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A cognitive model of social phobia

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... Thesis Abstract Clark and Wells (1995) suggest that following a social situation, individuals with social phobia engage in post-event processing (PEP), a 'post mortem' where they review the event in detail. The individual's negative self perception influences his or her review of the social encounter and consequently their performance is viewed as worse than it actually was. ...
... Theoretical perspectives relevant to Clark and Wells' (1995) conceptualisation of PEP Post-event processing -a failure in emotional processing? 35 ...
... Recent research on social phobia has sought to explain the development and persistence of the disorder. Clark and Wells (1995) have been particularly influential in this area with the development of their cognitive model of social phobia which has developed our theoretical understanding of the nature and persistence of social phobia and forms the basis of effective treatment approaches (Clark et al., 2003). The core of social phobia, according to Clark and Wells, is a strong desire to present a favourable impression of the self to others but a marked insecurity about one's ability to do so. ...
Thesis
p>Clark and Wells (1995) suggest that following a social situation, individuals with social phobia engage in PEP, a ‘post-mortem’ where they review the event in detail. The individual’s negative self perception influences his or her review of the social encounter and consequently performance is viewed as worse than it actually was. This results in increased feelings of anxiety and shame. The literature review examines the developing evidence base on PEP and as such research is currently limited, the review also draws on relevant evidence from other areas. Theoretical perspectives to PEP include self-focussed attention and attentional bias, imagery and the observer-perspective, interpretation bias, memory bias, rumination in depression and emotional processing. The empirical study manipulated PEP by asking participants to focus on either the positive or the negative aspects of a social situation and examined the effect on imagery, thinking, performance, appraisals, and mood in high and low socially anxious individuals. Consistent with Clark and Wells’ model, high socially anxious individuals rated their performance as worse, predicted worse performance, had more negatively valanced images, thought more about negative aspects of their performance in PEP and reported higher levels of anxiety and shame in a social situation compared to low socially anxious individuals. This study also provides a preliminary evidence to suggest that engaging in positive PEP may have beneficial effects on ratings of performance, future performance, image and impression valence and thoughts during PEP in high socially anxious participants.</p
... Cognitive models of SAD (Clark & Wells, 1995;Hofmann, 2007;Rapee & Heimberg, 1997) emphasize the centrality of interpretation bias in the development, maintenance, and treatment of this disorder (e.g., see Chen et al., 2020 andHirsch et al., 2016, for reviews). Much of the focus within the literature on interpretation bias has been on negative interpretation bias of negative, ambiguous, or neutral social events. ...
... At the end of group CBT, participants completed the SIAS and IPES again. 4 Participants received 12 consecutive weeks of manualized group CBT for SAD which included components from prominent CBT models (Clark & Wells, 1995;Hope et al., 2010) at a large university-based mental health hospital. Treatment comprised of psycho-education to the CBT model of SAD; exposure hierarchies and exposures, thought records; the focus of attention and safety behaviors experiment; videotape exposures with feedback; behavioral experiments; core beliefs interventions, and relapse prevention. ...
... Regarding the impact on social anxiety, exploratory analysis demonstrated a significant relationship between change in negative interpretations of positive social events and social interaction anxiety, highlighting the potential therapeutic relevance and importance of change in these negative interpretations to change in global social interaction anxiety severity. This association is consistent with cognitive models of SAD (e.g., Clark & Wells, 1995) and other studies reporting that improvements in negative interpretations more broadly are associated with social anxiety symptom reduction (e.g., Beard & Amir, 2008). ...
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Background Individuals with social anxiety disorder (SAD) report interpreting social events negatively regardless of valence. Fear of causing discomfort to others and intolerance of uncertainty (IU) are associated with negative interpretations of positive social situations. However, no studies have examined whether these negative interpretations change over CBT for SAD, nor predictors of such changes. This study examined if: negative interpretations of positive social events improve during CBT for SAD; these negative interpretations correlate with social anxiety symptom severity, fear of causing discomfort to others, and IU at the start of treatment; and fear of causing discomfort to others, IU and its subfactors at the start of treatment predict changes in these negative interpretations over treatment. Methods Eighty-five treatment-seeking DSM diagnosed individuals with primary SAD completed measures of the tendency to interpret positive events negatively pre-post CBT, and IU and fears of causing discomfort to others at pre-treatment. Results Results demonstrated significant pre-post decreases after CBT for SAD in negative interpretations of positive social events. All measures were significantly correlated with each other. None of the pre-treatment variables significantly predicted decreases in negative interpretations of positive social events over treatment. Conclusions CBT may be effective in reducing these negative interpretations.
... Social anxiety refers to feelings of unease, tension and fear in real or expected social situations (Heimberg et al., 1992;Skocic et al., 2015). Evidence from offline observations has shown that people scoring higher on social anxiety are more likely to avoid social situations or engage in safety-seeking behaviors than non-anxious individuals as they tend to allocate more attentional resources to perceived threats (Alden & Bieling, 1998;Clark & Wells, 1995;Cuming et al., 2009;Taylor & Alden, 2010). Evolutionary psychologists theorize that human protective behaviors are guided by two systems, the defense system and the safety system, which would motivate a person to respond to social threats or engage in social interactions, respectively (Gilbert, 2001;Trower & Gilbert, 1989). ...
... Individuals with social anxiety tend to use more protective behaviors because they are often in a hierarchical mindset in which they feel judged on their social performance by dominant members, and are thus at risk for being socially hurt (Gilbert, 2001). Within this context, these individuals are continually primed to detect threat and respond with safety-seeking behaviors, such as eye-gaze avoidance and not speaking much, in order to intentionally prevent possible aggression or rejection from the others and thereby allow them to remain part of the social group (Clark & Wells, 1995;Walters & Hope, 1998;Weeks, 2014). ...
... These two aforementioned concerns might be even more salient among users with social anxiety, as they are particularly likely to amplify potential threats in social situations (Clark & Wells, 1995;Trower & Gilbert, 1989), such as underestimating others' evaluations of their social performance (Schlenker & Leary, 1982). According to the cognitive-behavioral model, threat perceptions may further motivate socially anxious individuals to utilize safetyseeking behaviors to restore levels of comfort and security (Clark & Wells, 1995). ...
Article
Though socially anxious individuals tend to seek safety, little is known about whether this relationship depends on context, including the affordances of social networking sites (SNSs) to provide anonymity and publicness, and whether safety-seeking can be explained by impression management, privacy calculus or both. Based on the psychobiological model of social anxiety, we conducted two studies (Study 1: N = 103, Study 2: N = 1,184) to examine the contextual dependence of safety-seeking behaviors and to disentangle which types of concerns mediate the effect of social anxiety on safety-seeking behaviors. Results indicated that socially anxious individuals tend to seek safety on SNSs, and this tendency is stronger in less anonymous SNSs. Both evaluative concerns and privacy concerns mediate the relation between social anxiety and safety-seeking behaviors, while the indirect effect of evaluative concerns is stronger than that of privacy. Publicness of an SNS strengthened these indirect effects. These findings highlight the importance of safety perceptions in different online environments, and thereby enrich the literature related to social anxiety and social media use.
