Fear of blushing: fearful preoccupation irrespective of facial coloration.

Women, with high (n = 29) and low (n = 28) fear of blushing, were exposed to a mild social stressor (watching a television test card in the presence of two male confederates) and to an intense social stressor (watching their own prerecorded 'sing' video, in the presence of two male confederates). Facial coloration and facial temperature were measured and participants rated their own blush intensity. No differences in actual blushing emerged between both groups. Meanwhile, high fearful individuals' self-reported blush intensity was significantly higher than that of low fearful individuals. Thus, fear of blushing seems to reflect a fearful preoccupation, irrespective of differential facial coloration. The present findings concord with cognitive models of social phobia.     

Validity of Two Questionnaires to Assess Social Fears: The Dutch Social Phobia and Anxiety Inventory and the Blushing, Trembling and Sweating Questionnaire

This report evaluates some psychometric properties of the Dutch Social Phobia and Anxiety Inventory (SPAI-N) as well as a newly developed instrument to assess fear of showing somatic symptoms among social phobic, the Blushing, Trembling and Sweating Questionnaire (BTS-Q). Results support the reliability and discriminative validity of the Dutch SPAI and the BTS-Q. Both questionnaires are able to discriminate social phobics from a community sample. Social phobics with fear of blushing, trembling, and sweating as the main complaint could be discriminated from social phobics without fear of blushing, trembling, and sweating as the main complaint using the BTS-Q. In contrast with expectations derived from cognitive models of social phobia, social phobics with fear of blushing, trembling, and sweating did not have stronger dysfunctional beliefs about (the social consequences of) blushing, trembling, and sweating than social phobics without such fears.     

Empathic Blushing in Friends and Strangers

Three volunteers watched a previously recorded video of one of them singing, as cheek sensors monitored their blushing. When performers watched videotapes of their performance, they blushed significantly more than strangers, but not more than their own friends, watching with them. Friends and strangers did not differ significantly in blushing, however. Skin conductance arousal responses of performers and friends, but not performers and strangers, or friends of performers and strangers, were correlated. In a second experiment, strangers who sang before watching another person sing blushed more than strangers who did not sing first, or who sang and then watched a neutral video. This suggests that performing the embarrassing act may have predisposed people to blush, perhaps empathically, later. No gender differences were seen in blushing. Embarrassability questionnaire scores did not correlate with blushing. Empathic accuracy, and associative learning, are proposed to account for the results.     

Shyness: relationship to social phobia and other psychiatric disorders

The relationship between shyness, social phobia and other psychiatric disorders was examined. The prevalence of social phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of social phobia, but the data suggest that social phobia is not merely severe shyness. Social phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with social phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with social phobia from those without social phobia. The proportion of the shy group with psychiatric diagnoses other than social phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and social phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.     

Social Effects of Facial Blushing: Influence of Context and Actor Versus Observer Perspective

Blushing is restricted to the facial area that is uncovered and in the center of social attention. Together with the observation that blushing typically occurs in interpersonal situations, it has been proposed that the blush might have acquired signaling properties with relevant social implications. Following such a functional perspective, this article evaluates the signal value and social effects of the blush. First, it is argued that the blush fulfils all criteria for being a reliable social signal. It seems impossible to fake or to suppress, and it seems to co‐occur with a specific mental state: The acute awareness that one’s goal of esteem before others is at stake. Second, it is illustrated that the social effects of the blush may greatly vary as a function of context. In contexts that clearly imply some kind of misbehavior, the blush has face‐saving properties. Yet, in many other contexts, such as merely being the center of attention or situations that are ambiguous with regard to the blushing actors’ antecedent behaviors, the blush may have undesirable effects. Third, it is illustrated that the signal value of the blush not only affects the observers but also the blushing actors. It is shown that the anticipated influence of one’s blushing on other people’s judgments may help explain why actors often consider blushing as a highly undesirable response, and why some people may even develop a phobic fear of blushing.     

The effect of true and false feedback on blushing in women

The effect of true and false feedback of facial blood flow on blushing and embarrassment was investigated in high (n=24) and low (n=24) scorers on the Blushing Propensity Scale. Feedback was given while the participants sang and read aloud. Blushing while singing habituated rapidly in both groups and was not affected by true feedback. Blushing still developed in high scorers when given false-negative feedback of blushing when they first sang, whereas low scorers did not blush. False-positive feedback of blushing while reading aloud increased embarrassment, but facial blood flow decreased. High scorers gave higher ratings for embarrassment and blushing than low scorers during most of the tasks. The findings suggest that people who think that they are prone to blushing feel more self-conscious but generally do not blush more intensely or frequently than people with low blushing propensity scores during clearly embarrassing or innocuous social encounters. However, expecting to blush might actually increase the likelihood of embarrassment and blushing in potentially embarrassing situations.     

