Mental Imagery and Post-Event Processing in Anticipation of a Speech Performance Among Socially Anxious Individuals

The present study investigated whether post-event processing (PEP) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech. One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session. They were randomly assigned to one of three manipulation conditions: post-event processing about a past speech incorporating imagery (PEP-Imagery), semantic post-event processing about a past speech (PEP-Semantic), or a control condition, (n = 19 per experimental group, per condition [high vs low socially anxious]). After the condition inductions, individuals’ anxiety, their predictions of performance in the anticipated speech, and their interpretations of other ambiguous social events were measured. Consistent with predictions, high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task. They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition. High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions. The impact of imagery during post-event processing in social anxiety and its implications are discussed.     

Post-event processing in social anxiety

Clark and Wells’ [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.     

Shame as a predictor of post-event rumination in social anxiety

Evidence shows that people with high social anxiety levels ruminate about distressing social events, which contributes to the maintenance of social anxiety symptoms. The present study aimed to explore the role of shame in maintaining post-event rumination (PER) following a negative social event (an impromptu speech with negative feedback) in a student sample (N?=?104). Participants reported negative rumination related to the event one day and one week after the speech. PER measured one day after the speech was not associated with social anxiety symptoms and state anxiety. One week later, participants with clinically relevant social anxiety symptoms experienced greater PER. State shame was the only significant predictor of PER in a regression equation that also included social anxiety symptoms, state anxiety and self-evaluation of performance. Possible explanations and implications are discussed in light of cognitive models of social anxiety.     

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.     

Ruminative coping and post-event processing in social anxiety

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.     

Continual training of attentional bias in social anxiety

Using the dot-probe paradigm, it has been shown that high social anxiety is associated with an attentional bias toward negative information. In the present study, individuals with high social anxiety were divided into two groups randomly. One group was the attentional bias training group (Group T), and the other was the control group (Group C). For Group T, 7 days' continuous training of attentional bias was conducted using the dot-probe paradigm to make socially anxious individuals focus more on positive face pictures. The results showed that the training was effective in changing attentional bias in Group T. Scores of the Social Interaction Anxiety Scale (SIAS) in Group T were reduced compared to Group C, while the scores of Social Phobia Scale (SPS) and scores of Negative Evaluation Scale (FNE) showed no difference between the two groups, which suggested a limited reduction of social anxiety.     

Manualized Group Cognitive-Behavioral Therapy for Social Anxiety in At-Risk Mental State and First Episode Psychosis: A Pilot Study of Feasibility and Outcomes

Social anxiety has received scant attention in studies of schizophrenia and related psychoses. However, some data suggest it may be an obstacle to vocational and functional outcome. This pilot study investigated the feasibility of a group-based cognitive behavioral therapy (CBGT) to reduce social anxiety in those at risk for developing psychosis or in the early phase. Twenty-nine patients with first-episode psychosis (FEP) or at ultra high risk for developing psychosis or often referred to as at-risk mental state (ARMS) with comorbid social anxiety attended a CBGT intervention weekly for 14 weeks in 90-minute sessions. Baseline, post-treatment, and follow-up ratings of social anxiety were measured using the Social Interaction Anxiety Scale, the Social Phobia Inventory, and the Brief Social Phobia Scale. Psychotic symptoms and general psychopathology were also measured before and after the intervention. Results suggest that the proposed CBGT is feasible and beneficial for socially anxious patients at risk, or with experience of, psychosis. Participants significantly improved on three outcome measures of social anxiety after completing this intervention (all p’s < .002). Participants who completed treatment also showed a significant reduction on measures of depression and negative symptoms. Future research should examine the relative efficacy of this brief manualized CBGT intervention for the treatment of social anxiety and psychotic symptoms in a larger randomized controlled trial.     

Smiling when distressed: when a smile is a frown turned upside down

This research tested self-regulation and self-presentation as psychological mechanisms that motivate smiling when distressed. In Study 1, participants viewed moderately and intensely distressing, amusing, and neutral videos in social or nonsocial conditions. Smiling when distressed was most prevalent in conditions in which participants reported the greatest emotional distress. Specifically, while viewing distressing videos, men reported experiencing greater overall distress and also smiled more than women, especially in social conditions and while viewing intensely (as opposed to moderately) distressing stimuli. In general, smiling was related to more negative affect while viewing distressing videos but to more positive affect after viewing such stimuli. Study 2 explored raters' social perceptions of participants from Study 1, confirming that people judge distressed smilers as less socially appropriate and less likable than nonsmilers. Findings suggest that although distressed smiling serves a probable self-regulatory function, it may also bear some negative social consequences.     