... A number of cognitive models exist that elucidate potential mechanisms of these self-imagery biases central to SA (e.g., Clark & Wells, 1995;Heimberg et al., 2010;Rapee & Heimberg, 1997). For example, Clark and Wells (1995) assert that those with SA demonstrate heightened attention toward aversive internal states resulting from perceived social threat. ...
... A number of cognitive models exist that elucidate potential mechanisms of these self-imagery biases central to SA (e.g., Clark & Wells, 1995;Heimberg et al., 2010;Rapee & Heimberg, 1997). For example, Clark and Wells (1995) assert that those with SA demonstrate heightened attention toward aversive internal states resulting from perceived social threat. Similarly, Heimberg et al. (2010) provide an updated model of the cognitive components of SA, including central facets outlining attentional and self-imagery biases as well as difficulties regulating emotional responses to such biases. ...
... This dovetails with previous literature that suggests that those who have difficulty in controlling their attention may experience difficulty disengaging with their self-imagery thereby stimulating adverse effects of self-imagery (e.g., Derryberry & Reed, 2002). Similarly, those who have SA also engaged in more aversive, anxiety-provoking, and negative self-imagery relative to those who do not experience SA, consistent with models of social anxiety (e.g., Clark & Wells, 1995;Heimberg et al., 2010;Rapee & Heimberg, 1997). Moreover, within those individuals who endorsed greater AC, those with SA experienced a more aversive self-image. ...
Article
Full-text available
Models of social anxiety (SA) posit that socially-evaluative fears may be maintained by biased cognitive processes such as attention and self-imagery. However, extant literature has yielded inconsistent data regarding the differential roles that self-imagery plays in SA, as well as high and low attentional control (AC) abilities. These inconsistencies may be in part a result of differences in trait and state methodologies used to assess self-imagery. The present study provides a comparison of trait and state assessments of self-imagery between groups of individuals with high and low SA and AC. After completing self-report measures of social anxiety, attentional control, and trait self-imagery, 96 participants engaged in negative, positive, and neutral audio manipulations to evoke state self-imagery. Subsequently, participants responded to items regarding the extent to which and how they engaged with these self-imagery scenarios. Trait self-imagery results indicated that those with lower AC reported more anxiety-provoking and negative self-imagery, whereas those with higher SA engaged in more aversive, anxiety-provoking, and negative self-imagery. Those with greater AC accompanied with high SA reported more aversive self-images. Conversely, state self-imagery results indicated that valence of self-images affects different characteristics of self-images themselves (i.e., negatively-valenced self-images are more aversive, anxiety-provoking, negative, less accessible, and elicit greater urges to avoid in engagement) rather than serving as a distinguishing factor for SA or AC. Given these differential effects, trait assessment may reveal important characteristics of self-imagery that perpetuate SA, and state assessment may not measure the same mechanisms.
... This suggests that other factors are involved in the maintenance of social phobia, such as information processing biases. Clark and Wells (1995) In their cognitive model of social phobia (see Figure 3), Clark and Wells (1995) suggested that early experiences lead to the development of dysfunctional assumptions about oneself and the world, which result in increased perception of threat in social situations. When entering a social situation, these pre-existing dysfunctional assumptions are enhanced and maintained through a series of vicious circles. ...
... This suggests that other factors are involved in the maintenance of social phobia, such as information processing biases. Clark and Wells (1995) In their cognitive model of social phobia (see Figure 3), Clark and Wells (1995) suggested that early experiences lead to the development of dysfunctional assumptions about oneself and the world, which result in increased perception of threat in social situations. When entering a social situation, these pre-existing dysfunctional assumptions are enhanced and maintained through a series of vicious circles. ...
... When attention is focused internally it interferes with the processing of external social cues and can lead to unresponsive behaviour. Clark and Wells (1995) also propose that people with social phobia engage in a range of behaviours, that are intended to reduce the risk of negative evaluation. ...
Thesis
p>Recent cognitive theories of social phobia suggest that the enduring nature of the disorder may result from the biased processing of information within feared social situations. It is important for health care professionals involved in treatment of social phobia to understand the information processing biases which maintain this disorder, in order to guide interventions. This thesis critically reviews models of threat processing in anxiety (e.g., Mogg & Bradley, 1998), cognitive models of social phobia (Clark & McManus, 2002); Rapee & Heimberg, 1997) and empirical evidence of information processing biases in anxiety disorders. Specific predictions regarding selective attention to stimuli of varying emotional intensity and interpretation of ambiguity in social phobia are examined. In the present study individuals with a diagnosis of generalised social phobia, and non-socially phobic controls completed a modified visual probe task that measured attention allocation to angry, happy and fearful expressions of varying emotion intensities (25%, 50%, 75% 100%). Participants subsequently classified ambiguous emotional faces blended from two component prototype emotional expressions: angry-happy, happy-fear and fear-angry. Measures of emotion recognition accuracy and response bias were computed for each of the three emotion-combinations. Individuals with social phobia demonstrated a significant attentional bias towards expressions of strong (100%) emotional content, irrespective of type of emotion, relative to controls. However, the social phobia and control groups did not differ in their sensitivity to correctly classify ambiguous expressions, or in their tendency to classify a presented face as angry, happy or fearful. Findings are considered in light of evidence from other studies of attention and interpretive bias, and possible implications for models of threat processing are discussed.</p
... Beck (1976) suggested that spontaneously occurring images are common in anxiety disorders and enhance the perception of threat. According to Clark and Wells (1995) socially anxious people use thoughts, feelings and sensations to construct an image of themselves, which they assume reflects what others observe. This information can present an inaccurate picture of the way that they appear to others and distort their view of themselves. ...
... This information can present an inaccurate picture of the way that they appear to others and distort their view of themselves. Clark and Wells (1995) propose that this in-situation processing maintains the individual's negative selfperception, as he/she develops internal negative images that go unchallenged. ...
... It is proposed (Clark & Wells, 1995) that safety-seeking behaviours contribute to the maintenance of anxiety by preventing challenge of the individuals' negative beliefs. For example, when in socially anxious situations a socially phobic person uses safety-seeking behaviours designed to prevent or minimise the feared demonstrated high end-state functioning at 12-month follow-up. ...
Thesis
p>Disorders such as generalised anxiety disorder (GAD), panic disorder and social phobia are the most prevalent anxiety disorders (Kessler et al., 1994) and several different theories and models of treatment have been developed. Cognitive-behavioural therapy (CBT) has been identified as first-line treatment for anxiety (Bystritsky, 2006). Evidence suggests that it does not benefit everyone and CBT has been criticised for its focus on the content of thoughts. Little research has focused on what mindfulness-based interventions can contribute to our understanding and treatment of these disorders. This review describes anxiety, its aetiology, underlying mechanisms and maintaining factors according to several models. Discussion of the clinical application of mindfulness and active mechanisms follows. The integration of CBT and mindfulness is considered and a rationale for its use in understanding and treating these anxiety disorders is presented. Directions for further research are discussed. The contribution of mindfulness-based approaches in the understanding and treatment of anxiety disorders is unclear. The study had two components; firstly it investigated the impact of a mindfulness-based intervention on adults with persistent anxiety. Results suggested that the intervention was associated with an increase in mindfulness and significant decreases in symptoms of anxiety, depression and stress, and in overall scores on the Clinical Outcomes in Routine Evaluation outcome measures (CORE-OM; Mental Health Foundation & Core System Group, 1998). Secondly, it explored how adults with persistent anxiety experienced a mindfulness-based intervention. Five superordinate themes emerged through the IPA analysis (Smith, 1996); these were (1) Getting to grips with mindfulness, (2) Timing (3) Integration (4) Sense of change and (5) Shared experience. Methodological issues, clinical implications and directions for future research are addressed.</p
... Humans are motivated by a desire to be a valued by others (Baumeister & Leary, 1995;Gilbeti, 2001). They become anxious when they doubt their ability to make a favourable impression, and this leads to feelings of social anxiety, (Clark & Wells, 1995;Leary, 2001;Trower & Gilbert, 1989). Gilbeti (2001) has described how social anxiety is triggered in contexts where individuals perceive that they are relatively low in status and are at risk oflosing status and/or resources. ...
