Safety behaviors and judgmental biases in social anxiety disorder

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.     

Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression

People with social anxiety disorder (SAD) use different types of safety behaviors that have been classified as avoidance vs. impression management. The current study investigated differences in safety behavior subtype use in 132 individuals with principal diagnoses of social anxiety disorder (SAD, n = 69), major depressive disorder (MDD, n = 30), and nonpatient controls (n = 33) across two social contexts: an interpersonal relationship-building task (social affiliation) and a speech task (social performance). We examined whether diagnostic groups differed in safety behavior subtype use and whether group differences varied by social context. We also explored relationships between avoidance and impression management safety behaviors, respectively, and positive and negative valence affective and behavioral outcomes within the social affiliation and social performance contexts. Safety behavior use varied by diagnosis (SAD > MDD > nonpatient controls). The effect of diagnosis on impression management safety behavior use depended on social context: use was comparable for the principal SAD and MDD groups in the social performance context, whereas the SAD group used more impression management safety behaviors than the MDD group in the social affiliation context. Greater use of avoidance safety behaviors related to higher negative affect and anxious behaviors, and lower positive affect and approach behaviors across contexts. Impression management safety behaviors were most strongly associated with higher positive affect and approach behaviors within the social performance context. These findings underscore the potential value of assessing safety behavior subtypes across different contexts and within major depression, in addition to SAD.     

Social Anxiety Disorder and Social Support Behavior in Friendships

Relationship quality is a strong predictor of health outcomes, and individuals with social anxiety disorder (SAD) report increased interpersonal impairment. However, there are few studies testing the effect of SAD on friendships and it is thus unclear whether there are behavioral differences that distinguish friendships in which a target individual has SAD from friendships in which the target individual does not have SAD. We tested for differences in the provision and receipt of support behaviors as a function of having a SAD diagnosis and accounting for comorbid depressive symptoms. Participants with SAD (n = 90) and their friends engaged in support conversations that were coded using the Social Support Interaction Coding System. Structural equation modeling revealed some differences between participants and friends when accounting for depression. Specifically, friends of participants with SAD and comorbid depression engaged in fewer positive helper behaviors than the friends of participants who did not have SAD or comorbid depression. Additionally, dyads in which the primary participant had SAD engaged in more off-task behaviors. Results suggest that SAD does not result in global interpersonal impairment, but that receipt of positive support behaviors from friends may differ as a function of SAD and comorbid depression. Interpersonal interventions aimed at increasing adaptive friendships and aspects of CBT that target subtle avoidance (e.g., safety behaviors) may be useful in facilitating more satisfactory relationships for these individuals.     

Modifying automatic approach action tendencies in individuals with elevated social anxiety symptoms

Research suggests that social anxiety is associated with a reduced approach orientation for positive social cues. In the current study we examined the effect of experimentally manipulating automatic approach action tendencies on the social behavior of individuals with elevated social anxiety symptoms. The experimental paradigm comprised a computerized Approach Avoidance Task (AAT) in which participants responded to pictures of faces conveying positive or neutral emotional expressions by pulling a joystick toward themselves (approach) or by moving it to the right (sideways control). Participants were randomly assigned to complete an AAT designed to increase approach tendencies for positive social cues by pulling these cues toward themselves on the majority of trials, or to a control condition in which there was no contingency between the arm movement direction and picture type. Following the manipulation, participants took part in a relationship-building task with a trained confederate. Results revealed that participants trained to approach positive stimuli displayed greater social approach behaviors during the social interaction and elicited more positive reactions from their partner compared to participants in the control group. These findings suggest that modifying automatic approach tendencies may facilitate engagement in the types of social approach behaviors that are important for relationship development.     

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.     

Safety Behaviors in Adults With Social Anxiety: Review and Future Directions

Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.’s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social-anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.     

Loyal but ignored: The benefits and costs of constructive communication behavior

The consequences of exit, voice, loyalty, and neglect behavior were examined using retrospective questionnaires (Study 1) and 2 social interaction diary studies (Study 2). Exit and neglect were generally associated with more negative partner responses and reduced feelings of value and closeness, and were reported to be more harmful to the relationship. Voice was associated with more positive partner responses and greater value and intimacy, and was perceived to be most beneficial to the relationship. In contrast, loyalty was perceived to have the same detrimental consequences as destructive behaviors (Study 1) and did not predict more positive outcomes within daily interactions (Study 2). These results indicate that, despite good intentions, loyal intimates are often left feeling ignored and unappreciated.     

Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.     

