Social anxiety and emotion regulation flexibility: considering emotion intensity and type as contextual factors

Background and objectives: Individuals with social anxiety disorder have often been considered inflexible in their emotion regulation. The aim of this study was to investigate emotion regulation flexibility in socially anxious individuals in response to two contextual factors, namely different levels of emotion intensity and emotion type.

Methods: A daily diary approach was employed, investigating emotion regulation (i.e., experiential avoidance, expressive suppression and cognitive reappraisal) in college students scoring high (N?=?62; HSA) and low (N?=?52; LSA) on social anxiety.

Results: Results revealed that HSAs were found to use more experiential avoidance than LSAs, especially at higher levels of negative intensity. The use of this emotion regulation strategy appeared to be driven by guilt, nervousness, and sadness. There were no between-group differences concerning the other strategies in response to varying levels of emotional intensity.

Conclusions: Together, the results provide evidence for inflexible emotion regulation in HSAs, reflected in an unwillingness to experience negative emotions.     

The Influence of Anticipatory Processing on Attentional Biases in Social Anxiety

Research on cognitive theories of social anxiety disorder (SAD) has identified individual processes that influence this condition (e.g., cognitive biases, repetitive negative thinking), but few studies have attempted to examine the interaction between these processes. For example, attentional biases and anticipatory processing are theoretically related and have been found to influence symptoms of SAD, but they rarely have been studied together (i.e., Clark & Wells, 1995). Therefore, the goal of the current study was to examine the effect of anticipatory processing on attentional bias for internal (i.e., heart rate feedback) and external (i.e., emotional faces) threat information. A sample of 59 participants high (HSA) and low (LSA) in social anxiety symptoms engaged in a modified dot-probe task prior to (Time 1) and after (Time 2) an anticipatory processing or distraction task. HSAs who anticipated experienced an increase in attentional bias for internal information from Time 1 to Time 2, whereas HSAs in the distraction condition and LSAs in either condition experienced no changes. No changes in biases were found for HSAs for external biases, but LSAs who engaged in the distraction task became less avoidant of emotional faces from Time 1 to Time 2. This suggests that anticipatory processing results in an activation of attentional biases for physiological information as suggested by Clark and Wells.     

The association between ruminative thinking and negative interpretation bias in social anxiety

Cognitive models propose that both, negative interpretations of ambiguous social situations and ruminative thoughts about social events contribute to the maintenance of social anxiety disorder. It has further been postulated that ruminative thoughts fuel biased negative interpretations, however, evidence is rare. The present study used a multi-method approach to assess ruminative processing following a social interaction (post-event processing by self-report questionnaire and social rumination by experience sampling method) and negative interpretation bias (via two separate tasks) in a student sample (n?=?51) screened for high (HSA) and low social anxiety (LSA). Results support the hypothesis that group differences in negative interpretations of ambiguous social situations in HSAs vs. LSAs are mediated by higher levels of post-event processing assessed in the questionnaire. Exploratory analyses highlight the potential role of comorbid depressive symptoms. The current findings help to advance the understanding of the association between two cognitive processes involved in social anxiety and stress the importance of ruminative post-event processing.     

Consequences of anticipatory processing on cognitive symptoms of social anxiety

Anticipatory processing is an anxious style of repetitive negative thought associated with social anxiety (SA) that was proposed by Clark and Wells. Considerable research has examined factors of Clark and Wells' cognitive model of SA (e.g. attention, interpretation), but few studies have examined anticipatory processing, which is hypothesized to interact with other components in the model. In the current study, individuals high in social anxiety symptoms (HSA; N = 56) and control participants [Normal Control (NC); N = 52] engaged in an anticipation or distraction task prior to a threatened social interaction. HSAs who anticipated had higher self-focused attention than NCs who anticipated and HSAs in the distraction condition, suggesting an important relationship between anticipation and self-focus that is specific to HSAs. Those who anticipated endorsed more negative interpretations than those who engaged in distraction, regardless of SA status. However, this relationship was mediated by self-focus. Implications in the context of Clark and Wells' model and future directions are discussed.     