... A critical view of self is at the centre of current information processing models of social phobia (Clark & Wells, 1995;Hoffman, 2007;. The models propose that social phobia is maintained by cognitive distortions and a bias in the way that social information is processed. ...
... People with high levels of social anxiety have high standards and expectations about how they think they should perfonn in social situations They believe that they will fail to meet these standards (Clark & Wells, 1995;Leary, 2001) and fear the consequences ofthis (Clark & Wells, 1995;Wilson & Rapee, 2005). They overestimate the perceived threat of social situations (Beck, Emery & Greenberg, 1985;Clark & Wells, 1995;. ...
Thesis
p>Cognitive models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997; Hofmann, 2007) propose that social phobia is maintained by a fear of negative self evaluation. The literature review focuses on the role implicit and explicit self evaluations play in social phobia, including visual self-images. It then examines the ways in which self-compassion may counter negative self-evaluations. The empirical paper examines whether a self-compassionate induction can influence implicit and explicit measures of self-esteem. Sixty-three socially anxious participants gave a two-minute speech and were then randomly assigned to one of three conditions (Self-compassionate induction; emotional processing control; pure control) in order to examine the impact of self-compassion on implicit and explicit self-esteem and visual self-images in social anxiety. Consistent with previous research, all participant's exhibited a positive implicit self-esteem, as measured by the Implicit Association's Test (IAT). The three groups did not differ significantly on levels of implicit and explicit self-esteem, or the valence of visual self-images. However a significant correlation between implicit and explicit self-esteem was observed in the self compassionate group only, providing pmiial support for the hypothesis that self compassion may reduce the discrepancy between implicit and explicit self-esteem. Implications of the results are discussed, as are the limitations of the study and suggestions for future research.</p
... Recent cognitive models propose a variety of information processing biases considered to play a key role in the etiology and maintenance of social phobia (e. g. Clark & Wells, 1995;Rapee & Heimberg, 1997). The present thesis examined high and low socially anxious individuals' biases in attention, appraisal, interpretation andjudgment, when processing external social cues (facial expressions). ...
... initial orienting to threat in social anxiety (adapted from Figure 3. A cognitive model of social phobia (adapted from Clark & Wells, 1995). 15 Left and right panels depict expectancy data for low and high social anxiety groups respectively. ...
... However, unfortunately for some individuals, this and other forms of social interaction are perceived to be sources of extreme threat and danger. For these individuals, overwhelming cognitions involving perceptions of threat combine with debilitating elevations in autonomic and somatic activity leading to further increases in anxiety and associated dysfunctional behaviours (Clark & Wells, 1995). Individuals who frequently and persistently endure these extreme levels of anxiety invariably suffer marked impairment in their quality of life and as a result often seek medical treatment. ...
Thesis
p>Recent cognitive models propose a variety of information processing biases considered to play a key role in the etiology and maintenance of social phobia (e.g. Clark and Wells, 1995; Rapee and Heimberg, 1997). The present thesis examined high and low socially anxious individuals’ biases in attention, appraisal, interpretation and judgement, when processing external social cues (facial expressions). Experiments 1 and 2 monitored eye-movements to pictures of faces and objects in high socially anxious and low socially anxious individuals. Under no-stress conditions (Experiment 1), high socially anxious individuals initially directed their gaze towards neutral faces, relative to objects, more often than low anxious individuals. However, under social-evaluative stress (Experiment 2), high socially anxious individuals showed reduced biases in initial orienting and maintenance of gaze on faces (cf. objects), compared with the low anxious participants. High socially anxious individuals were also relatively quicker to look at emotional faces than neutral faces, but looked at emotional faces for less time, compared with low socially anxious individuals. In a third experiment (Experiment 3, task 1), participants’ general tendency initially to orient towards and maintain attention for longer on a variety of social cues (angry, happy and neutral faces) relative to non-social cues (objects) was unaffected by social anxiety group. However, reduced maintenance of attention on face cues in general, relative to non-social cues was demonstrated in high compared to low socially anxious individuals in Experiment 4. Results from a modified visual probe task (Experiment 5 task 1) provided no evidence of selective attention in either social anxiety group. In Experiments 3 and 4, explicit (valence and arousal ratings) and implicit (EAST, startle magnitude, skin conductance) measures of stimulus appraisal for social relative to non-social cues were unaffected by social anxiety group (Exp. 3,4). However, high socially anxious individuals negatively rated and produced greater startle amplitude in response to all face/object cues compared to low anxious individuals in Experiment 4. Using a modified illusory correlation paradigm (Experiment 5, task 2), low socially anxious individuals demonstrated a relatively persistent tendency to over-associate positive social cues with pleasant outcomes. High socially anxious lacked this positive bias, and instead were biased in selectively recalled negative social cues. Finally, in a novel emotion classification paradigm (Experiment 5, task 3), high socially anxious individuals tended to interpret ambiguous (computer manipulated) emotional facial expressions in a negative fashion. Results provide evidence of biases in various aspects of processing in social anxiety: reduced attention to external social cues; enhanced detection and recall of negative social cues; and negative inferential processes. These findings provide some support for recent cognitive models that emphasise the role of these biases in maintaining the concerns of individuals with social phobia.</p
... increases in heart rate. This cognitive and physiological reaction could lead to behavioural avoidance (Clark & Wells, 1995). The persistence of this non-adaptive reaction over time could place the child at risk of developing pathological anxiety, in other words an AD. ...
... Interestingly Clark and Wells (1995) and Rapee and Heimberg (1997) developed a model of social phobia in which both the allocation of attentional resources and the evaluation of stimuli are taken into account. In Clark and Wells's (1995) model it is hypothesised that in social phobic individuals, attentional allocation away from external cues is biased in favour of detecting from others cues that can be interpreted negatively. ...
... Interestingly Clark and Wells (1995) and Rapee and Heimberg (1997) developed a model of social phobia in which both the allocation of attentional resources and the evaluation of stimuli are taken into account. In Clark and Wells's (1995) model it is hypothesised that in social phobic individuals, attentional allocation away from external cues is biased in favour of detecting from others cues that can be interpreted negatively. The authors argue that the individuals are placing their attentional resources to their self image. ...
