Psychometric evaluation of the Fear of Positive Evaluation Scale in patients with social anxiety disorder

The Fear of Positive Evaluation Scale (FPES; J. W. Weeks, R. G. Heimberg, & T. L. Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only 1 previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (T. A. Fergus et al., 2009). The primary purpose of the present study was to conduct a large multisite examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype = 97.8%). Responses of nonanxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples.     

Predictors of post-event rumination related to social anxiety

Post-event processing is the cognitive rumination that follows social events in cognitive models of social anxiety. The aim of this study was to examine factors that may predict the extent to which individuals engage in post-event processing. Anxious rumination, social anxiety, anxiety sensitivity and post-event processing related to a recent anxiety-provoking social event were assessed in a college student sample (n = 439). Social anxiety and anxious rumination, but not anxiety sensitivity, significantly predicted the extent to which the participants engaged in post-event processing related to an anxiety-provoking social event. Factors that appear to impact on the post-event period include the nature of the social situation and the ethnicity of the participant. It appears that both general rumination over anxious symptoms, and specific rumination related to social events are relevant for cognitive models of social anxiety.     

Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia.

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921-928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.     

大学生社交焦虑对躯体变形障碍的影响：外表拒绝敏感性的中介作用

躯体变形障碍在大学生群体中具有较高的发病率,在其发展过程中,社交焦虑是重要的预测因素;然而两者潜在的中介机制却未得到研究者关注。本研究采用问卷调查法,旨在大学生 (N = 875)中探究外表拒绝敏感性在社交焦虑与躯体变形障碍之间的中介作用。结果发现： (1) 社交焦虑显著正向预测外表拒绝敏感性与躯体变形障碍,且外表拒绝敏感性显著正向预测躯体变形障碍; (2) 外表拒绝敏感性在社交焦虑与躯体变形障碍之间具有显著的部分中介作用。本研究发现,个体的社交焦虑可直接影响躯体变形障碍,也可通过提高外表拒绝敏感性间接影响。     

Expectations and attributions in social anxiety disorder: diagnostic distinctions and relationship to general anxiety and depression

Contemporary cognitive models suggest that social anxiety disorder arises from a number of cognitive factors, including tendencies to form pessimistic (rather than optimistic) attributions and expectations for socially-related events. These models also assume that the strengths of such attributions and expectations are more closely linked with social anxiety than with general anxiety or depression. To test these assumptions, a battery of self-report measures was completed by participants with a primary diagnosis of generalized social anxiety disorder (n = 75), panic disorder with agoraphobia (n = 44), or post-traumatic stress disorder (n = 59). To examine differences on these cognitive variables, group comparisons were performed controlling for general anxiety, depression and medication status. Social anxiety disorder, compared with panic disorder with agoraphobia and post-traumatic stress disorder, was characterized by lower expectations for positive social events and higher expectations for negative social events. There was no difference among the groups on expectations for non-social positive or negative events. Stable and global attributions for social negative events were more closely associated with social anxiety disorder than with panic disorder with agoraphobia and post-traumatic stress disorder. Correlational analyses also revealed specific relationships among social-cognitive measures and social anxiety, even after controlling for general anxiety and depression. The results are consistent with cognitive models of social anxiety disorder.     

The pattern of subjective anxiety during in-session exposures over the course of cognitive-behavioral therapy for clients with social anxiety disorder

Exposure-based therapies are efficacious treatments for social anxiety disorder (i.e., Gould et al., 1997). Much of the theory behind these treatments is derived from Foa and colleagues' (Foa, Huppert, & Cahill, 2005; Foa & Kozak, 1986) work on emotional processing. However, there has been little research examining individual differences in emotional processing patterns within and between treatment sessions among clients with social anxiety disorder. This study utilized longitudinal data analytic methods to examine changes in subjective anxiety during the first 3 exposure sessions in group and individual cognitive-behavioral therapy for social anxiety disorder. The results of this study provide preliminary evidence that, although anxiety generally decreases across exposures, some individuals experience considerable fluctuations in anxiety during a single exposure. Although anxiety during the first exposure was not significantly related to outcome, the relationship between anxiety during exposure and outcome became stronger during subsequent exposures. Overall, this study highlights the need to conduct more fine-grained analyses to better understand the mechanisms underlying exposure-based therapies for social anxiety disorder.     