Theory of Mind Impairments in Social Anxiety Disorder

Social anxiety disorder (SAD) is a common psychiatric disorder characterized by a persistent, excessive fear and avoidance of social and performance situations. Research on cognitive biases indicates individuals with SAD may lack an accurate view of how they are perceived by others, especially in social situations when they allocate important attentional resources to monitoring their own actions as well as external threat. In the present study, we explored whether socially anxious individuals also have impairments in theory of mind (ToM), or the ability to comprehend others’ mental states, including emotions, beliefs, and intentions. Forty socially anxious and 40 non-socially-anxious comparison participants completed two ToM tasks: the Reading the Mind in the Eyes and the Movie for the Assessment of Social Cognition. Participants with SAD performed worse on ToM tasks than did non-socially-anxious participants. Relative to comparison participants, those with SAD were more likely to attribute more intense emotions and greater meaning to what others were thinking and feeling. These group differences were not due to interpretation bias. The ToM impairments in people with SAD are in the opposite direction of those in people with autism spectrum conditions whose inferences about the mental states of other people are absent or very limited. This association between SAD and ToM may have important implications for our understanding of both the maintenance and treatment of social anxiety disorder.     

Interpretation bias and social anxiety: does interpretation bias mediate the relationship between trait social anxiety and state anxiety responses?

Two studies aimed to examine whether high socially anxious individuals are more likely to negatively interpret ambiguous social scenarios and facial expressions compared to low socially anxious individuals. We also examined whether interpretation bias serves as a mediator of the relationship between trait social anxiety and state anxiety responses, in particular current state anxiety, bodily sensations, and perceived probability and cost of negative evaluation pertaining to a speech task. Study 1 used ambiguous social scenarios and Study 2 used ambiguous facial expressions as stimuli to objectively assess interpretation bias. Undergraduate students with high and low social anxiety completed measures of state anxiety responses at three time points: baseline, after the interpretation bias task, and after the preparation for an impromptu speech. Results showed that high socially anxious individuals were more likely to endorse threat interpretations for ambiguous social scenarios and to interpret ambiguous faces as negative than low socially anxious individuals. Furthermore, negative interpretations mediated the relationship between trait social anxiety and perceived probability of negative evaluation pertaining to the speech task in Study 1 but not Study 2. The present studies provide new insight into the role of interpretation bias in social anxiety.     

Understanding associations between negatively biased attention and depression and social anxiety: positively biased attention is key

ABSTRACT

Background and objectives: Although research supports the premise that depressed and socially anxious individuals direct attention preferentially toward negative emotional cues, little is known about how attention to positive emotional cues might modulate this negative attention bias risk process. The purpose of this study was to determine if associations between attention biases to sad and angry faces and depression and social anxiety symptoms, respectively, would be strongest in individuals who also show biased attention away from happy faces.

Methods: Young adults (N?=?151; 79% female; M?=?19.63 years) completed self-report measures of depression and social anxiety symptoms and a dot probe task to assess attention biases to happy, sad, and angry facial expressions.

Results: Attention bias to happy faces moderated associations between attention to negatively valenced faces and psychopathology symptoms. However, attention bias toward sad faces was positively and significantly related to depression symptoms only for individuals who also selectively attended toward happy faces. Similarly, attention bias toward angry faces was positively and significantly associated with social anxiety symptoms only for individuals who also selectively attended toward happy faces.

Conclusions: These findings suggest that individuals with high levels of depression or social anxiety symptoms attend preferentially to emotional stimuli across valences.     