Thesis
p>The thesis investigates cognitive and family factors linked to childhood anxiety in a non-referred population taking a developmental approach. It examines whether children with symptoms of anxiety exhibit a threat-related cognitive bias. Attentional and interpretive biases are specifically looked at. It also examines maternal variables that would be influential to the child’s levels of anxiety. Maternal parenting behaviours, maternal mental health and maternal beliefs and attitudes towards the child are specifically looked at. Cognitive and maternal factors are integrated in the explanation of childhood anxiety. Whether links between maternal factors and childhood anxiety are mediated by the development of biased cognitive styles is explored. A total of 129 children aged 7-14 years and their mothers participated in the study. Children are assessed on cognitive tasks tapping into attentional and interpretive biases. Their levels of anxiety are assessed with questionnaire reports completed by themselves and their mothers. Maternal parenting behaviours and maternal mental health variables are assessed with questionnaire reports completed by the mothers. Maternal beliefs and attitudes towards the child are assessed with the Expressed Emotion index following five minute interviews. The results show that children with symptoms of anxiety exhibit a threat-related cognitive bias. In support of developmental theories of cognition and anxiety, threat-related attentional biases (Abs) emerged for children aged over 10 years. The results also single out maternal variables that are contributing to a child’s anxiety. The association between maternal parenting behaviours or maternal beliefs and attitudes and a child’s anxiety however is shown to not be consistent. In contrast maternal depression is found to be consistently associated with a child’s symptoms of separation anxiety independent of the age of the child. Support for a cognitive mediated pathway in which threat-related ABs are partially mediating a link between maternal overprotection and a child’s separation anxiety is found. These findings add to developmental models of childhood anxiety.</p
... According to the cognitive behavioral models of SAD (Clark and Wells, 1995;Rapee and Heimberg, 1997;Hofmann and Otto, 2008), self-focused attention, cost/probability bias, and avoidance behavior are maintaining and exacerbating factors of social anxiety. Self-focused attention refers to the perception of internal self-related information, such as body state, thoughts, feelings, and behaviors in threatening social situations (Bögels et al., 1996;Noda et al., 2021a). ...
... Individuals with high selffocused attention have a higher degree of social anxiety symptoms than those with low self-focused attention (Noda et al., 2021a). Furthermore, heightened self-focused attention increases negative cognitions such as cost/probability bias, and contributes to the exacerbation of social anxiety and avoidance behavior (Clark and Wells, 1995;Rapee and Heimberg, 1997;Hofmann and Otto, 2008). ...
... When faced with threatening social situations, individuals with high social anxiety adopt avoidance behavior to relieve anxiety (Hofmann and Otto, 2008). While avoidance behavior temporarily relieves anxiety, it also increases social anxiety in the long term (Clark and Wells, 1995;Hofmann and Otto, 2008). Avoidance behavior is strongly correlated with (Noda et al., 2017a(Noda et al., , 2018a and increases social anxiety (Okajima et al., 2009). ...
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Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors for social anxiety. In particular, cost bias and avoidance behavior predict social anxiety. It has been shown that the enhancement of trait mindfulness improves these maintaining factors. This study examines the relationships among trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety, and clarifies whether they mediate the relationship between trait mindfulness and social anxiety. A cross-sectional design was used to examine the relationships among these variables. Participants were recruited from three universities in Japan (January 2019–December 2019). Undergraduate students (N = 367) completed a set of self-report measures assessing trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Results of path analyses revealed that the hypothesized model’s goodness-of-fit indices had high values. Trait mindfulness showed a direct negative association with self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Moreover, trait mindfulness was negatively associated with social anxiety via self-focused attention, cost/probability bias, and avoidance behavior. These findings indicate that mindfulness plays an important role in social anxiety and provide impetus for future research involving clinical studies of mindfulness-based interventions for social anxiety.
... indicative of an interpretation bias that is present with stimuli that are high in uncertainty (here, sensory ambiguity), Zinbarg, 2007, 2008). Similarly, when asked to give interpretations of social events, people with social anxiety will evaluate ambiguous events more negatively (Clark and Wells, 1995). This suggests that people with social anxiety process uncertainty differently to their neurotypical counterparts in that high uncertainty and negative interpretations tend to co-occur. ...
... Cognitive theories of depression and social anxiety hold that repeated exposure to social adversity can teach an individual that the world is an unpredictable and hostile place, where they should expect criticism and poor social outcomes (Beck, 2008;Clark and Wells, 1995). ...
... This negative learning forms the schema, a system of beliefs and expectations through which future self-relevant social information is processed (Clark and Wells, 1995;Rapee and Heimberg, 1997). Once activated, the self-schema acts as an information filter, influencing attention, perception, learning and memory, such that the dysfunctional self-views are maintained (Beck, 2008). ...
Thesis
Anxiety disorders are the most common mental health disorders and comprise a large number of years lost to disability. The work in this thesis is oriented towards understanding anxiety using a computational approach, focusing on uncertainty estimation as a key process. Chapter 1 introduces the role of uncertainty within anxiety and motivates the subsequent experimental chapters. Chapter 2 is a review of the computational role of the amygdala in humans, a key area for uncertainty computation. Chapter 3 is an experimental chapter which aimed to address gaps in the literature highlighted in the preceding chapters, namely the link between sensory uncertainty processing and anxiety and the role of the amygdala in this process. This chapter focuses on the development of a novel computational hierarchical Bayesian model to quantify sensory uncertainty and its application to neuroimaging data, with intolerance of uncertainty relating to greater neural activation in the insula but not amygdala. Chapter 4 targets the computational mechanisms underlying the negative self-bias observed in subclinical social anxiety. Again, this chapter focuses on the development of novel computational belief-update models which explicitly model uncertainty. Here, we see that a reduced trait self-positivity underpins this negative social evaluation process. The final experimental chapter presented in Chapter 5 investigates the link between different computational mechanisms, such as uncertainty, and a range of mood and anxiety symptomatology. This study revealed cognitive, social and somatic computational profiles that share a threat bias mechanism but have distinct negative-self bias and aversive learning signatures. Contrary to expectations, none of the uncertainty measures showed any associations with anxiety symptom subtypes. Finally, chapter 6 brings together the work in this thesis and alongside limitations of the work, discusses how these experiments contribute to our understanding of anxiety and the role of uncertainty across the anxiety spectrum.
... Encouraged by the general success of internet-based CBT, we decided to develop an internet programme (iCT-SAD) that faithfully implements all the key procedures in CT-SAD. Although some of the existing internet CBT programmes for SAD (such as Andersson et al., 2006) present patients with the Clark and Wells (1995) model on which CT-SAD is based, none implement the full set of CT-SAD procedures, including video feedback and work on social trauma-related memories. In a small pilot study (Stott et al., 2013) improvements in social anxiety with the new iCT-SAD programme were broadly in line with those observed in previous trials of CT-SAD. ...
... CT-SAD was the same as in Clark et al. (2006). Several procedures (therapist manual & video illustrations available at www.oxcadatresources.com) were used to reverse maintaining factors identified in Clark and Wells (1995) model of social phobia. These include: (a) an individualised version of Clark and Wells (1995) model; (b) experiential exercises to demonstrate the adverse effects of self-focused attention and safety behaviours; (c) systematic training in externally focused attention; (d) video feedback for restructuring distorted self-imagery (see Warnock-Parkes et al., 2017); (e) surveys of other peoples' attitudes to issues (such as blushing) that concern patients; (f) behavioural experiments in which patients test pre-specified negative predictions while dropping their safety behaviours and focusing externally; (g) decatastrophizing exercises; and (h) techniques (discrimination training and memory rescripting) for reducing the impact of early socially traumatic memories (see Wild and Clark, 2011). ...