Blushing-fearful individuals overestimate the costs and probability of their blushing

It has been proposed that blushing-fearful individuals overestimate both the probability and the interpersonal costs of blushing. To study these judgmental biases, we presented a treatment-seeking sample of blushing-fearful individuals a series of vignettes describing social events and tested whether this clinical sample would overestimate the costs and probability of blushing compared to non-fearful controls. To test if blushing-fearfuls overestimate and/or low-fearful individuals underestimate the cost of displaying a blush, a second experiment examined the effects of blushing in these situations on observers' judgments. Experiment 1 showed that blushing-fearfuls indeed have judgmental biases for the probability and costs of blushing. Experiment 2 showed that the observers' judgments were very similar to the judgments anticipated by the low-fear group in Experiment 1. Thus the judgmental biases that were evident in the high-fearfuls can be best interpreted as an overestimation of the social costs of displaying a blush. These findings help improving our understanding of the mechanisms that may drive blushing phobia and also point to the clinical implication that it might be worthwhile to challenge blushing-fearfuls' judgmental biases.     

Prediction of treatment outcome in social phobia: a cross-validation.

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.     

Cognitive Correlates of Social Phobia Among Children and Adolescents

We examined different cognitive phenomena in relation to social phobia among children (aged 7 to 11) and adolescents (aged 12–16) separately. Fifty socially phobic youths were compared to 30 normal control children on measures of social anxiety, social expectation as well as self- and observer-rated performance during two social tasks involving a same-aged peer. Additionally, a video-mediated recall procedure was conducted immediately following the two behavioral tasks to examine specific types of self-talk. Results indicated that socially phobic youths had lower expectations of their performance and rated their actual performance worse than controls during a social interaction task, but not a read-aloud task. Self-ratings of decreased performance among socially phobic youths were corroborated by blind observers. Although differences in specific types of self-talk were found between the two groups, these findings were generally moderated by age. Furthermore, certain cognitive symptoms associated with the disorder were more commonly found among older socially phobic youths. The current findings highlight the importance of considering developmental factors in the presentation and treatment of social phobia in youths.     

Interpersonal subtypes in social phobia: diagnostic and treatment implications

Interpersonal assessment may provide a clinically useful way to identify subtypes of social phobia. In this study, we examined evidence for interpersonal subtypes in a sample of 77 socially phobic outpatients. A cluster analysis based on the dimensions of dominance and love on the Inventory of Interpersonal Problems-Circumplex Scales (Alden, Wiggins, & Pincus, 1990) found 2 interpersonal subtypes of socially phobic patients. These subtypes did not differ on pretreatment global symptom severity as measured by the Brief Symptom Inventory (Derogatis, 1993) or diagnostic comorbidity but did exhibit differential responses to outpatient psychotherapy. Overall, friendly-submissive social phobia patients had significantly lower scores on measures of social anxiety and significantly higher scores on measures of well-being and satisfaction at posttreatment than cold-submissive social phobia patients. We discuss the results in terms of interpersonal theory and the clinical relevance of assessment of interpersonal functioning prior to beginning psychotherapy with socially phobic patients.     

Subjectively rated physiological and cognitive symptoms in six different clinical phobias

The purpose of the present study was an attempt to describe clinical symptoms in terms of physiological reactions and negative cognitions experienced by phobic patients. A total of 267 clinical phobic patients divided among blood phobia, small animals phobia, dental phobia, claustrophobia, social phobia and agoraphobia, participated in the study. The patients within each phobic category were separated into a Conditioned and an Indirect Acquisition group, based on their answers to a set of specific questions concerning the etiology of the phobia. All patients rated (0–4) how intensively they experienced 11 specified physiological reactions and 10 negative cognitions when confronted with their phobic situation in vivo. A mean score was calculated for each item within each group, and an item rank-order hierarchy was set up for each group. Differences between items within each hierarchy were statistically evaluated by one-way ANOVAs and Turkey's HSD-tests. Results showed particular idiosyncratic patterns of responding for the blood phobic, agoraphobic and social phobic groups as well as several commonalities among all the groups concerning activation of specific physiological reactions and negative cognitions. A more fine-grained analysis of the data is best made by direct visual inspection of the figures in this paper.     

