Cognitive Factors that Maintain Social Anxiety Disorder: a Comprehensive Model and its Treatment Implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post‐event rumination, which leads to further social apprehension in the future. Possible disorder‐specific intervention strategies are discussed.     

A feasibility study of psychological strengths and well-being assessment in individuals living with recurrent depression

Current conceptualizations of mental illness focus on assessing psychopathology. A balanced approach would assess strengths that individuals bring to coping with illness. This study measures psychological strengths in individuals with recurrent depression, their coping strategies, and their perceptions of the usefulness of strengths assessment as a component of psychological assessment. Individuals (N?=?112) with recurrent depression completed an online questionnaire measuring several psychological strengths, including gratitude, forgiveness, spirituality, and hope. Participants also described their use of coping strategies and their reaction to the utility of the two-continua model of mental health. A subset (n?=?10) completed a follow-up telephone interview. Higher levels of gratitude, self-forgiveness, hope, and spirituality and lower levels of optimism were indicative of higher life satisfaction. Self-forgiveness, spirituality, and gratitude were predictors of happiness. Higher levels of hope and self-forgiveness predicted positive affect whereas lower levels of self-forgiveness predicted negative affect. Participants reported using a range of coping resources and indicated that they valued strengths assessment, perceiving the two-continua model of mental health as empowering. The researcher discusses implications for clinical practice.     

To be or not to be at risk: Spontaneous reactions to risk information

Rheumatoid arthritis (RA) is a chronic disease, which can lead to considerable psychological distress. The present study evaluated anxiety and depression symptoms for this chronic and painful illness within the framework of the conservation of resources (COR) theory. Coping strategies, coping self-efficacy, religiousness and social support are very important personal resources, which have been found to protect individuals from psychological distress. The aim of the present study was to examine the predictive values of socio-demographic and illness-related variables, perceived social support, ways of coping, religiousness, arthritis self-efficacy and resource loss for psychological distress in a sample of 117 RA patients from Turkey, a secular, Islamic, non-western developing country. The results revealed that RA patients experience considerable anxiety and depressive symptoms. The results of the regression analysis showed that gender, helplessness coping and resource loss are significant predictors of anxiety, whereas arthritis self-efficacy and resource loss are significant predictors of depression. Resource loss appeared as an important predictor for both anxiety and depression. This finding was consistent with the COR theory. The clinical implications of these findings are discussed.     

Illness Perceptions,Coping, Benefit Finding,and Adjustment in Individuals with Hepatitis C

Objective

To investigate the ability of illness perceptions, adaptive, and maladaptive coping strategies, and benefit finding to predict physical and psychosocial adjustment among individuals diagnosed with the hepatitis C virus (HCV), within an expanded self‐regulatory model of illness (SRM).

Method

A total of 126 participants with HCV completed an online questionnaire assessing illness perceptions, coping, benefit finding, and four adjustment outcomes, depression, physical functioning, life satisfaction and positive affect.

Results

Illness perceptions made significant contributions to the variance in adjustment outcomes across the four psychosocial and physical adjustment areas. At an individual level, personal control, identification with HCV symptoms, perceptions related to illness duration, illness coherence, and emotional responses to HCV made significant contributions to the prediction of adjustment. Similarly, the combined contributions of adaptive and maladaptive coping strategies explained significant variance across the four adjustment areas. Greater adoption of maladaptive coping strategies predicted poorer physical health, higher reported depression, greater life satisfaction, and positive affect outcomes, while increased engagement with adoptive coping strategies predicted higher positive affect. Increased benefit finding predicted greater positive affect, life satisfaction, and higher depression.

Conclusion

Results demonstrate the ability of the SRM features of illness perceptions and coping, and benefit finding to predict physical and psychosocial adjustment outcomes within the context of HCV.     

Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.     

Generalized expectancies for negative mood regulation predict change in anxiety and depression among college students

Negative mood regulation (NMR) expectancies, or the beliefs held by individuals that, when faced with various manifestations of stress and negative affect, they can successfully cope with such mood states, have proven to be a most useful construct in the context of better understanding self-regulatory processes. In the present prospective study, we examined the predictive utility of NMR expectancies with respect to its ability to predict residual change in both depressive and anxiety symptoms over an 8-week timeframe in a sample of 322 college students. Initial correlational analyses revealed that, as anticipated, NMR expectancies were negatively correlated with depressive and anxiety symptomatology, as well as with maladaptive coping style. Conversely, NMR expectancies were positively associated with self-reported adaptive coping. A series of hierarchical regression analyses revealed that, even when controlling for age, sex, baseline levels of affective distress (depression or anxiety), and coping styles, NMR expectancies predicted change in both depressive and anxiety symptomatology. Implications of the findings pertinent to theory building and testing are discussed.     