... Several procedures (therapist manual & video illustrations available at www.oxcadatresources.com) were used to reverse maintaining factors identified in Clark and Wells (1995) model of social phobia. These include: (a) an individualised version of Clark and Wells (1995) model; (b) experiential exercises to demonstrate the adverse effects of self-focused attention and safety behaviours; (c) systematic training in externally focused attention; (d) video feedback for restructuring distorted self-imagery (see Warnock-Parkes et al., 2017); (e) surveys of other peoples' attitudes to issues (such as blushing) that concern patients; (f) behavioural experiments in which patients test pre-specified negative predictions while dropping their safety behaviours and focusing externally; (g) decatastrophizing exercises; and (h) techniques (discrimination training and memory rescripting) for reducing the impact of early socially traumatic memories (see Wild and Clark, 2011). The protocol allowed up to 14 weekly (90 min) face-to-face therapy sessions and 3 booster sessions in the first 3 months of follow-up. ...
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Background Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time. Methods 102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test. Results CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test. Conclusions When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.
... Symptoms of social anxiety are associated with bias socially threatening information in young people and adults (Abend et al., 2019). According to cognitive theories, self-related negative cognitions play a significant role in development (Spence & Rapee, 2016) and maintenance (Clark & Wells, 1995;Rapee & Heimberg, 1997) of social anxiety. The ability to understand personal capacities in a field ensures that one performs well in that particular field (Leduc & Bouffard, 2017). ...
... The more individuals expect of their social evaluation, the more they tend to filter out their positive achievements. This thinking pattern leads to a greater tendency to avoid social situations (Clark & Wells, 1995). Avoiding social situations is associated with negative problem orientation and rumination. ...
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Due to the high rate of comorbidity of social anxiety disorder and major depressive disorder, this study aimed to examine the mediation effect of depressive symptoms on the association between emotion regulation, negative self-evaluation, and social anxiety symptoms. The population of this study consisted of all students of the Faculty of Architecture, Islamic Azad University. The sample included 284 of the students based on convenience sampling method. Depressive symptoms were measured by Beck Depression Inventory-II (Beck et al., 1996), emotion regulation was measured by Cognitive Emotion Regulation Questionnaire (Garnefski et al., Personality and Individual Differences, 30(8), 1311–1327, 2001), social anxiety was measured by Social Phobia Inventory (Connor et al., Depression and Anxiety, 14(2), 137–140, 2001) and, negative self-evaluation was measured by Consequences of Negative Social Events Questionnaire (Wilson and Rapee, Journal of Anxiety Disorders, 19(3), 245–274, 2005). We used Path analysis to test the significance of mediation. The result of the study indicated that the direct and indirect effects of all maladaptive emotion regulation strategies, negative self-evaluation and evaluation from the others’, and depression components on social anxiety symptoms components was positive and significant.From these results, we conclude that high levels of depressive symptoms accompanied by high levels of maladaptive emotion regulation and high levels of negative self-evaluation can lead to increased social anxiety symptoms. The theoretical and practical issues have been discussed.
... Characteristic symptoms are related to the physical, cognitive, and behavioral features with most prominent factors being fear of scrutiny and negative evaluation from others that leads to feelings of embarrassment, humiliation, and shame (Brunello et al., 2000). Post-event rumination and safety-behaviors along with self-focused attention play a crucial role in the maintenance of SAD (Clark & Wells, 1995). A clinical diagnosis requires that individuals' anxiety has to be out of proportion-in frequency and/or duration-to the actual situation, with significant distress or impairment that interferes with ordinary routine in social settings (APA, 2013). ...
... In addition, meta-analyses have documented its positive long-term effects (Fogarty et al., 2019;van Dis et al., 2020). Although there are various CBT treatment programs for SAD (Clark & Wells, 1995;Heimberg & Becker, 2002;Hope et al., 2006), the common denominator is identifying and changing maladaptive beliefs about physical symptoms and their consequences, conceptualizing avoidance behavior as the maintaining factor of SAD as well as exposure to anxiety-provoking stimuli. ...
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This is the protocol for a Campbell systematic review. The objectives are as follows: (a) to quantify the effect sizes for virtual reality exposure therapy (VRET) in the treatment of social anxiety disorder (SAD), targeting primary social anxiety symptoms, comorbid anxiety and depression symptoms and improvements in quality of life, when compared to WL, information control, care‐as‐usual and placebo; (b) to compare VRET to in vivo cognitive and cognitive‐behavioral interventions in treating SAD, at posttest and follow‐up, using between‐group design; (c) to identify the key features which are linked to beneficial outcomes in the two formats in treating SAD and (d) to collect and interpret information on differences in treatment uptake, adherence and attrition, as well as clinical significance and therapist‐time in both treatment formats.
... The significant impacts of self-esteem on anxiety and depression symptoms have been documented in previous longitudinal studies and meta-analyses (Orth et al., 2008;Sowislo and Orth, 2013;Rieger et al., 2016). Theories from the cognitive perspective, which propose that the negative beliefs of the self in social situations are risk factors for the development of social anxiety and depression (Beck, 1967;Clark and Wells, 1995), provide insights for the study of the etiology of affective disorders. Youth with low self-esteem from Western and Chinese societies are more likely to exhibit social anxiety Cheng et al., 2015;Abdollahi and Abu Talib, 2016;Hiller et al., 2017) and depressive symptoms (Li et al., 2015;Rieger et al., 2016;Gao et al., 2022). ...
... As the theories (Beck, 1967;Clark and Wells, 1995) and empirical studies (Cheng et al., 2015;Li et al., 2015;Abdollahi and Abu Talib, 2016;Rieger et al., 2016;Hiller et al., 2017;Gao et al., 2022) suggested, low self-esteem increases the risks of experiencing social anxiety and depression symptoms in the current study. The findings support the proposed mediation effects of self-esteem on the links from three types of social achievement goals to the concurrent and longitudinal social anxiety and depression symptoms except on the links from social mastery goals and social performance-approach goals to the longitudinal social anxiety symptoms. ...
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The pursuit of relationship goals is critical to the wellbeing of young adults. This study investigated different achievement goals toward social competence as potential predictors of social anxiety and depression symptoms. It proposed that self-esteem may function as a mediator on the pathway from endorsing social achievement goals to undergraduates' concurrent and longitudinal social anxiety and depression symptoms. Social achievement goal theory proposes three types of goals: social mastery goals (striving to improve one's social competence), social performance-approach goals (striving to prove one's social competence and win positive evaluation), and social performance-avoid goals (striving to avoid incompetent social behaviors and negative evaluation). One hundred and eighty-five Chinese undergraduates aged from 18 to 23 (50% female) completed this study across two-time points. Path analyses indicated that social mastery (marginally) and performance-approach goals were positively associated with self-esteem, whereas social performance-avoid goals were negatively associated with self-esteem; self-esteem was negatively associated with the concurrent social anxiety and depression symptoms and the longitudinal depression symptoms. The proposed mediation effects of self-esteem on the links from three types of social achievement goals to the concurrent and longitudinal social anxiety and depression symptoms were significant except on the links from social mastery goals and social performance-approach goals to the subsequent social anxiety symptoms. Self-esteem and the baseline social anxiety and depressive symptoms have a chain mediating effect between social achievement goals and the longitudinal symptoms of social anxiety and depression. These findings suggest that the pursuit of social mastery goals and performance-approach goals in initiating and maintaining social relationships boosts undergraduates' self-worth and reduces their concurrent and longitudinal depression experiences. However, the strivings to hide inadequacy and avoid negative evaluation in social contexts impede one's self-worth and increase concurrent and longitudinal social anxiety and depression symptoms. Implications and limitations are discussed.