Cognitive Indicators of Social Anxiety in Youth: A Structural Equation Analysis

Previous studies have demonstrated significant relationships among various cognitive variables such as negative cognition, self-efficacy, and social anxiety. Unfortunately, few studies focus on the role of cognition among youth, and researchers often fail to use domain-specific measures when examining cognitive variables. Therefore, the purpose of the present study was to examine domain-specific cognitive variables (i.e., socially oriented negative self-referent cognition and social self-efficacy) and their relationships to social anxiety in children and adolescents using structural equation modeling techniques. A community sample of children and adolescents (n = 245; 55.9% female; 83.3% Caucasian, 9.4% African American, 2% Asian, 2% Hispanic, 2% “other,” and 1.2% not reported) completed questionnaires assessing social cognition and social anxiety symptomology. Three latent variables were created to examine the constructs of socially oriented negative self-referent cognition (as measured by the SONAS scale), social self-efficacy (as measured by the SEQSS-C), and social anxiety (as measured by the SPAI-C and the Brief SA). The resulting measurement model of latent variables fit the data well. Additionally, consistent with the study hypothesis, results indicated that social self-efficacy likely mediates the relationship between socially oriented negative self-referent cognition and social anxiety, and socially oriented negative self-referent cognition yields significant direct and indirect effects on social anxiety. These findings indicate that socially oriented negative cognitions are associated with youth's beliefs about social abilities and the experience of social anxiety. Future directions for research and study limitations, including use of cross-sectional data, are discussed.     

Attachment in individuals with social anxiety disorder: the relationship among adult attachment styles,social anxiety,and depression

Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive-behavioral treatment of social anxiety disorder.     

Cognitive risk factors explain the relations between neuroticism and social anxiety for males and females

The hierarchical model of vulnerabilities to emotional distress contextualizes the relation between neuroticism and social anxiety as occurring indirectly through cognitive risk factors. In particular, inhibitory intolerance of uncertainty (IU; difficulty in uncertain circumstances), fear of negative evaluation (FNE; fear of being judged negatively), and anxiety sensitivity (AS) social concerns (fear of outwardly observable anxiety) are related to social anxiety. It is unclear whether these risk factors uniquely relate to social anxiety, and whether they account for the relations between neuroticism and social anxiety. The indirect relations between neuroticism and social anxiety through these and other risk factors were examined using structural equation modeling in a sample of 462 individuals (M age = 36.56, SD = 12.93; 64.3% female). Results indicated that the relations between neuroticism and social anxiety could be explained through inhibitory IU, FNE, and AS social concerns. No gender differences were found. These findings provide support for the hierarchical model of vulnerabilities to emotional distress disorders, although the cognitive risk factors accounted for variance beyond their contribution to the relation between neuroticism and social anxiety, suggesting a more complex model than that expressed in the hierarchical model of vulnerabilities.     

The post-event processing questionnaire in a clinical sample with social phobia

Post-event processing (PEP) involving rumination about perceived inadequacy in a past social situation has been proposed as an important maintaining factor in social phobia. The three aims of this study were to examine (a) the factor structure and internal reliability of a modified version of the Post-Event Processing Questionnaire [Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38, 611-617] in a clinical sample with social phobia (N=117), (b) the associations between PEP and symptoms of anxiety and depression, and (c) the relationship between perspective-taking ('field' and 'observer') and anxiety. Principal axis factor analysis yielded a highly reliable one-factor solution in our clinical sample, which generally replicated Rachman et al.'s findings with a sample of undergraduate students. PEP was most strongly and independently associated with state anxiety when depression, general anxiety and stress were controlled for. Contrary to expectations, PEP was not related to measures of social anxiety. The relationship between perspective-taking and anxiety was more complex than expected. Theoretical implications of these findings are discussed with reference to contemporary cognitive-behavioural models of social phobia.     

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.     

