The observer perspective: effects on social anxiety and performance

The cognitive model of social phobia by Clark and Wells (Social phobia : Diagnosis, Assessment and treatment (1995)) proposes that individuals with social phobia generate a negative impression of how they appear to others, constructed from their own thoughts, feelings and internal sensations. This impression can occur in the form of a visual image from an external, or "observer", perspective. Although social phobics use this perspective more than controls, the impact of the observer perspective has not been tested experimentally. This study investigated the effects of taking the observer perspective on thinking, anxiety, behaviour and social performance in high and low socially anxious participants. Forty-four participants (N=22 in each group) gave two speeches, one in the observer and one in the field perspective. Use of the observer perspective produced more frequent negative thoughts, more safety behaviours, and worse self-evaluation of performance in both groups. There were also clear trends demonstrating increases in anxiety and in thought belief ratings in the observer perspective compared to the field perspective. Results are consistent with the Clark and Wells model of social phobia. This study also suggests that in low socially anxious individuals, the observer perspective may contain positive information.     

Not self-focused attention but negative beliefs affect poor social performance in social anxiety: An investigation of pathways in the social anxiety-social rejection relationship

Patients with social anxiety disorder (SAD) not only fear negative evaluation but are indeed less likeable than people without SAD. Previous research shows social performance to mediate this social anxiety-social rejection relationship. This study studied two pathways hypothesized to lead to poor social performance in social anxiety: increased self-focused attention and negative beliefs. State social anxiety was experimentally manipulated in high and low-blushing-fearful individuals by letting half of the participants believe that they blushed intensely during a 5 min getting-acquainted interaction with two confederates. Participants rated their state social anxiety, self-focused attention, and level of negative beliefs. Two confederates and two video-observers rated subsequently likeability (i.e., social rejection) and social performance of the participants. In both groups, the social anxiety-social rejection relationship was present. Although state social anxiety was related to heightened self-focused attention and negative beliefs, only negative beliefs were associated with relatively poor social performance. In contrast to current SAD models, self-focused attention did not play a key-role in poor social performance but seemed to function as a by-product of state social anxiety. Beliefs of being negatively evaluated seem to elicit changes in behavioral repertoire resulting in a poor social performance and subsequent rejection.     

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.     

Social emotions and social cognition in the development of social anxiety disorder

ABSTRACT

Social anxiety disorder (SAD) is one of the most prevalent mental disorders with serious individual impairments and societal costs. Little is known about the mechanisms involved in SAD development. Here, I propose that dysregulated social emotions (social fear and shyness) are crucial for SAD development and that these dysregulated social emotions originate in the disturbances in socio-cognitive abilities. The research from our lab confirmed this. It showed that behavioural and physiological indices of social fear contribute to the development of SAD in toddlerhood and early childhood. Later in childhood, between ages 4.5 and 7.5, we found a new risk factor for SAD―dysregulated shyness. Specifically, we found that negative shy expressions and prolonged physiological blushing (temperature increase) contribute to SAD development. Whereas elevated fear may be rooted in deficits in socio-cognitive skills, dysregulated shyness may be rooted in advanced socio-cognitive abilities. These findings imply that dysregulated social emotions play an important role in SAD and should be explicitly targeted in clinical treatments of SAD.     

Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

The structure of feared social situations among individuals with a lifetime diagnosis of social anxiety disorder in two independent nationally representative mental health surveys

The present study employed both exploratory and confirmatory factor analytic approaches with nationally representative samples of individuals with a lifetime diagnosis of social anxiety disorder (n=1123; n=3091, respectively) using split-halves of the National Comorbidity Replication Survey (n=9282) and cross-validated with the Canadian Community Health Survey on Mental Health and Wellbeing (n=36,984). Strong support was found for a three-factor solution. This model was obtained from exploratory factor analysis and was further evaluated using two confirmatory factor analytic investigations in the two national samples. The three social situational domains reflected (1) Social Interaction Fears, (2) Observation Fears, and (3) Public Speaking Fears. Individuals with generalized social anxiety disorder (i.e., those who endorsed 7 or more of 13 feared social situations assessed in the survey) were significantly more likely to report Social Interaction Fears and Observation Fears compared to individuals with non-generalized social anxiety disorder (i.e., those who endorsed only 6 or fewer of 13 feared social situations). Individuals with generalized social anxiety were particularly characterized by combinations of Public Speaking Fears plus Social Interaction Fears and Observation Fears. The clinical and classification implications of our study for DSM-V are discussed.     