... Cognitive behavioural accounts emphasise the role of mental imagery (also known as self-imagery) in the maintenance of SAD (Clark & Wells, 1995;Hofmann, 2007;Rapee & Heimberg, 1997). It has been proposed that selfimagery that is excessively negative, vivid, and seen from an observer perspective functions as a maintenance mechanism by directly increasing anxiety, confirming negative self-evaluations, enhancing self-focused attention, and motivating the use of safety behaviours (Clark & Wells, 1995). ...
... Cognitive behavioural accounts emphasise the role of mental imagery (also known as self-imagery) in the maintenance of SAD (Clark & Wells, 1995;Hofmann, 2007;Rapee & Heimberg, 1997). It has been proposed that selfimagery that is excessively negative, vivid, and seen from an observer perspective functions as a maintenance mechanism by directly increasing anxiety, confirming negative self-evaluations, enhancing self-focused attention, and motivating the use of safety behaviours (Clark & Wells, 1995). In a systematic review on self-imagery in social anxiety, Ng et al. (2014) found that imagery valence, perspective, and vividness are the three main imagery characteristics that have been examined in previous studies. ...
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Background Understanding the role of self-imagery in the development of social anxiety in adolescence holds promise for improving intervention. Cross-sectional studies indicate that imagery characteristics are associated with social anxiety symptoms, however, prospective studies are lacking. The current study examined concurrent and prospective associations between two image characteristics, namely observer-perspective and vividness, with social anxiety symptoms in a community adolescent sample (N = 616; 53% girls; aged 11–15 years). In addition, we examined common themes in the negative social anxiety-related images. Methods Negative self-imagery and social anxiety symptoms were assessed using questionnaires at baseline and at 4–6-month follow-up. A series of multiple linear regression analyses were performed to see if each image characteristic predicts concurrent and prospective social anxiety symptoms. Topic modelling was performed to infer key topics from verbal data. Results Observer-perspective and vividness significantly predicted concurrent social anxiety symptoms beyond the influence of age and gender. Observer-perspective significantly predicted prospective levels of social anxiety symptoms beyond the influence of age, gender, and baseline social anxiety and depression symptoms. Negative self-images clustered into two themes: the fear of appearing anxious and the fear of being judged or viewed as unacceptable. Conclusions Specific characteristics and contents of negative self-images may be particularly relevant to the development of adolescent social anxiety.
... The efficacy of cognitive behavioral therapy (CBT) for social anxiety disorder is well established (National Institute for Health and Clinical Excellence, 2011), and a core technique according to cognitive models is behavioral experiments (e.g., Clark & Wells, 1995). In behavioral experiments, patients test the validity of their dysfunctional negative beliefs in real-life situations (Bennett-Levy et al., 2004). ...
... This may result from mental imagery about feared outcomes. Distressing mental imagery is common in anxiety disorders, including social anxiety disorder (Clark & Wells, 1995;Rapee & Heimberg, 1997; for a review, see; Ng, Abbott, & Hunt, 2014), in which it is commonly related to social memories (Hackmann, Clark, & McManus, 2000) and represents feared outcomes (e.g., 'looking foolish'; Hackmann, Surawy, & Clark, 1998). Such negative self-imagery appears to play a role in the maintenance of social anxiety disorder. ...
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Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.
... A negative interpretation bias is a central component of cognitive models of adult SAD and childhood anxiety (e.g., Kendall, 1985;D. M. Clark & Wells, 1995;Spence & Rapee, 2016). These models posit that the biased tendency to interpret ambiguous social cues as negative or threatening plays an important role in the maintenance of social anxiety. Consistent with these predictions, a large body of research has shown that (sub)clinically anxious children display a negative interpretation bias ( ...
... Although cognitive models of SAD specifically predict a negative bias in response to stimuli that possibly convey negative evaluations (D. M. Clark & Wells, 1995;Rapee & Heimberg, 1997), cognitive models on general anxiety predict a negative bias for all anxiety subtypes in response to (physical) threat (Clark & Beck, 2010). The latter would have been supported by differences between the anxious groups and the non-anxious group. ...
Article
Objective: The current study examined whether children with a social anxiety disorder (SAD) demonstrate divergent facial emotion processing and a disorder-specific negative interpretation bias in the processing of facial emotional expressions. This study aimed to overcome previous study limitations by including both a nonsocially anxious control group and a healthy control group to examine whether childhood SAD is characterized by a general emotion labeling deficit, and/or by a negative interpretation bias, indicated by systematic misclassifications, or a lower threshold for recognizing threatening emotions. Method: Participants were 132 children aged 7-12 years (Mage = 9.15; 45.5% female). Children with SAD (n = 42) were compared to children with other, nonsocial, anxiety disorders (n = 40) and healthy control children (n = 50) on a novel facial emotion recognition task. Children judged ambiguous happy/neutral, angry/neutral and fear/neutral faces that were morphed at different intensities (10%, 30%, 50%, 70%). Results: Children with SAD did not differ from other groups in their accuracy of identifying emotions. They did not show systematic misclassifications or a heightened sensitivity to negative, threatening faces either. Rather, children with nonsocial anxiety disorders showed a generally heightened sensitivity to emotional faces. Conclusions: The current study does not provide evidence for a general deficit in labeling of emotional faces in childhood SAD. Childhood SAD was not characterized by an interpretation bias in processing emotional faces. Children with nonsocial anxiety disorders may benefit from assistance in accurately interpreting the degree of emotionality in interpersonal situations.
... Cognitive models suggest that irrational beliefs and thoughts may also be fundamental to understanding anxiety disorders. For example, cognitive model of social anxiety disorder (SAD) posits that socially anxious individuals show a strong desire to make good impression on others and a lack of confidence about one's ability to do so (Clark & Wells, 1995). People with SAD develop negative self-impressions based on their prior beliefs about the self. ...
Article
The current study presents the psychometric investigation of the Georgian version of the Cognitive Distortion Scale (G-CDS) (Covin et al., 2011). The Cognitive Distortion Scale measures the 10 cognitive distortions in interpersonal and achievement domains. Altogether 941 individuals, across seven samples (37 clinical participants amongst them) participated in the standardization of the instrument. Confirmatory factory analysis demonstrated good model fit with a 10-factor solution. The G-CDS exhibited acceptable internal reliability and correlated in expected directions with other clinically relevant inventories. Although women scored higher than men on one factor (Should Statements) there were no other gender differences. There were significant differences in all cognitive distortions scores between clinical and control group. Given its respectable psychometric properties, the G-CDS appears to have a high degree of both clinical and research potential.