Alcohol intoxicated witnesses' interpretation of social behavior in intimate partner violence

Alcohol intoxication affects social information processing, though research is scarce regarding how alcohol affected eyewitnesses' perception of social interaction within an applied forensic context. In the present study, the effects of alcohol intoxication on eyewitnesses' perception of interaction in intimate partner violence (IPV) were investigated. The participants (n = 152) were randomized to an experimental (alcohol) or control group (juice). After consumption, they viewed a filmed IPV scenario where both interacting parties were confrontational. Afterwards, they rated the involved parties' behavior. Several behaviors were perceived in a similar manner by intoxicated and sober participants, but intoxicated participants perceived both parties' attacking behaviors and some of the man's prosocial behaviors differently than sober participants. Hence, alcohol affected some, but not all, kinds of social behaviors investigated in the present study. This would be of interest to legal praxis and to future studies on intoxicated witnesses to interpersonal violence.     

What do you do when you're happy or blue? Mood,expectancies, and behavioral interest

The effects of induced moods on interest in performing a wide spectrum of behaviors were examined in two experiments. In Experiment 1, subjects who received the Velten Mood Induction elation manipulation indicated significantly greater interest than neutral subjects in social, prosocial, strenuous, leisure, and general activities on a shortened version of the Pleasant Events Schedule. Subjects who received the depression induction indicated lower interest in social, leisure, and strenuous activities. Depressed mood was associated with an interest in sitting and thinking, being alone, and taking a nap, but depression produced no increase in interest in prosocial behavior or in 12 forms of self-gratification. Experiment 2 focused on seven potential mediators in the effects of mood on behavior interests. Following a positive, negative, or neutral mood induction, subjects were asked to record their positive and negative outcome expectancies, positive and negative emotion expectancies, and their self-perceptions of energy, ability, and opportunity for active and passive, social and nonsocial behaviors. Induced elation, depression, and neutral moods again were found to influence interest in both active and passive types of social and nonsocial behaviors. The subjects' expectations of positive outcomes, and to a lesser extent their perceived energy for the behavior, were the strongest mediators of the effect of mood on behavior interests.The present experiments were conducted at Elmhurst College; thanks to Cindy Argianis, Chris Jankowski, and Victoria Mandell for their work in Experiment 1, and to Russell Fett for his help in Experiment 2. Valuable comments on an earlier draft were provided by Henry Adams, Anita Barbee, Katherine Noll, Sid Rosen, and David Shaffer.     

Social rank and affiliation in social anxiety disorder

The present study examined the interpersonal lives of individuals with social anxiety disorder (SAD). According to evolutionary and interpersonal theories, we construed the interpersonal world using the social rank and the affiliation psychological systems. Two studies assessed measures of social rank, affiliation, social anxiety and depression among a population of treatment-seeking individuals with SAD. In study 1, individuals with SAD without major depressive disorder (MDD; n=42) were compared to healthy controls (n=47). In study 2, individuals with SAD and MDD (n=45) were compared to individuals with other anxiety disorders and MDD (n=31). Results indicated that SAD was related to perceiving oneself as having low social rank, being inferior, and behaving submissively, as well as to low perceived intimacy and closeness among peer relations, friendships and romantic relations. SAD was distinctly associated with these perceptions above and beyond the symptomatic (study 1) and the syndrome-level (study 2) effects of depression. These findings were further supported by a path analysis of the SAD participants from both studies. Our findings highlight the need to address both social rank and affiliation issues in the assessment and treatment of SAD.     

Social allergies in romantic relationships: Behavioral repetition,emotional sensitization,and dissatisfaction in dating couples

A social allergy is a reaction of hypersensitive annoyance or disgust to a repeated behavior. Two studies were conducted on the social allergen categories of uncouth habits, inconsiderate acts, intrusive behaviors, and norm violations. Study 1 focused on hypothetical male and female partner behaviors at 2 and 12 months in a dating relationship. Study 2 obtained reports of social allergens performed by the individual and partner in dating couples, as well as the individual's emotional responses and relationship outcomes. Social allergens were perceived to increase in frequency over time in both studies, with some indications that men were more uncouth and norm violating and women were more inconsiderate and intrusive. Study 2 also found that the more often that the partner performed an allergenic behavior, the stronger was the individual's negative emotional reaction. Further, frequent and emotionally intense social allergens were associated with relationship dissatisfaction, and with termination assessed a year later.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

Affect dysregulation in individuals with borderline personality disorder: persistence and interpersonal triggers

We hypothesized that affect dysregulation among individuals with borderline personality disorder (BPD) would involve greater persistence of negative affect between interpersonal events and heightened reactivity to stimuli indicating risk of rejection or disapproval, specifically perceptions of others' communal (agreeable-quarrelsome) behaviors. A total of 38 participants with BPD and 31 controls collected information about affect and perceptions of the interaction partner's behavior during interpersonal events for a 20-day period. Negative and positive affect persisted more across interpersonal events for individuals with BPD than for controls. In addition, individuals with BPD reported a greater increase in negative affect when they perceived less communal behavior and a smaller increase in positive affect when they perceived more communal behavior in others. Findings indicate the importance of interpersonal perceptions in the affect dysregulation of individuals with BPD.     