Safety behaviors and judgmental biases in social anxiety disorder

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 randomly 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.     

Differential effects of safety behaviour subtypes in social anxiety disorder

Clinical observations indicate that individuals with Social Anxiety Disorder (SAD) use a variety of safety behaviours; however, virtually no research has examined the functional effect of different safety-seeking strategies. Accordingly, we conducted two studies to address this issue. Study 1 measured global patterns of safety behaviour use in a large analogue sample. Factor analysis revealed two primary safety behaviour categories, avoidance and impression management. Study 2 assessed situational use of safety behaviours during a controlled social interaction in a clinical sample of 93 patients with Generalised SAD. Factor analysis again revealed support for avoidance and impression-management subtypes. Notably, the two types of safety behaviours were associated with different social outcomes. Avoidance safety behaviours were associated with higher state anxiety during the interaction and negative reactions from participants’ interaction partners. Impression-management strategies appeared to impede corrections in negative predictions about subsequent interactions. These findings suggest that it may be beneficial to consider the unique effects of different safety-seeking strategies when assessing and treating SAD.     

Sleep quality and treatment of social anxiety disorder

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment.

Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs.

Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment.

Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety.

Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.     

Jumping to interpretations: social anxiety disorder and the identification of emotional facial expressions

A small body of research suggests that socially anxious individuals show biases in interpreting the facial expressions of others. The current study included a clinically anxious sample in a speeded emotional card-sorting task in two conditions (baseline and threat) to investigate several hypothesized biases in interpretation. Following the threat manipulation, participants with generalized social anxiety disorders (GSADs) sorted angry cards with greater accuracy, but also evidenced a greater rate of neutral cards misclassified as angry, as compared to nonanxious controls. The controls showed the opposite pattern, sorting neutral cards with greater accuracy but also misclassifying a greater proportion of angry cards as neutral, as compared to GSADs. These effects were accounted for primarily by low-intensity angry cards. Results are consistent with previous studies showing a negative interpretive bias, and can be applied to the improvement of clinical interventions.     

Disclosure of anxiety in everyday life: Effects of social anxiety

The current study examined the likelihood of disclosing one’s anxiety to others during anxiety-provoking conversations, as reported by individuals high or low in social anxiety. It investigated to whom these disclosures are made, and the content and intended purposes of these disclosures. Undergraduate students and community members low (n = 79) or high (n = 81) in social anxiety completed the Anxiety Disclosure in Everyday Life questionnaire, as well as several other measures as part of another study. Analyses indicated that individuals high in social anxiety were significantly less likely to disclose their anxiety as compared to individuals low in social anxiety. The likelihood of disclosing one’s anxiety varied significantly depending on to whom one was speaking, with intimate partners being disclosed to the most. The content of the disclosures typically involved stating that one is feeling shy or nervous without offering an explanation, or attributing it to one’s personality traits (e.g., shyness), with the intended purpose often being to elicit assistance or reassurance from their conversation partner or to manage the impressions of others.     

The latent structure of posttraumatic stress disorder: a taxometric investigation of reactions to extreme stress

Mental health professionals have debated whether posttraumatic stress disorder (PTSD) can be qualitatively distinguished from normal reactions to traumatic events. This debate has been fueled by indications that many trauma-exposed individuals evidence partial presentations of PTSD that are associated with significant impairment and help-seeking behavior. The authors examined the latent structure of PTSD in a large sample of male combat veterans. Three taxometric procedures-MAMBAC, MAXEIG, and L-Mode-were performed with 3 indicator sets drawn from a clinical interview and a self-report measure of PTSD. Results across procedures, consistency tests, and analysis of simulated comparison data all converged on a dimensional solution, suggesting that PTSD reflects the upper end of a stress-response continuum rather than a discrete clinical syndrome.     