... This pattern of thinking in social situations is cognitively demanding, requires a high level of self-focussed attention, and has implication for the success of interpersonal interactions. Indeed, theoretical and empirical work has noted a positive correlation between self-focussed attention and social anxiety (Clark & Wells, 1995;Norton & Abbott, 2016;Spurr & Stopa, 2002), as well as with both FNE and FPE (Craven, 2015). Other work has also illustrated that FNE and FPE are related to less positive self-imagery in social situations, including more negative perceptions of social performance (Craven, 2015), less perceived accuracy of others' positive statements, and concerns of social reprisal (Cook et al., 2019;Weeks et al., 2015), all of which may underlie social anxiety symptoms. ...
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Social anxiety is characterized by fear, nervousness, and avoidance in social situations and can emerge as early as childhood. Recent theoretical models have proposed a two-factor model of social-evaluative concerns in social anxiety, including fear of negative evaluation (FNE), as well as fear of positive evaluation (FPE). Previous work in adolescents and adults has provided empirical support for this two-factor structure of social-evaluative fear, but it remains unclear whether FNE and FPE are distinct constructs in childhood. We collected parent-report of FNE, FPE, and social anxiety in 119 children (M = 8.84 years, SD = 0.44) and self-report of FNE, FPE, and social anxiety in 609 adults (M = 18.93 years, SD = 2.03). Confirmatory factor analyses revealed a two-factor structure of FNE and FPE in children and adults. Further, tests of measurement invariance across the child and adult samples were supported, suggesting psychometric equivalence across parent- and self-report of the FNE and FPE questionnaires. Finally, both FNE and FPE were each uniquely, positively related to social anxiety in children and adults. These findings provide evidence that FNE and FPE are distinct constructs in children and adults linked to social anxiety and illustrate that a two-factor structure of social-evaluative fear may be evident as early as childhood which is comparable to adult samples.
... To relieve social anxiety, shy individuals indulge in the online world to satisfy their normal social needs. According to the cognitive model of social phobia (18,19), individuals with social anxiety generally exhibit negative thinking patterns and are more likely to view neutral social cues as negative signs. This may explain why shy people are vulnerable to anxiety in face-to-face social situations. ...
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Background and Aims Mobile phone addiction among college students has gained considerable research attention because of its adverse effects on their health and academic performance. However, little is known about the mechanisms underlying the relationship between shyness and mobile phone addiction among college students. Methods Four questionnaires were used to examine whether mobile phone addiction tendency was predicted by shyness and the mediating roles of social anxiety and self-control among 3,189 Chinese college students. Correlation and mediation analyses were conducted using Hayes PROCESS. Results The results showed that (1) social anxiety (indirect effect = 0.22, 95% CI = 0.18–0.26) and self-control (indirect effect = 0.23, 95% CI = 0.21–0.25) played a partial mediating role in the relationship between shyness and mobile phone addiction tendency; (2) social anxiety and self-control also mediated the link between shyness and mobile phone addiction tendency sequentially (indirect effect = 0.10, 95% CI = 0.09 to 0.12). Conclusion These results suggest that mobile phone addiction among shy college students could be eliminated by alleviating social anxiety and strengthening self-control.
... The cloverleaf model can also be used for descriptive formulations that link the 'Big Idea' with a specific situation. For example, collaboratively formulating a client's difficulties using the Clark and Wells (1995) model of social anxiety, revealed the idiosyncratic 'Big Idea' that 'People reject you if you act strangely: I couldn't cope with the pain of rejection'. This led to the situation-specific assumption that 'When I meet my friend for coffee, I could start shaking. ...
Article
Cognitive behaviour therapy (CBT) is an evidence-based psychotherapy for a wide variety of psychological problems. While the exact working mechanisms of CBT remain unknown, its mode of action might usefully be conceptualised as facilitated experiential learning. An adapted ‘cloverleaf’ version of Borton’s ‘ what , so what , now what ’ learning model is presented to elaborate some of the potential benefits of taking an experiential learning perspective on CBT. These include conceptualising the maintenance of client problems as inhibited experiential learning and the CBT therapeutic process as the cultivation of more effective experiential learning. An experiential learning perspective might also provide an accessible way for trainee and early-career CBT therapists to understand more clearly the learning methodology that underlies CBT’s distinctive approach to psychotherapy. The model is also intended to create an overarching conceptual bridge between reflective practice, the therapist’s experiential learning in the client role, and the client’s experience of CBT as facilitated experiential learning. Key learning aims (1) To introduce a modified ‘cloverleaf’ experiential learning process model that can be applied to the conceptualisation of client difficulties, CBT therapeutic processes, and practitioner development. (2) To demonstrate how the model can be used to develop cross-sectional and descriptive maintenance formulations of client problems and client wellbeing. (3) To show how the model can be used as a conceptual and practical tool to help formulate both the therapeutic process and challenges and obstacles to that process. (4) To help practitioners make links between the process of personal and professional development and client change processes.
... Social anxiety refers to a persistent fear of being involved in social or performance contexts that are exposed to unfamiliar people and/or potential scrutiny by others [1]. Fear of negative evaluation (FNE) is considered to be a core feature of social anxiety and social anxiety disorder (SAD) in many clinical theories such as the cognitive-behavioral models [2,3]. ...
Article
Background: Fear of negative evaluation (FNE), referring to negative expectation and feelings toward other people's social evaluation, is closely associated with social anxiety that plays an important role in our social life. Exploring the neural markers of FNE may be of theoretical and practical significance to psychiatry research (e.g., studies on social anxiety). Methods: To search for potentially relevant biomarkers of FNE in human brain, the current study applied multivariate relevance vector regression, a machine-learning and data-driven approach, on brain morphological features (e.g., cortical thickness) derived from structural imaging data; further, we used these features as indexes to predict self-reported FNE score in each participant. Results: Our results confirm the predictive power of multiple brain regions, including those engaged in negative emotional experience (e.g., amygdala, insula), regulation and inhibition of emotional feeling (e.g., frontal gyrus, anterior cingulate gyrus), and encoding and retrieval of emotional memory (e.g., posterior cingulate cortex, parahippocampal gyrus). Conclusions: The current findings suggest that anxiety represents a complicated construct that engages multiple brain systems, from primitive subcortical mechanisms to sophisticated cortical processes. Author summary: The current findings indicate that fear of negative evaluation, an anxiety-related trait, could be decoded from the structural features of individual brains. These findings advance our understanding on the neural signatures of anxiety and implicate potential clinical applications of brain imaging measures.
... indicating that students found it generally difficult to decrease burden resulting from these tasks by themselves. Furthermore, students may have experienced stress due to reviewing previous socially uncomfortable situations in detail, a phenomenon referred to as post-event processing (Clark & Wells, 1995). More specifically, postevent processing concerns the reconstruction of social events ensuing their occurence, characterized by ruminative process which facilicatates the reconstruction of the event in a negative light, further making the person more prone of anticipating future events to be negative. ...