Social phobia: Axis I and II correlates

The presence of Axis I and Axis II disorders in 71 social phobic patients was examined. Generalized anxiety disorder was the most common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Subjects with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agoraphobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed.     

The causal role of self-awareness in blushing-anxious,socially-anxious and social phobics individuals

This study examined the effect of attentional focus on social anxiety in three groups of subjects: high versus low blushing-anxious participants (n=48); high versus low socially anxious participants (n=60); and social phobic patients compared to patients with other anxiety disorders (n=48). Participants were asked to imagine two series of social situations, in which the hero was in the centre of others' attention. In the first series of stories, the type of feedback from the audience (positive, negative and neutral) and the direction of attention of the hero (self- versus task-focused) were manipulated, and in the second series of stories, the presence or absence of blushing and the direction of attention of the hero were manipulated. In line with the expectations, self-focused attention (SFA) led to more social anxiety than task-focused attention (TFA) in all the three experiments, and high blushing-anxious, socially anxious, and social phobic groups reported higher levels of self-awareness than their low-anxious comparison groups. No evidence was found for the idea that self-focusing is specifically detrimental for participants who are already socially anxious, blushing-anxious, or socially phobic. Also, attentional focus did not interact with the valence of social feedback. Finally, results provided some support for the hypothesis that fear of blushing is mediated by self-focusing. The results suggest that irrespective of trait social anxiety, and irrespective of the outcome of a social situation (positive, neutral or negative), SFA increases state social anxiety, or TFA decreases state social anxiety.     

Psychometric properties and factor structure of the Fear Questionnaire phobia subscale items in two normative samples

Normative data for the Fear Questionnaire (Marks & Mathews, 1979), a popular self-report instrument measuring phobic concerns, were collected from both a community and a collegiate sample. The covariation and internal consistency of the blood-injury phobia (BI), social phobia (SO), and agoraphobia (AG) subscales were assessed in each sample, and the factor structure of the items from these three subscales was examined. Results indicated that, in general, community subjects reported more phobic concerns than did collegiate subjects, and females reported greater phobic concerns than did males. Results from confirmatory factor analyses suggest that the three factors of BI, SO, and AG did not emerge from either data set. Follow-up exploratory factor analyses did identify the general factors of blood-injury phobia and agoraphobia. Normative data from the present study are compared to those obtained previously, and directions for future research are provided.     

I blush, therefore I will be judged negatively: influence of false blush feedback on anticipated others’ judgments and facial coloration in high and low blushing-fearfuls

In the present study, we investigate whether people attribute costs to displaying a blush. Individuals with and without fear of blushing were invited to have a short conversation with two confederates. During the conversation, half of the individuals received the feedback that they were blushing intensely. The study tested whether the belief that one is blushing leads to the anticipation that one will be judged negatively. In addition, the set-up permitted the actual physiological blush response to be investigated. In line with the model that we propose for erythrophobia, participants in the feedback condition expected the confederates to judge them relatively negatively, independent of their fear of blushing. Furthermore, sustaining the idea that believing that one will blush can act as a self-fulfilling prophecy, high-fearfuls showed relatively intense facial coloration in both conditions, whereas low-fearfuls only showed enhanced blush responses following false blush feedback.     

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.     

Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia

The present study was designed to examine the operation of depression-specific biases in the identification or labeling of facial expression of emotions. Participants diagnosed with major depression and social phobia and control participants were presented with faces that expressed increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expression. The authors assessed individual differences in the intensity of facial expression of emotion that was required for the participants to accurately identify the emotion being expressed. The depressed participants required significantly greater intensity of emotion than did the social phobic and the control participants to correctly identify happy expressions and less intensity to identify sad than angry expressions. In contrast, social phobic participants needed less intensity to correctly identify the angry expressions than did the depressed and control participants and less intensity to identify angry than sad expressions. Implications of these results for interpersonal functioning in depression and social phobia are discussed.     

Social blushing.

This article reviews theory and research regarding the physiology, situational and dispositional antecedents, behavioral concomitants, and interpersonal consequences of social blushing and offers a new theoretical account of blushing. This model posits that people blush when they experience undesired social attention. Puzzling questions involving blushing in solitude, the phenomenology of blushing, types of blushing, and blushing in dark-skinned people are discussed.