The relationship of post-event processing to self-evaluation of performance in social anxiety

Socially anxious and control participants engaged in a social interaction with a confederate and then wrote about themselves or the other person (i.e., self-focused post-event processing [SF-PEP] vs. other-focused post-event processing [OF-PEP]) and completed several questionnaires. One week later, participants completed measures concerning their evaluation of their performance in the social interaction and the degree to which they engaged in post-event processing (PEP) during the week. Socially anxious individuals evaluated their performance in the social interaction more poorly than control participants, both immediately after and 1 week later. Socially anxious individuals assigned to the SF-PEP condition displayed fewer positive feelings about their performance compared to the socially anxious individuals in the OF-PEP condition as well as controls in either condition. Also, the trait tendency to engage in PEP moderated the effect of social anxiety on participants' evaluation of their performance in the interaction, such that high socially anxious individuals with high trait PEP scores evaluated themselves in the interaction more negatively at the later assessment. These results suggest that PEP and other self-evaluative processes may perpetuate the cycle of social anxiety.     

An Assessment of Social Phobia and Social Anxiety and their Relation to Self-Consciousness

Abstract

The translation of the Social Phobia and Anxiety Inventory (SPAI) into Icelandic was submitted to a psychometric assessment. Two hundred sixty-three university students participated in the study. In addition to the SPAI they filled in Fenigstein, Scheier and Buss' (1975) Self-Consciousness Scale (SCS) as well as Spielberger's (1983) State-Trait Anxiety Inventory (STAI). A principal components analysis of the SPAI yielded as expected an agoraphobia and a social phobia factor. As expected the Social Anxiety Scale of the SCS correlated much more strongly with the Social Phobia than the Agoraphobia Scale. The correlation of the Social Phobia Scale with the Social Anxiety Scale was substantially higher than its correlation with any other anxiety measure. The relationships between the Social Phobia Scale and Public versus Private Self-Consciousness were moreover in accordance with theoretical expectations as well as prior research. Generally the discriminant and convergent validity of the Icelandic translation of the Social Phobia Scale as a measure of social anxiety is supported.     

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.     

Self-focused attention before and after treatment of social phobia

It has been hypothesized that effective psychological treatment for social phobia changes the person's representation of the self in a more positive direction. In order to test this hypothesis, we analyzed 506 thoughts that were endorsed by 23 social phobic individuals while anticipating socially stressful situations before and after exposure therapy. Treatment efficacy was assessed with the Social Phobia and Anxiety Inventory (SPAI) [Turner, S. M., Beidel, D. C., Dancu, C. V., & Stanley M. A. (1989) An empirically derived inventory to measure social fears and anxiety: the Social Phobia and Anxiety Inventory. Psychological Assessment, 1, 35-40)]. Subjects endorsed significantly fewer negative self-focused thoughts after treatment (on average 8.7% of the thoughts) than before treatment (26.5%, p < 0.005). These changes were highly correlated with pre-post difference scores in the social phobia subscale of the SPAI (r = 0.74, p < 0.0001). Implications of the results for the cognitive model of social phobia will be discussed.     

Validity of the social avoidance and distress and fear of negative evaluation scales

The Social Avoidance and Distress Scale (SAD) and the Fear of Negative Evaluation Scale (FNE), two commonly accepted measures of social anxiety, were administered to a large group of patients diagnosed as having Agoraphobia with Panic Attacks, Agoraphobia without Panic Attacks, Social Phobia, Simple Phobia, Generalized Anxiety Disorder, Panic Disorder and Obsessive-Compulsive Disorder. On the SAD and FNE, social phobies did not differ significantly from the other major anxiety disorders, with the exception of simple phobies. Performance on the SAD and FNE was significantly correlated with measures of anxiety, depression and general emotional distress. The lack of discriminative validity of the SAD and FNE is discussed.     

The social phobia and social interaction anxiety scales: An exploration of the dimensions of social anxiety and sex differences in structure and relations with pathology

This study sought to provide information on the Social Phobia Scale (SPS) and Social Interaction Anxiety Scale (SIAS) of Mattick and Clarke (1989) with respect to factor structure, relations with psychopathology, and sex differences. A sample of 200 university students completed the SPS and SIAS and various measures of anxiety symptoms and depression. The results from the factor analyses for the sample as a whole suggest the presence of three factors corresponding to scrutiny fears, social interaction anxiety, and a general level of discomfort in social interactions. The results for men replicated this structure. For women, the three-factor solution demonstrated a blurring between the types of anxiety-provoking situations, and a general discomfort in situations involving differences in social power. In general, the discomfort factor was not correlated with measures of pathology, raising the possibility that uneasiness in these situations represents a process that is not part of social anxiety. The distinction between scrutiny fears and social interaction anxiety was also supported by the pattern of partial correlations that suggests that the presence of scrutiny fears is a stronger predictor of psychopathology than is social interaction anxiety, especially for men.     