Nonreligious coping and religious coping as predictors of expressed emotion in relatives of patients with schizophrenia

Expressed emotion (EE) is a measure of the amount of criticism and emotional over involvement expressed by a key relative towards a relative with a disorder or illness. Research has established that living in a high EE environment, which is characterised by increased levels of critical and emotionally exaggerated communication, leads to a poorer prognosis for patients with a mental illness when compared to low EE environments. Despite evidence that EE is a strong predictor of the course of the illness, there continue to be questions concerning why some family members express excessive levels of high EE attitudes about their mentally ill relatives while others do not. Based on indirect evidence from previous research, the current study tested whether religious and nonreligious coping serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed an EE interview, along with questionnaires assessing situational nonreligious coping and religious coping. In line with the hypotheses, results indicated that nonreligious coping predicted EE. Specifically, less use of adaptive emotion-focused coping predicted high EE. Also consistent with predictions, maladaptive religious coping predicted high EE above and beyond nonreligious coping.     

Perfectionism and its relationship with anticipatory processing in social anxiety

Cognitive‐behavioural models suggest that perfectionistic beliefs and anticipatory processing are key maintaining factors of social anxiety. The present study examined the moderating and mediating role that anticipatory processing has on the relationship between perfectionism and social anxiety. The sample consisted of 245 individuals from the general community who completed an online questionnaire package comprising depression, perfectionism, and social anxiety measures. Participants also rated their levels of anticipatory processing in response to vignettes describing an upcoming social interaction and performance situation. Results showed that maladaptive perfectionism and maladaptive anticipatory processing were positively associated with social anxiety. Furthermore, maladaptive anticipatory processes (stagnant deliberation and outcome fantasy) remained significantly and positively associated with social anxiety even after controlling for depression and maladaptive perfectionism, whereas adaptive anticipatory processes (plan rehearsal and problem analysis) were not significantly associated with social anxiety. These findings support current classifications of anticipatory processing in social anxiety. Contrary to predictions, maladaptive anticipatory processing did not moderate the relationship between maladaptive perfectionism and social anxiety. An exploratory analysis indicated that maladaptive anticipatory processing mediated the relationship between maladaptive perfectionism and social anxiety. Implications for therapeutic intervention are discussed.     

Experiential avoidance and self‐compassion in chronic pain

The present study investigates the role of coping, experiential avoidance, and self‐compassion on psychological distress prediction (i.e., depression, anxiety, and stress symptoms). A battery of self‐report questionnaires was used to assess coping, experiential avoidance, self‐compassion, and psychological distress in 103 adults with chronic pain from Portuguese primary health care units. Hierarchical regression analyses were performed and showed that experiential avoidance and self‐compassion are the factors that mostly explain psychological distress. Our results suggest that when people with chronic pain are willing to remain in contact with particular private experiences without attempting to control them, they reported less depression, anxiety, and stress. Implications for clinical practice were discussed, suggesting the importance of helping people with chronic pain to increase their willingness to pain rather than avoiding it.     

Individual differences in responses to workplace stress: the contribution of attachment theory

Work stress is a major cause of physical and psychological distress, and both theory and research highlight the importance of individual differences in coping efforts. The present research clarifies the mechanisms linking attachment insecurities (anxiety and avoidance) to maladaptive coping; specifically, we tested an integrative model assessing stress appraisals as a mediator between attachment insecurities and coping strategies, together with mediating and moderating effects of coping resources (perceived self‐efficacy and social support). A community sample of 113 men and 115 women completed an online survey which incorporated a standardized vignette depicting workplace stress. The results supported stress appraisal as a mediator between attachment anxiety and less adaptive coping, and established both mediating and moderating effects of perceived coping resources. The effects support the relevance of attachment theory to the study of workplace stress.     

Multidimensional Perfectionism and Anxiety: Differences Among Individuals With Perfectionism and Tests of a Coping‐Mediation Model

This study examined the relationship between adaptive and maladaptive perfectionism, anxiety, and coping processes in a sample of 329 undergraduate students. Specifically, participants with adaptive perfectionism had the lowest levels of anxiety, followed by participants with nonperfectionism, and participants with maladaptive perfectionism had the highest levels. Various coping processes mediating the relationship between maladaptive perfectionism and anxiety are discussed.     

The stigma of seeking help for mental health issues: mediating roles of support and coping and the moderating role of symptom profile

A key factor to the prevalence of mental illness might be the disinclination to seek help, perhaps owing to the stigma of mental illness. In two studies, the contribution of severity of depressive symptoms, social support, and unsupport, coping strategies, and salience of psychological versus biological features of depression in relation to perceived self‐ and other‐stigma of help‐seeking for mental health issues were examined. Participants were first year students experiencing a transitional stressor, namely entry to university. Together, the findings point to the contribution of social support and unsupportive interactions, and coping methods to the prediction of perceived stigma of seeking help, but that the framing of mental illness can limit or strengthen these relations.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

Psychological, cognitive, and interpersonal correlates of attributional change in adolescents

Examined the role of attributional style in adolescent's psychological functioning. Specifically, we examined the cross-sectional correlates of attributional style, as well as the correlates of changes in attributional style over time. A sample of 841 adolescents with either maladaptive or adaptive attributional styles completed a battery of self-report measures at 2 points in time, 1 year apart. Measures assessed depressive symptoms and suicidality, cognitive functioning (self-esteem, pessimism, coping skills), and interpersonal functioning (social competence, conflict with parents, social support from family and friends). Results indicated that attributional style is associated with multiple depression-related variables. In addition, youth experienced significant changes in their attributional styles over time (from adaptive to maladaptive and vice versa). Finally, changes in attributional style were associated with changes in psychological symptoms and other psychosocial variables. Results are discussed in terms of their implications for the prevention and treatment of adolescent depression.     