Implicit associations and social anxiety

The aim of this study was to test whether an Implicit Association Test (IAT) with self- and social anxiety-words is sensitive to differences in trait social anxiety, and to an experimental induction of social anxiety. This was performed in the context of a partial replication of a previous study, in which Mauss et al. (2004) compared high and low trait socially anxious individuals before and after a social anxiety induction (an impromptu speech). Mauss et al.'s findings were replicated; that is, (i) the social anxiety induction produced increases in self-rated anxiety, self-rated physiological responses, and actual physiological arousal; and (ii) higher trait social anxiety was associated with stronger self-rated anxiety and stronger self-rated physiological responses, but not with stronger actual physiological responses. In addition, the results showed higher IAT social anxiety scores, both (i) as a result of the social anxiety induction, and (ii) as a function of self-reported trait social anxiety. It is suggested that the IAT may be a useful method for the experimental study of automatic evaluational thought patterns.     

激活右腹外侧前额叶提高抑郁症患者对社会疼痛的情绪调节能力：一项TMS研究

负性人际交往经历和负性社会事件是抑郁症的重要诱导因素, 而社会功能受损是抑郁症患者的重要特征之一, 患者通常表现出对社会疼痛的情绪失调。为了提高抑郁症患者在负性社交情境中或面对负性社会事件时的情绪调节能力, 本研究采用经颅磁刺激技术(transcranial magnetic stimulation, TMS), 考察抑郁症患者在腹外侧前额叶(the ventrolateral prefrontal cortex, VLPFC)被激活后其情绪调节能力的改变。结果表明, 当右侧VLPFC被TMS激活且患者采用认知重评策略调节情绪时, 实验组患者(n = 64)比对照组患者(n = 63)在社会排斥情境下报告了更弱的负性情绪体验, 这说明激活右侧VLPFC可以有效提高患者对社会疼痛的外显性情绪调节能力。本研究是采用TMS提高抑郁症患者情绪调节能力的首次尝试, 实验发现不但支持了VLPFC与认知重评策略的因果关系, 还为临床改善抑郁症等社会功能障碍患者的情绪调节能力提供了明确的神经治疗靶点。后续研究还需探讨多疗程TMS刺激方案、改变社会疼痛的诱发方式、对比左右侧VLPFC的治疗效果、尝试使用其他的情绪调节策略, 进一步验证本研究的结论, 优化TMS治疗方案。     

Individual differences in neonatal “imitation” fail to predict early social cognitive behaviour

The influential hypothesis that humans imitate from birth – and that this capacity is foundational to social cognition – is currently being challenged from several angles. Most prominently, the largest and most comprehensive longitudinal study of neonatal imitation to date failed to find evidence that neonates copied any of nine actions at any of four time points (Oostenbroek et al., [2016] Current Biology, 26, 1334–1338). The authors of an alternative and statistically liberal post‐hoc analysis of these same data (Meltzoff et al., [2017] Developmental Science, 21, e12609), however, concluded that the infants actually did imitate one of the nine actions: tongue protrusion. In line with the original intentions of this longitudinal study, we here report on whether individual differences in neonatal “imitation” predict later‐developing social cognitive behaviours. We measured a variety of social cognitive behaviours in a subset of the original sample of infants (N = 71) during the first 18 months: object‐directed imitation, joint attention, synchronous imitation and mirror self‐recognition. Results show that, even using the liberal operationalization, individual scores for neonatal “imitation” of tongue protrusion failed to predict any of the later‐developing social cognitive behaviours. The average Spearman correlation was close to zero, mean r_s = 0.027, 95% CI [?0.020, 0.075], with all Bonferroni adjusted p values > .999. These results run counter to Meltzoff et al.'s rebuttal, and to the existence of a “like me” mechanism in neonates that is foundational to human social cognition.     

A social cognitive explanation of situational and individual effects on moral sensitivity

Models of moral decision making describe the process as beginning with the recognition of moral content in the decision environment. This recognition ability, or moral sensitivity, represents a key input to moral decision making. Adopting a social cognitive perspective, this paper studies the degree to which moral sensitivity is explained in terms of moral schema activation. In a single experiment, two situational factors (moral content priming and issue moral intensity) and two individual characteristics (moral identity and need for cognition) are tested for their effects on moral sensitivity. Results support the social cognitive explanation of moral sensitivity. The moral schema's propensity for activation, development, and accessibility significantly influence the ability to recognize moral issues in the decision environment.     

