depression on perceptions of social support and social demand among older adults (n = 851) over two years. Factor-analyses confirmed the factor structure of our multicomponential model of depression. Results supported our proposal that interpersonal specificity, as measured by depressive cognition about self and others, is important to predicting changes in perceived support and demand over time. Each component of depression was related to social support and social demand cross-sectionally, whereas only the cognitive component of depression predicted changes in support and demand prospectively. Future research should consider the pathways linking depressive cognition to perceived support and demand.     

Depressive Symptoms and Conversational Self-Focus in Adolescents’ Friendships

This multi-method, longitudinal study considered the interplay among depressive symptoms, aversive interpersonal behavior, and interpersonal rejection in early and middle adolescents’ friendships. In particular, the study examined a newly identified interpersonal process, conversational self-focus (i.e., the tendency to redirect conversations about problems to focus on the self). Traditional interpersonal theories of depression suggest that individuals with depressive symptoms engage in aversive behaviors (such as conversational self-focus) and are rejected by others. However, in the current study, not all adolescents with depressive symptoms engaged in conversational self-focus and were rejected by friends. Instead, conversational self-focus moderated prospective relations of depressive symptoms and later friendship problems such that only adolescents with depressive symptoms who engaged in conversational self-focus were rejected by friends. These findings are consistent with current conceptualizations of the development of psychopathology that highlight heterogeneity among youth who share similar symptoms and the possibility of multifinality of outcomes.     

Self-Construction and Interpersonal Distances of Juveniles Living in Residential Communities

Within the framework of constructivism, and more specifically personal construct psychology, the current research aims at exploring self-construction and interpersonal relationships of juveniles living in residential communities. It proposes a method of doing so that is coherent with the framework adopted. Repertory grids were used with 59 youths, ages 9 to 20 years, and 176 significant others (father, mother, houseparent, and a teacher or employer); interpersonal distances were measured. Identification with others and an authority, perceived change, self and social acceptance, social negativity, self-fulfillment, commonality, and sociality led to the discrimination of different profiles that indicate different (inter)personal configurations.     

Interpersonal Subtypes Within Social Anxiety: The Identification of Distinct Social Features

Although social anxiety disorder is defined by anxiety-related symptoms, little research has focused on the interpersonal features of social anxiety. Prior studies (Cain, Pincus, & Grosse Holtforth, 2010; Kachin, Newman, & Pincus, 2001) identified distinct subgroups of socially anxious individuals' interpersonal circumplex problems that were blends of agency and communion, and yet inconsistencies remain. We predicted 2 distinct interpersonal subtypes would exist for individuals with high social anxiety, and that these social anxiety subtypes would differ on empathetic concern, paranoia, received peer victimization, perspective taking, and emotional suppression. From a sample of 175 undergraduate participants, 51 participants with high social anxiety were selected as above a clinical cutoff on the social phobia scale. Cluster analyses identified 2 interpersonal subtypes of socially anxious individuals: low hostility–high submissiveness (Cluster 1) and high hostility–high submissiveness (Cluster 2). Cluster 1 reported higher levels of empathetic concern, lower paranoia, less peer victimization, and lower emotional suppression compared to Cluster 2. There were no differences between subtypes on perspective taking or cognitive reappraisal. Findings are consistent with an interpersonal conceptualization of social anxiety, and provide evidence of distinct social features between these subtypes. Findings have implications for the etiology, classification, and treatment of social anxiety.     

Interpretations for anxiety symptoms in social phobia

This study explored the ways in which people interpret visible physical symptoms of anxiety. A group of participants with social phobia (SP) and a nonclinical control (NCC) group completed either the Actor version or the Observer version of the Symptom Interpretation Scale (SIS), designed for the purposes of this study. The SIS asks participants to rate the extent to which each of eight interpretations is a likely explanation for a number of visible symptoms of anxiety. On the Actor version of the SIS, participants are asked to judge how their own anxiety symptoms are interpreted by others. On the Observer version of the SIS, participants are asked how they typically interpret anxiety symptoms that they notice in others. When participants were asked about anxiety symptoms that they themselves exhibit, people with social phobia were more likely than nonclinical controls to think that others interpreted these symptoms as being indicative of intense anxiety or a psychiatric condition and were less likely to think that others interpreted these symptoms as being indicative of a normal physical state. Data also suggested that people with social phobia have a more flexible cognitive style when asked to interpret anxiety symptoms exhibited by others than when asked about how others view their own anxiety symptoms. These findings are discussed in the context of recent psychological models of social anxiety and social phobia.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Effects of Analytical and Experiential Self-focus on Rumination After a Stress Induction in Patients with Social Anxiety Disorder: A Pilot Study

According to cognitive models, negative post-event processing rumination is a key maintaining factor in social anxiety disorder (SAD). Analogue research has supported the differentiation of self-focus into different modes of self-focused attention with distinct effects on rumination in depression and social anxiety. The purpose of this study was to replicate these effects with a sample of clients with SAD (N = 12) using (a) an experimental, cross-over design and (b) an evaluation situation (impromptu speech) prior to manipulation. Processing an identical list of symptoms, half of a sample was asked to successively adopt an analytic (abstract, evaluative) and an experiential (concrete, process-focused) self-focus; the other half employed the modes in the reversed order. Effects were assessed with a thought-listing (TL) procedure. As predicted, the two modes of self-focused attention affected cognitions differently; participants in the experiential condition showed a tendency for a decreased proportion of negative thoughts, whereas those in the analytical condition reported a decreased proportion of neutral thoughts. No difference was shown on positive cognitions. Furthermore, the participants' self-evaluation following the speech predicted their degree of subsequent negative thinking. After self-focus inductions, however, this effect was only seen in those participants who started by receiving the analytical self-focus induction. The results support previous findings that the analytical and the experiential self-focus modes affect cognitions differently, and that experiential processing may have beneficial effects on rumination in SAD. However, results need to be replicated in a larger sample.