Social anxiety and cognitive expectancy of aversive outcome in avoidance conditioning

Fear conditioning studies have shown that social anxiety is associated with enhanced expectancy of aversive outcome. However, the relation between cognitive expectancy and social anxiety has never been tested in avoidance conditioning paradigms. We compared 48 low (LSA) and high socially anxious individuals (HSA) on subjective expectancy of aversive outcome during an avoidance conditioning task. Displays of neutral faces were coupled with an aversive outcome (US): a shout and a shock. Participants could avoid the US by pressing a correct button from a button box. First, HSA showed higher US expectancy than LSA during the initial phase of avoidance conditioning, supporting the view that socially anxious individuals have an expectancy bias when social situations are ambiguous. Second, when the avoidance response became unavailable, LSA showed lower US expectancy than HSA, suggesting that low socially anxious individuals are prone to a positive bias when perceived threat is high. A lack of such positive bias in socially anxious individuals may lead to higher susceptibility to safety behavior interpretations. Together, these findings support the role of cognitive processes in avoidance conditioning and underscore the relevance to encounter avoidance learning when studying social anxiety.     

Social Anxiety Symptoms in Young Children: Investigating the Interplay of Theory of Mind and Expressions of Shyness

Children’s early onset of social anxiety may be associated with their social understanding, and their ability to express emotions adaptively. We examined whether social anxiety in 48-month-old children (N = 110; 54 boys) was related to: a) a lower level of theory of mind (ToM); b) a lower proclivity to express shyness in a positive way (adaptive); and c) a higher tendency to express shyness in a negative way (non-adaptive). In addition, we investigated to what extent children’s level of social anxiety was predicted by the interaction between ToM and expressions of shyness. Children’s positive and negative expressions of shyness were observed during a performance task. ToM was measured with a validated battery, and social anxiety was assessed using both parents’ reports on questionnaires. Socially anxious children had a lower level of ToM, and displayed more negative and less positive shy expressions. However, children with a lower level of ToM who expressed more positive shyness were less socially anxious. Additional results show that children who displayed shyness only in a negative manner were more socially anxious than children who expressed shyness only in a positive way and children who did not display any shyness. Moreover, children who displayed both positive and negative expressions of shyness were more socially anxious than children who displayed shyness only in a positive way. These findings highlight the importance of ToM development and socio-emotional strategies, and their interaction, on the early development of social anxiety.     

Effects of gender role self-discrepancies and self-perceived attractiveness on social anxiety for women across social situations

Background and objectives: Psychosocial factors, such as gender role norms, may impact how social anxiety disorder (SAD) is experienced and expressed in different social contexts for women. However to date, these factors have not been examined via experimental methodology. Design: This was a cross-sectional, quasi-experimental controlled study. Methods: The current study included 48 highly socially anxious (HSA) women (70.9% meeting criteria for SAD) and examined the relationships among psychosocial factors (i.e. gender role self-discrepancies and self-perceived physical attractiveness), self-perceived social performance, and state anxiety, across two in vivo social tasks (i.e. conversation and opinion speech). Results: On average, participants reported belief that they ought to be less feminine for the speech task and more masculine for both the conversation and speech tasks. Also, for the conversation task, only lower self-rated attractiveness predicted poorer self-perceived performance and greater post-task state anxiety, above gender role self-discrepancies and confederate gender. For the speech task, only greater self-discrepancy in prototypical masculine traits predicted poorer performance ratings, and it was related to greater state anxiety in anticipation of the task. Conclusion: For HSA women, psychosocial factors may play different roles in social anxiety across social contexts.     

Attention to Positive and Negative Social-Evaluative Words: Investigating the Effects of Social Anxiety,Trait Anxiety and Social Threat

The study investigated how attention to negative (threatening) and positive social-evaluative words is affected by social anxiety, trait anxiety and the expectation of social threat. High and low socially anxious individuals carried out a modified dot-probe task either while expecting to give a speech or under non-threatening conditions. High socially anxious individuals showed no significant attentional bias towards or away from social-evaluative words. This result significantly contrasted with an identical design that showed avoidance of emotional faces in high socially anxious participants drawn from the same population (Mansell et al ., 1999). Participants who expected to give a speech showed less attentional avoidance of negative and positive social-evaluative words. High trait anxiety was associated with selective attention to negative relative to positive social-evaluative words, consistent with earlier findings of attention to threat cues in high trait-anxious individuals. Implications for designing attention tasks and attentional bias across different dimensions of anxiety are discussed.     