Time perception and its relationship to memory in Autism Spectrum Conditions

Timing is essential for the development of cognitive skills known to be impaired in Autism Spectrum Conditions (ASC), such as social cognition and episodic memory abilities. Despite the proposal that timing impairments may underpin core features of ASC, few studies have examined temporal processing in ASC and they have produced conflicting results. The present study first addressed discrepancies between previous experiments before testing the assumption that timing impairments may underpin key aspects of autism, by relating differences in temporal processing in the ASC group to memory abilities. Errors in duration reproduction in high functioning children with ASC were observed for the shortest and longest duration tested. While the former was due to attentional factors, the latter was due to deficient timing related to atypical episodic memory processing. These findings suggest that temporal processing abilities play a key role in the poor development of both social cognition and episodic memory abilities associated with ASC.     

Cognitive Behavioral Therapy for Social Anxiety Disorder: Predictors of Treatment Outcome in a Quasi-Naturalistic Setting

We examined the outcomes of individual cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) in a sample of 93 adults seeking treatment in a university outpatient clinic specializing in CBT for SAD. Treatment followed the structure of a manual, but number of sessions varied according to client needs. After approximately 20 weeks of therapy, patients’ social anxiety had decreased and their quality of life had increased. Patients with more severe SAD or comorbid major depressive disorder (MDD) at pretreatment demonstrated higher levels of social anxiety averaged across pre- and posttreatment. However, clinician-rated severity of SAD, comorbid MDD, or comorbid generalized anxiety disorder did not predict treatment outcome. Higher pretreatment scores on measures of safety behaviors and cognitive distortions were associated with higher social anxiety averaged across pre- and posttreatment and predicted greater decreases from pre- to posttreatment on multiple social anxiety outcome measures. We found no predictors of change in quality of life. Those with high levels of safety behaviors and distorted cognitions may benefit more from CBT, perhaps due to its emphasis on targeting avoidance through exposure and changing distorted thinking patterns through cognitive restructuring methods. Our study lends support to the body of research suggesting that manualized CBT interventions can be applied flexibly in clinical settings with promising outcomes for patients over a relatively short course of therapy.     

A Psychometric Analysis of the Revised Child Anxiety and Depression Scales—Parent Version in a School Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a parent-report questionnaire of youth anxiety and depression with scales corresponding to the DSM diagnoses of separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. The RCADS-P was recently developed and has previously demonstrated strong psychometric properties in a clinic-referred sample (Ebesutani et al., Journal of Abnormal Child Psychology 38, 249–260, 2010b). The present study examined the psychometric properties of the RCADS-P in a school-based population. As completed by parents of 967 children and adolescents, the RCADS-P demonstrated high internal consistency, test-retest reliability, and good convergent/divergent validity, supporting the RCADS-P as a measure of internalizing problems specific to depression and five anxiety disorders in school samples. Normative data are also reported to allow for the derivation of T-scores to enhance clinicians’ ability to make classification decisions using RCADS-P subscale scores.     

A comparative outcome study of four cognitive therapies in the treatment of social anxiety

This clinical outcome study compared four separate cognitive behavioral and one behavioral treatment for reducing social anxiety with a waiting list control. Subjects were adults who responded to advertisements for treatment. In the cognitive-behavioral conditions, subjects were trained to modify their disruptive cognitions and/or emit adaptive cognitions relevant to interpersonal behavior with the specific content and techniques determined by the particular cognitive therapy. In the behavioral condition, subjects modeled and rehearsed appropriate social interpersonal behaviors. Subjects were assessed pre and post-treatment on self-report measures of social anxiety, measures of general anxiety, clinical scales of anxiety, depression and hostility, and behavioral, and physiological concomitants of social anxiety. Subjects in all active treatment conditions showed improvement on the measures of social anxiety and the behavioral measure. However, only those in the cognitive treatment conditions, demonstrated treatment effects on general anxiety and the clinical scales. The results indicate the efficacy of both cognitive and behavioral approaches to the reduction of social anxiety. However, they fail to demonstrate clear distinctions between the various cognitive therapies.