Maladaptive coping, adaptive coping, and depressive symptoms: Variations across age and depressive state

Rumination has consistently been found to be associated with the onset and duration of major depressive episodes. Little research, however, has examined factors that may weaken the association between maladaptive coping, such as rumination, and depressive symptoms. In three samples of participants, including 149 never-depressed adolescent girls, 41 never-depressed women, and 39 depressed women, we examined whether generally adaptive forms of coping interacted with generally maladaptive forms of coping to predict depressive symptoms. Age-appropriate measures of coping and depression were administered to participants in each sample. In never-depressed females, maladaptive coping/rumination were more strongly related to depressive symptoms in the presence of lower levels of adaptive coping. The relation between depression and maladaptive coping/rumination was weaker in the context of higher levels of adaptive coping. In contrast, for the depressed females, we found main effects for rumination and adaptive coping, with higher levels of rumination and lower levels of adaptive coping being associated with higher levels of depressive symptoms. The present findings highlight how adaptive coping and maladaptive coping, including rumination, differentially relate to each other and depressive symptoms depending on individuals' current depressive state.     

Exploring Sexual Minority Women’s Experiences of External and Internalized Heterosexism and Sexism and their Links to Coping and Distress

This study examined experiences of external and internalized heterosexism and sexism and their links to coping styles and psychological distress among 473 sexual minority women. Using an online sample of United States lesbian and bisexual women, the findings indicated that many participants experienced heterosexist and sexist events at least once during the past 6 months, and a number of participants indicated some level of internalized oppression. Supporting an additive multiple oppression perspective, the results revealed that when examined concurrently heterosexist events, sexist events, internalized heterosexism, and internalized sexism were unique predictors of psychological distress. In addition, suppressive coping and reactive coping, considered to be maladaptive coping strategies, mediated the external heterosexism-distress, internalized heterosexism-distress, and internalized sexism-distress links but did not mediate the external sexism-distress link. Reflective coping, considered to be an adaptive coping strategy, did not mediate the relations between external and internalized heterosexism and sexism and psychological distress. Finally, the variables in the model accounted for 54 % of the variance in psychological distress scores. These findings suggest that maladaptive but not adaptive coping strategies help explain the relationship between various oppressive experiences and psychological distress.     

Trajectories of resilience, depression, and anxiety following spinal cord injury

Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Good and Bad Sides of Self-Compassion: A Face Validity Check of the Self-Compassion Scale and an Investigation of its Relations to Coping and Emotional Symptoms in Non-Clinical Adolescents

To demonstrate that the positive and negative subscales of Self-Compassion Scale (SCS) are very different in nature, we conducted a series of face validity checks on the items of this questionnaire among psychologists and psychology students (Study 1). Furthermore, a survey was administered to a convenience sample of non-clinical adolescents to examine the relations between various SCS subscales and symptoms of anxiety and depression as well as coping styles (Study 2). The results of the face validity checks revealed that the positive subscales seem to be well in line with the protective nature of self-compassion as they were mainly associated with cognitive coping and healthy functioning, whereas the negative subscales were chiefly associated with psychopathological symptoms and mental illness. The survey data demonstrated that the positive SCS subscales were positively correlated with adaptive coping (r’s between .22 and .50) and negatively correlated with symptoms of anxiety and depression (r’s between ?.19 and ?.53), while the negative subscales were positively correlated with symptoms (r’s between .49 and .61) and maladaptive coping strategies such as passive reacting (r’s between .53 and .56). Additional analyses indicated the negative subscales of the SCS accounted for a significant proportion of the variance in symptoms, whereas the unique contribution of the positive SCS subscales was fairly marginal. We caution to employ the total SCS score that includes the reversed negative subscales as such a procedure clearly inflates the relation between self-compassion and psychopathology.     

Lifetime Abuse and Mental Health Among Older Persons: A European Study

This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.     

Coping behaviors and managers' affective reactions to role stressors

This study assessed the role of adaptive versus maladaptive coping behaviors and personal characteristics in influencing the affective reactions of managers to four role stressors. Maladaptive coping was found to moderate the relationships of several role stressors with felt stress and job satisfaction. Maladaptive coping and trait anxiety also demonstrated independent additive effects on felt stress and job satisfaction over and above that of all four stressors.