Adolescent social anxiety undermines adolescent-parent interbrain synchrony during emotional processing: A hyperscanning study

Social anxiety severely impacts adolescents’ social interactions with others; however, the underlying neural mechanism has not been revealed. This study examined how adolescent's social anxiety level influences the interbrain synchrony within adolescent-parent dyads during emotional processing by using electroencephalograph (EEG) hyperscanning. A sample of 25 adolescent-parent dyads completed the picture processing task. Adolescents’ ages ranged from 10 to 14 years old. The results showed that (1) at parietal areas, greater gamma interbrain synchrony was observed in the high social anxiety adolescent-parent dyads (HSAs) than the low social anxiety adolescent-parent dyads (LSAs) in the positive conditions. However, greater gamma interbrain synchrony of the picture processing task was observed in the LSAs than the HSAs in the negative conditions. (2) Compared with the neutral condition, LSAs induced greater interbrain synchronization in the negative condition than in the neutral condition at central and parietal areas. However, HSAs induced greater interbrain synchronization in the positive condition than in the negative condition at parietal areas. (3) HSAs induced greater interbrain synchronization at parietal areas than in the central areas in positive conditions. The results provide neurological evidence that the way parent and adolescent process different emotions in the same emotional episode could be affected by the adolescent's anxiety level.     

Facilitating a benign interpretation bias in a high socially anxious population

Previous research has shown that high socially anxious individuals lack the benign interpretation bias present in people without social anxiety. The tendency of high socially anxious people to generate more negative interpretations may lead to anticipated anxiety about future social situations. If so, developing a more benign interpretation bias could lead to a reduction in this anxiety. The current study showed that a benign interpretation bias could be facilitated (or 'trained') in a high socially anxious population. Participants in the benign training groups had repeated practice in accessing benign (positive or non-negative) interpretations of potentially threatening social scenarios. Participants in the control condition were presented with the same social scenarios but without their outcomes being specified. In a later recognition task, participants who received benign interpretation training generated more benign, and less negative, interpretations of new ambiguous social situations compared to the control group. Participants who received benign training also predicted that they would be significantly less anxious in a future social situation than those in the control group. Possible implications of the findings for therapeutic interventions in social phobia are discussed.     

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N?=?447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N?=?325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.     

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents.

Design: Cross-sectional design was utilized.

Methods: IB, measured by the Adolescents’ Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n?=?25) and a control group (n?=?29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation.

Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn’t have more negative interpretations of non-social situations, after controlling for depression.

Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.     

Investigating ToM in aging with the MASC: from accuracy to error type

Growing evidence indicates that Theory of Mind (ToM) declines in normal aging. However, the majority of this research has used classic and static verbal tasks that present scenarios, which are very different from real life. The present study was designed to fill this gap by administering the Movie for the Assessment of Social Cognition (MASC) to young and older participants. It allows one to analyze not only the accuracy, but also the typology of error in mental states attribution distinguishing between iper-ToM (over-mentalization), ipo-ToM (insufficient mentalization), and no-ToM (lack of mentalization). We recruited 30 young (20–29 years), 39 young-old (65–74 years), and 31 old-old (75–86 years) participants. Along with the MASC, we administered a classic ToM task, the Strange Stories, and several measures of cognitive functioning. Results showed that older adults were less accurate in mental state attribution than young adults in the MASC, but not in the Strange Stories. In addition, compared to young adults, older adults committed more errors of both ipo- and no-ToM, while young adults committed more often iper-ToM errors. Additionally, older adults, but not young adults, did not show a difference between iper-ToM and ipo-ToM errors, which were equally frequent in this age group. Globally, results indicated that older adults’ failure in classic ToM tasks may be due to both ipo- and iper-ToM and provide needed evidence for the MASC as a suitable measure of ToM in aging.     