Affect Dysregulation in Individuals With Borderline Personality Disorder: Persistence and Interpersonal Triggers

We hypothesized that affect dysregulation among individuals with borderline personality disorder (BPD) would involve greater persistence of negative affect between interpersonal events and heightened reactivity to stimuli indicating risk of rejection or disapproval, specifically perceptions of others’ communal (agreeable-quarrelsome) behaviors. A total of 38 participants with BPD and 31 controls collected information about affect and perceptions of the interaction partner's behavior during interpersonal events for a 20-day period. Negative and positive affect persisted more across interpersonal events for individuals with BPD than for controls. In addition, individuals with BPD reported a greater increase in negative affect when they perceived less communal behavior and a smaller increase in positive affect when they perceived more communal behavior in others. Findings indicate the importance of interpersonal perceptions in the affect dysregulation of individuals with BPD.     

Failure to replicate the deleterious effects of safety behaviors in exposure therapy

The current study attempted to replicate the finding obtained by Powers, Smits, and Telch (2004; Journal of Consulting and Clinical Psychology, 72, 448–545) that both the availability and utilization of safety behaviors interfere with the efficacy of exposure therapy. An additional goal of the study was to evaluate which explanatory theories about the detrimental effects of safety behaviors best account for this phenomenon. Undergraduate students (N = 58) with high claustrophobic fear were assigned to one of three treatment conditions: (a) exposure only, (b) exposure with safety behavior availability, and (c) exposure with safety behavior utilization. Participants in each condition improved substantially, and there were no significant between-group differences in fear reduction. Unexpectedly, exposure with safety behavior utilization led to significantly greater improvement in self-efficacy and claustrophobic cognitions than exposure only. The extent to which participants inferred danger from the presence of safety aids during treatment was associated with significantly less improvement on all outcome measures. The findings call into question the hypothesized deleterious effects of safety behaviors on the outcome of exposure therapy and highlight a possible mechanism through which the mere presence of safety cues during exposure trials might affect treatment outcomes depending on participants’ perceptions of the dangerousness of exposure stimuli.     

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

Background: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).

Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).

Method: Participants with symptoms meeting criteria for SAD (N?=?137) were randomly assigned to the 12-week-treatment groups (n?=?53 for each condition) or a waitlist control (n?=?31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.

Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.

Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.     

Truth and bias in daily judgments of support receipt between romantic partners

The perception that a partner is supportive, tied to beneficial relational and personal outcomes, may be shaped by reality (the partner's actual support) but is often also biased. Using T. V. West and D. A. Kenny's (2011) truth‐and‐bias model, the balance between truth and one bias type—the tendency to maintain perceived mutuality by projecting one's own supportiveness onto one's partner—was examined. It was hypothesized that this balance will be altered by the behavior's psychological significance and by the scope of the behavior being judged. In a 35‐day diary, 80 couples reported perceived and provided emotional/practical support. Participants' judgments included less biased projection when they addressed behaviors of lower emotional significance or greater contextual specificity.     

Interpersonal coping styles and couple relationship quality: Similarity versus complementarity hypotheses

This study employs a dyadic approach and examines how two partners' interpersonal coping styles may independently and jointly predict their relationship quality. Hypotheses were derived on the basis of dyadic coping theory focusing on how similar versus complementary styles of interpersonal coping may be useful in explaining couples' relationship quality. On the basis of attachment theory and self‐determination theory, three interpersonal coping styles were included: dismissive, adaptive, and anxious/expressive. Data were collected from 123 romantic couples. Actor–partner interdependence models revealed that interpersonal coping styles were related to self‐perceived (actor effect) and partner‐perceived (partner effect) relationship quality. Furthermore, results also showed that relationship quality was predicted by the interactions between self's and partner's interpersonal coping styles. Findings suggest that future research should focus on understanding interpersonal coping behaviors of both partners in a relationship, especially the complex interactions between two partners' characteristics and their effects on relationship outcomes. Copyright © 2014 John Wiley & Sons, Ltd.