Confirming the latent structure and base rate of schizotypy: a taxometric analysis.

Meehl's (1962, 1990) model of schizotypy and the development of schizophrenia implies that the structure of liability for schizophrenia is dichotomous and that a "schizogene" determines membership in a latent class, or taxon (Meehl & Golden, 1982). The authors sought to determine the latent structure and base rate of schizotypy. They applied Meehl's (1973; Meehl & Golden, 1982) MAXCOV-HITMAX taxometric analytic procedures to a subset of items from the Perceptual Aberration Scale (PAS; Chapman, Chapman, & Raulin, 1978), a prominent psychometric index of schizotypy, derived from a randomly ascertained nonclinical university sample (N = 1,093). The results, in accordance with Meehl's conjectures, strongly suggest that schizotypy, as assessed by the PAS, is taxonic at the latent level with a general population taxon base rate of approximately .10.     

Self-representation in social anxiety disorder: linguistic analysis of autobiographical narratives

Cognitive models of social anxiety disorder (SAD) posit aberrant beliefs about the social self as a key psychological mechanism that maintains fear of negative evaluation in social and performance situations. Consequently, a distorted self-view should be evident when recalling painful autobiographical social memories, as reflected in linguistic expression, negative self-beliefs, and emotion and avoidance. To test this hypothesis, 42 adults diagnosed with SAD and 27 non-psychiatric healthy controls (HC) composed autobiographical narratives of distinct social anxiety related situations, generated negative self-beliefs (NSB), and provided emotion and avoidance ratings. Although narratives were matched for initial emotional intensity and present vividness, linguistic analyses demonstrated that, compared to HC, SAD employed more self-referential, anxiety, and sensory words, and made fewer references to other people. There were no differences in the number of self-referential NSB identified by SAD and HC. Social anxiety symptom severity, however, was associated with greater self-referential NSB in SAD only. SAD reported greater current self-conscious emotions when recalling autobiographical social situations, and greater active avoidance of similar situations than did HC. These findings support cognitive models of SAD, and suggest that autobiographical memory of social situations in SAD may influence current and future thinking, emotion, and behavioral avoidance.     

Constructing a self: The role of self-structure and self-certainty in social anxiety

Current cognitive models stress the importance of negative self-perceptions in maintaining social anxiety, but focus predominantly on content rather than structure. Two studies examine the role of self-structure (self-organisation, self-complexity, and self-concept clarity) in social anxiety. In study one, self-organisation and self-concept clarity were correlated with social anxiety, and a step-wise multiple regression showed that after controlling for depression and self-esteem, which explained 35% of the variance in social anxiety scores, self-concept clarity uniquely predicted social anxiety and accounted for an additional 7% of the variance in social anxiety scores in an undergraduate sample (N = 95) and the interaction between self-concept clarity and compartmentalisation (an aspect of evaluative self-organisation) at step 3 of the multiple regression accounted for a further 3% of the variance in social anxiety scores. In study two, high (n = 26) socially anxious participants demonstrated less self-concept clarity than low socially anxious participants (n = 26) on both self-report (used in study one) and on computerised measures of self-consistency and confidence in self-related judgments. The high socially anxious group had more compartmentalised self-organisation than the low anxious group, but there were no differences between the two groups on any of the other measures of self-organisation. Self-complexity did not contribute to social anxiety in either study, although this may have been due to the absence of a stressor. Overall, the results suggest that self-structure has a potentially important role in understanding social anxiety and that self-concept clarity and other aspects of self-structure such as compartmentalisation interact with each other and could be potential maintaining factors in social anxiety. Cognitive therapy for social phobia might influence self-structure, and understanding the role of structural variables in maintenance and treatment could eventually help to improve treatment outcome.     