Working memory load moderates late attentional bias in social anxiety

The vigilance–avoidance hypothesis suggests that socially anxious individuals attempt to detect signs that they are being evaluated (vigilance) and subsequently direct attention away from such stimuli (avoidance). Although extensive evidence supports vigilance, data concerning subsequent avoidance is equivocal. Drawing from models of attention, the current study hypothesised that working memory load moderates late attentional bias in social anxiety such that avoidance occurs if working memory load is low, and difficulty disengaging attention occurs if working memory load is high. Forty-one undergraduates (19 socially anxious; 22 non-anxious controls) completed a dot-probe task with emotional (happy and disgust) and neutral facial expressions and a concurrent n-back task. Results supported the hypothesis such that socially anxious subjects demonstrated avoidance of disgust faces when working memory load was absent, but had difficulty disengaging attention during high working memory load. Theoretical implications and directions for future research are discussed.     

The effects of self-focus on attentional biases in social anxiety:An ERP study

Cognitive theories of social anxiety disorder suggest that biased attention plays a key role in maintaining symptoms. These biases include self-focus and attention to socially threatening stimuli in the environment. The goal of this study was to utilize ERPs that are elicited by a change detection task to examine biases in selective attention (i.e., N2pc) and working memory maintenance (i.e., contralateral delay activity; CDA). Additionally, the effect of self-focus was examined using false heart rate feedback. In support of the manipulation, self-focus cues resulted in greater self-reported self-consciousness and task interference, enhanced anterior P2 amplitude and reduced SPN amplitude. Moreover, P2 amplitude for self-focus cues was correlated with reduced task performance for socially anxious subjects only. The difference in P2 amplitude between self-focus and standard cues was correlated with social anxiety independent of depression. As hypothesized, socially anxious participants (n = 20) showed early selection and maintenance of disgust faces relative to neutral faces as indicated by the N2pc and CDA components. Nonanxious controls (n = 22) did not show these biases. During self-focus cues, controls showed marginal evidence of biased selection for disgust faces, whereas socially anxious subjects showed no bias in this condition. Controls showed an ipsilateral delay activity after being cued to attend to one hemifield. Overall, this study supports early and persistent attentional bias for social threat in socially anxious individuals. Furthermore, self-focus may disrupt these biases. These findings and supplementary data are discussed in light of cognitive models of social anxiety disorder, recent empirical findings, and treatment.     

A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms

Previous research suggests that socially anxious individuals interpret ambiguous social information in a more threatening manner compared to non-anxious individuals. Recently, studies have experimentally modified interpretation and shown that this subsequently affected anxiety in non-anxious individuals. If similar procedures can modify interpretation biases in socially anxious individuals, they may lead to a reduction in social anxiety symptoms. In the current study, we examined the effect of a computerized Interpretation Modification Program (IMP) on interpretation bias and social anxiety symptoms. Twenty-seven socially anxious individuals were randomly assigned to the IMP or a control condition. Participants completed eight computer sessions over four weeks. The IMP modified interpretation by providing positive feedback when participants made benign interpretations and negative feedback in response to threat interpretations. The IMP successfully decreased threat interpretations, increased benign interpretations, and decreased social anxiety symptoms compared to the control condition. Moreover, changes in benign interpretation mediated IMP's effect on social anxiety. This initial trial suggests that interpretation modification may have clinical utility when applied as a multi-session intervention.     

Autobiographical memory bias in social anxiety

In social anxiety the psychological self is closely related to the feared stimulus. Socially anxious individuals are, by definition, concerned about how the self is perceived and evaluated by others. As autobiographical memory is strongly related to views of the self it follows that biases in autobiographical memory play an important role in social anxiety. In the present study high (n = 19) and low (n = 29) socially anxious individuals were compared on autobiographical memory bias, current goals, and self-discrepancy. Individuals high in social anxiety showed a bias towards recalling more negative and more social anxiety-related autobiographical memories, reported more current goals related to overcoming social anxiety, and showed larger self-discrepancies. The pattern of results is largely in line with earlier research in individuals with PTSD and complicated grief. This suggests that the relation between autobiographical memory bias and the self is a potentially valuable trans-diagnostic factor.