Social anxiety disorder in veterans affairs primary care clinics

To examine the prevalence and correlates of social anxiety disorder (SAD) in veterans, 733 veterans from four VA primary care clinics were evaluated using self-report questionnaires, telephone interviews, and a 12-month retrospective review of primary care charts. We also tested the concordance between primary care providers’ detection of anxiety problems and diagnoses of SAD from psychiatric interviews. For the multi-site sample, 3.6% met criteria for SAD. A greater rate of SAD was found in veterans with than without post-traumatic stress disorder (PTSD) (22.0% vs. 1.1%), and primary care providers detected anxiety problems in only 58% of veterans with SAD. The elevated rate of comorbid psychiatric diagnoses and suicidal risk associated with SAD was not attributable to PTSD symptom severity. Moreover, even after controlling for the presence of major depressive disorder, SAD retained unique, adverse effects on PTSD diagnoses and severity, the presence of other psychiatric conditions, and suicidal risk. These results attest to strong relations between SAD and PTSD, the inadequate recognition of SAD in primary care settings, and the significant distress and impairment associated with SAD in veterans.     

Being good by doing good: Daily eudaimonic activity and well-being

Eudaimonic theories of well-being assert the importance of achieving one’s full potential through engaging in inherently meaningful endeavors. In two daily diary studies, we assessed whether reports of engagement in behaviors representative of eudaimonic theories were associated with well-being. We also examined whether eudaimonic behaviors were more strongly related to well-being than behaviors directed toward obtaining pleasure or material goods. In both studies, eudaimonic behaviors had consistently stronger relations to well-being than hedonic behaviors. Data also provided support for a temporal sequence in which eudaimonic behaviors were related to greater well-being the next day. Overall, our results suggest that “doing good” may be an important avenue by which people create meaningful and satisfying lives.     

Emotion regulation strategies in daily life: mindfulness,cognitive reappraisal and emotion suppression

Most empirical studies of emotion regulation have relied on retrospective trait measures, and have not examined the link between daily regulatory strategies and every day emotional well-being. We used a daily diary methodology with multilevel modelling data analyses (n = 187) to examine the influence of three emotion regulation strategies (mindfulness, cognitive reappraisal and emotion suppression) on the experience of daily negative and positive affect. Our results suggested that daily mindfulness was associated with lower negative and higher positive affect whereas the converse pattern was found for daily emotion suppression; cognitive reappraisal was related to daily positive, but not negative affect. When daily mindfulness, suppression and reappraisal were included in the same models, these strategies predicted unique variance in emotional well-being. Random slope analyses revealed substantial variability in the utility of these strategies. Indeed the presumably “adaptive” cognitive reappraisal strategy seemed to confer no benefit to the regulation of negative affect in approximately half the sample. Additional analyses revealed that age moderates the effect of cognitive reappraisal on daily negative affect: Higher use of reappraisal was associated with more negative affect for adolescents (aged 17 to 19) but became associated with less negative affect with increasing age. We interpret these results in line with a contextual view of emotion regulation where no strategy is inherently “good” or “bad”.     

Discomfort and avoidance of touch: new insights on the emotional deficits of social anxiety

Physical touch is central to the emotional intimacy that separates romantic relationships from other social contexts. In this study of 256 adults (128 heterosexual couples, mean relationship length?=?20.5 months), we examined whether individual differences in social anxiety influenced comfort with and avoidance of physical touch. Because of prior work on sex difference in touch use, touch comfort, and social anxiety symptoms and impairment, we explored sex-specific findings. We found evidence that women with greater social anxiety were less comfortable with touch and more avoidant of touch in same-sex friendships. Additionally, a woman’s social anxiety had a bigger effect on a man’s comfort with touch and avoidance of touch in the romantic relationship than a man’s social anxiety had on the woman’s endorsement of touch-related problems. These effects were uninfluenced by the length of romantic relationships. Touch is a neglected emotional experience that offers new insights into the difficulties of individuals suffering from social anxiety problems, and their romantic partners.     

Anhedonia, Emotional Numbing, and Symptom Overreporting in Male Veterans with PTSD

We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the F(p) (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans' psychological experiences, providing insight into the nature of symptom overreporters.     

Failure to capitalize on sharing good news with romantic partners: Exploring positivity deficits of socially anxious people with self-reports,partner-reports,and behavioral observations

Extending prior work on social anxiety and positivity deficits, we examined whether individual differences in social anxiety alter the ability to share and respond to the good news of romantic partners (i.e., capitalization support) and how this influences romantic relationship satisfaction and commitment. In this study of 174 heterosexual couples (average age of 21.5 with 58.3% identifying as Caucasian), greater social anxiety was associated with the provision and receipt of less supportive responses to shared positive events as measured by trait questionnaires, partner reports, and behavioral observations in the laboratory. In longitudinal analyses, individuals in romantic relationships with socially anxious partners who experienced inadequate capitalization support were more likely to terminate their relationship and report a decline in relationship quality six months later. As evidence of construct specificity, social anxiety effects were independent of depressive symptoms. Taken together, social anxiety influenced a person's ability to receive and provide support for shared positive events; these deficits had adverse romantic consequences. Researchers and clinicians may better understand social anxiety by exploring a wider range of interpersonal contexts and positive constructs. The addition of capitalization support to the social anxiety literature offers new insights into interpersonal approaches and treatments.     

Examination of the factor structure and concurrent validity of the Langer Mindfulness/Mindlessness Scale

Langer's theory of mindfulness proposes that a mindful person seeks out and produces novelty, is attentive to context, and is flexible in thought and behavior. In three independent studies, the factor structure of the Langer Mindfulness/Mindlessness Scale was examined. Confirmatory factor analysis failed to replicate the four-factor model and a subsequent exploratory factor analysis revealed the presence of a two-factor (mindfulness and mindlessness) solution. Study 2 demonstrated that the two factors assessed discrete constructs and were not merely products of acquiescence. Support was also found for a nine-item, one-factor model comprised solely of mindfulness items. On comparing models, Study 3 suggested the superiority of the one-factor mindfulness model. Finally, a preliminary investigation of the concurrent validity of the revised nine-item Langer Mindfulness/Mindlessness Scale is presented. The current article offers researchers a revised version of a mindfulness measure derived from a cognitive perspective.     

When social anxiety disorder co-exists with risk-prone, approach behavior: Investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication

Little is known about people with social anxiety disorder (SAD) who are not behaviorally inhibited. To advance knowledge on phenomenology, functional impairment, and treatment seeking, we investigated whether engaging in risk-prone behaviors accounts for heterogeneous outcomes in people with SAD. Using the National Comorbidity Survey-Replication (NCS-R) dataset, our analyses focused on people with current (N = 679) or lifetime (N = 1143) SAD diagnoses. Using latent class analysis on NCS-R risk-prone behavior items, results supported two SAD classes: (1) a pattern of behavioral inhibition and risk aversion and (2) an atypical pattern of high anger and aggression, and moderate/high sexual impulsivity and substance use problems. An atypical pattern of risk-prone behaviors was associated with greater functional impairment, less education and income, younger age, and particular psychiatric comorbidities. Results could not be subsumed by the severity, type, or number of social fears, or comorbid anxiety or mood disorders. Conclusions about the nature, course, and treatment of SAD may be compromised by not attending to heterogeneity in behavior patterns.