An analysis of social anxiety in anorexic,bulimic, social phobic,and control women

Responses to the Social Phobia and Anxiety Inventory (SPAI) were examined in 23 women with anorexia nervosa, 54 women with bulimia nervosa, 50 female college undergraduates, and 43 social phobic women. Results indicated that women with anorexia nervosa and bulimia nervosa scored comparably high to social phobic women on measures of social anxiety and that these fears were not limited to fears of eating or drinking in public. This study suggests that fears of negative evaluation in women with eating disorders may generalize beyond the fears of scrutiny of body shape and size to more traditional social situations.     

Relationships between psychoevolutionary fear of evaluation,cognitive distortions,and social anxiety symptoms: A preliminary structural equation model

Social anxiety disorder is a mental health condition that affects 4.7% of Australians each year. The complex interplay between psychoevolutionary and cognitive models has become the focus of research in recent years, particularly with the development of the bivalent fear of evaluation model (i.e., negative and positive evaluation fears). The present study aimed to test a model of social anxiety symptoms using structural equation modelling, integrating previously fragmented evidence. A sample of 255 participants (75.3% female; M_age = 31.9, SD = 10.3) undertook an online survey, including Social Phobia Scale, Brief Fear of Negative Evaluation—Straightforward, Fear of Positive Evaluation, Concerns of Social Reprisal, and Disqualifications of Positive Social Outcomes measures. The hypothesised model for social anxiety symptoms described the data reasonably well (χ²(1) = 4.917, p = .027, CFI = .995, GFI = .992, SRMR = .017), explaining 57.1% of social anxiety variance. Study hypotheses were supported with bivalent fear of evaluation accounting for unique variance in cognitive distortions, which in turn accounted for unique variation in social anxiety symptoms. Effect sizes indicate bivalent fears of evaluation and disqualification of positive social outcomes as important predictors of social anxiety symptoms. Although replication in a clinical cohort and experimental confirmation are needed, the findings suggest a focus on disqualification of positive social outcomes to alleviate social anxiety symptoms.     

Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: an experimental study

Cognitive models of social phobia (SP) assume that following social evaluative stress, individuals with SP engage into dysfunctional post-event processing (PEP), a detailed negative review of the past event. While previous research has already shown, that children with high levels of social fears suffer from more frequent negative PEP, it remains unclear how stable PEP is across time in this age group and whether it leads to degraded self-appraisals of performance. Therefore in the present study we exposed a group of high (HSA) and low socially anxious children (LSA; both n = 20), aged 10–12 years, to a social evaluative situation and assessed negative and positive PEP as well as self-rated performance at 2.5 h and one week after the task. Our results revealed that HSA children reported more negative PEP than LSA children, independent of levels of depression. Moreover, negative PEP was related to measures of social anxiety and performance ratings within the tasks. Only the performance ratings in HSA children worsened over the course of the following week and were related to more negative PEP. Thus, these results speak for the high clinical relevance dysfunctional PEP may have for the maintenance of social fears already in childhood.     

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n?=?30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

     

Social Anxiety and Its Relationship to Functional Impairment in Body Dysmorphic Disorder

Social anxiety appears to be a prominent characteristic of body dysmorphic disorder (BDD). However, few previous studies have examined social anxiety and its facets (i.e., physiological arousal, fear and avoidance of social situations) and their relationship to psychosocial functioning in BDD. The present study aimed to fill these gaps by examining (a) social anxiety and its facets in BDD, and b) cross-sectional and prospective relationships between social anxiety symptoms and functional impairment in BDD. Individuals with DSM-IV BDD without comorbid social phobia (N = 108) completed measures of social anxiety and psychosocial functioning at study intake (T1). Psychosocial functioning was also assessed at a 12-month follow-up interview (T2). Severity of social anxiety (i.e., due to BDD or any other source) was rated with the Social Phobia Inventory (SPIN). In addition, participants were interviewed with the Duke Brief Social Phobia Scale (BSPS) to assess social anxiety independent of BDD. At T1, participants endorsed high levels of social anxiety on the SPIN and subclinical levels of social anxiety on the BSPS. Greater social anxiety was associated with poorer psychosocial functioning in cross-sectional and prospective analyses, particularly fear and avoidance of social situations. These results suggest that certain aspects of social anxiety, especially social fear and avoidance, may be significant contributing factors to functional impairment in individuals with BDD.