Predicting anxious response to a social challenge: the predictive utility of the social interaction anxiety scale and the social phobia scale in a college population

Trait anxiety is believed to be a hierarchical construct composed of several lower-order factors (Adv. Behav. Res. Therapy, 15 (1993) 147; J. Anxiety Disorders, 9 (1995) 163). Assessment devices such as the Social Interaction Anxiety Scale, the Social Phobia Scale (SIAS and SPS; Behav. Res. Therapy, 36 (4) (1998) 455), and the Anxiety Sensitivity Index (ASI; Behav. Res. Therapy, 24 (1986) 1) are good measures of the presumably separate lower-order factors. This study compared the effectiveness of the SIAS, SPS, ASI-physical scale and STAI-T (State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press (1970)) as predictors of anxious response to a social challenge (asking an aloof confederate out on a date). Consistent with the hierarchical model of anxiety, the measures of trait anxiety were moderately correlated with each other and each was a significant predictor of anxious response. The specific measures of trait social anxiety were slightly better predictors of anxious response to the social challenge than was either the ASI-physical scale or the STAI-T. The results provide evidence of the predictive validity of these social trait measures and some support for their specificity in the prediction of anxious response to a social challenge.     

Stuttering and social anxiety

The aim of the present study was to investigate the presence of social anxiety in adults who stutter. This was done by administering the Inventory of Interpersonal Situations (IIS) (Van Dam-Baggen & Kraaimaat, 1999), a social anxiety inventory, to a group of 89 people who stuttered and 131 people who did not stutter. Two components of social anxiety were measured by the ISS, the extent to which emotional tension or discomfort is perceived in social situations and the frequency with which social responses are executed. The people who stuttered displayed significantly higher levels of emotional tension or discomfort in social situations. They also reported a significantly lower frequency of social responses compared to their nonstuttering peers. In addition, about 50% of the scores of the people who stuttered fell within the range of a group of highly socially anxious psychiatric patients. The results of the study suggest that the measurement of social anxiety is an important element in the assessment of adults who stutter. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) the IIS as an assessment procedure for evaluating social anxiety, (2) the level of discomfort expressed by adult stutterers in social situations, and (3) the effect of social anxiety on stutterers' responsiveness in social situations.     

The influence of social anxiety on the body checking behaviors of female college students

Social anxiety and eating pathology frequently co-occur. However, there is limited research examining the relationship between anxiety and body checking, aside from one study in which social physique anxiety partially mediated the relationship between body checking cognitions and body checking behavior (Haase, Mountford, & Waller, 2007). In an independent sample of 567 college women, we tested the fit of Haase and colleagues’ foundational model but did not find evidence of mediation. Thus we tested the fit of an expanded path model that included eating pathology and clinical impairment. In the best-fitting path model (CFI = .991; RMSEA = .083) eating pathology and social physique anxiety positively predicted body checking, and body checking positively predicted clinical impairment. Therefore, women who endorse social physique anxiety may be more likely to engage in body checking behaviors and experience impaired psychosocial functioning.     

The psychometric properties of the Interpersonal Sensitivity Measure in social anxiety disorder

The Interpersonal Sensitivity Measure (IPSM) was developed to assess hypersensitivity to interpersonal rejection, a suggested trait of depression-prone personality (Aust NZ J Psychiatry 23 (1989) 341). Although studies of the IPSM and interpersonal rejection sensitivity have primarily been conducted in depressed populations, it is important to investigate interpersonal rejection sensitivity as a relevant construct in the assessment of social anxiety. This study examined the psychometric properties of the IPSM in treatment-seeking individuals with social anxiety disorder. The results of this investigation support the convergent and divergent validity and internal consistency of the IPSM in socially anxious individuals. An exploratory factor analysis of the scale was also conducted after the original factor and subscale structure was shown to be a poor fit for the present data. Three factors emerged (Interpersonal Worry and Dependency, Low Self-Esteem, and Unassertive Interpersonal Behavior), and 29 items were retained. Because they demonstrated negative factor loadings on Factor 2, it is suggested that the scoring for four items of the original IPSM be reversed. In summary, the revised IPSM assesses three aspects of interpersonal rejection sensitivity and appears to be a valid and reliable instrument for its assessment in social anxiety disorder.