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Lockdown measures during the COVID-19 pandemic resulted in drastic disruptions of university students' everyday life and study mode, such as marked reductions in face-to-face teaching activities. Previous research on student mental health during the pandemic found that prolonged campus relocation had negative effects on students' mental well-being. However, these studies focussed on the initial lockdown period, or periods of active lockdown measures. This longitudinal study collected 456 observations of 23 undergraduate students in the Netherlands using ecological momentary assessment data on mental health related items (anxiety, stress, social context) during the first two weeks of on-campus teaching after prolonged lockdown measures. Using multi-level dynamic network modelling, we analysed the temporal and contemporaneous interplay of students' mental health factors following the return to campus in September 2021. On average, students reported low to medium scores on stress and anxiety both before and after the assessment period. Results of network analyses showed that students experienced social unease in relation to accumulating difficulties at university and vice versa. Furthermore, there were clusters of different states of social unease next to clusters of stress, anger, loss of control, and feeling upset. Lastly, we found beneficial effects of self-efficacy on experiencing social comfort in university. We discuss implications and concrete examples of interventions in universities, such as the promotion of self-efficacy, providing guidance in structuring study load, as well as help with stress management. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-022-03196-7.
... What's more, the cognitive behavioral model of social anxiety posited that individuals' attention to the evaluation from others is one of the main causes of social anxiety (Heimberg et al. 2010;Clark and Wells 1995). That is, people who view the social world as a potentially social-evaluative situations may more frequently perceive the fear of negative evaluation from others who they interact with (Heimberg et al. 2010), and such profound feelings of fear would in turn result in social anxiety syndromes, which suggested that fear of negative evaluation may be one of the antecedents of social anxiety (Cheng et al. 2015;Weeks et al. 2008aWeeks et al. , 2008b. ...
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Loneliness is an unpleasant experience of lacking desired interpersonal relationships. Abundant evidence has clarified the negative outcomes of loneliness, such as anxiety, even suicidal behaviors. However, relatively few is known about the internal buffering elements for loneliness, especially in adolescents. The current research aimed to investigate the relationship between self-compassion and adolescents’ loneliness, as well as the mediating roles of fear of negative evaluation and social anxiety in this relationship. A total of 871 Chinese adolescents completed a set of questionnaires, including the measures of loneliness, self-compassion, social anxiety and the fear of negative evaluation. We tested the proposed serial mediation model and the results suggested that self-compassion was negatively associated with loneliness, and social anxiety served as a mediator in the relationship. Besides, we found that the fear of negative evaluation and social anxiety serially mediated the negative association. Specifically, self-compassionate adolescents reported less fear of negative evaluation, which resulted in decreased social anxiety symptoms. In turn, the decreased social anxiety was linked to reduced feelings of loneliness. The present study sheds lights on the mediating effects of fear of negative evaluation and social anxiety in the relationship between self-compassion and loneliness. The theoretical and practical implications, as well as the limitations of the present study, are discussed.
... The findings of greater success in autistic peer to peer information transfer and higher autistic peer to peer rapport (Crompton, Sharp, et al., 2020) provide some indirect support for this. The cognitive behavioural model of social anxiety posits negative self-beliefs, high standards for performance, and catastrophic beliefs about failure underpin the development of social anxiety in an individual (Clark and Wells, 1995). Autistic young people are often subject to peer victimisation (Weiss & Fardella, 2018) which may increase their vulnerability to these cognitive processes. ...
... Notably, Hofmann et al. (2016) have developed a measure of interpersonal emotional regulation to capture the capacity to draw on the support of others reflecting the other-to-self flow of compassion. Moreover, Gilbert's treatment model for social anxiety recommends the adoption of a more compassionate attitude towards other people (i.e., self-to-others flow) to overcome the negatively self-focused attention that characterizes problematic social anxiety (Clark & Wells, 1995;Gilbert, 2014aGilbert, , 2014b. ...
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Objectives: Self-compassion constitutes a positive way of relating towards the self that enables emotional regulation and reduces emotional distress. This research first explored differences among a sample of persons with social anxiety disorder (SAD) and groups of high socially anxious (HSA) and low socially anxious (LSA) students on self-compassion, emotion regulation, and social anxiety. We then investigated emotional regulation as a mediator of the prediction of social anxiety by self-compassion and the influence of depressed mood on those relationships. Design: Study 1 compared a SAD group to matched groups of HSA and LSA students. Study 2 utilized the total sample (n = 330 students and n = 33 SAD) to test mediation. Self-compassion and emotion regulation were predictors of social anxiety and depression a covariate. Results: In Study 1, the SAD group did not differ from the HSA group on most aspects of self-compassion and emotional regulation but was higher on depression. Both were lower on most measures and higher on depression than the LSA group. In Study 2, higher self-compassion predicted lower social interaction anxiety, and emotional regulation strategies mediated this effect, regardless of depression. However, for social performance anxiety, controlling for depression removed mediation. Refraining from uncompassionate responses was directly connected to social anxiety, whereas compassionate responses influenced social anxiety via emotional regulation. Conclusions: Results affirm the ameliorative role of self-compassion on social anxiety and emotion regulation strategies as mechanisms of that influence. However, self-compassion's influence was affected by depression and type of social anxiety. Also, refraining from uncompassionate self-responding appears to be of prime importance in predicting social anxiety, whereas compassionate self-responding influences social anxiety via emotion regulation.
... At present, cognitive behavioural therapy (CBT) is the gold standard treatment for SAD (Lincoln et al., 2003;Mayo-Wilson et al., 2014;Taylor, 1996). CBT involves addressing unhelpful behaviours which are believed to maintain SAD, such as avoidance, safety behaviours, and self-focused attention (see further, Clark and Wells, 1995;Rapee and Heimberg, 1997). Studies have shown that CBT can significantly reduce anxiety symptoms (e.g., Andersson, 2009). ...
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Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.
... At the heart of social anxiety lies the fear of negative evaluation that involves the assumptions of being negatively evaluated, and the overestimation of the consequences this will have. Models of social anxiety suggest that limitations in social performance, which often causes negative evaluation, are a consequence of anxiety (10,81). However, the speech of someone who stutters can be the source of continued negative evaluation throughout life, meaning reconciling these expectations is made particularly difficult. ...
Article
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Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.
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We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.
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Background Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets memories of distressing formative events linked to negative self-imagery (NSI). IR is thought to update unhelpful schema by addressing the needs of the younger self within the memory. An accumulating body of evidence indicates that by modifying NSI, IR can significantly affect distressing imagery, memory appraisal, and beliefs about the self. Aims This systematic review aims to critically evaluate and synthesise literature investigating the existing research on the effects IR has on NSI in SAD. Method A systematic electronic search of Academic Search Complete, ProQuest, Medline, Scopus and PubMed was performed in February 2021 using pre-defined criteria. Ten studies met the inclusion criteria and were selected for review. Results Analysis of the reviewed articles’ findings identified three main themes: Changes to negative self-images , Memories linked to images and Encapsulated beliefs . IR was associated with significant decreases in image distress, image vividness, memory vividness, memory distress, and encapsulated beliefs. Although reductions were found with image frequency, they were non-significant. Interpretation of results is limited by the small number of studies. Conclusions IR appears to effectively alter images, memories and beliefs in SAD in as little as a single session. The findings indicate that IR could be utilised as a cost-effective intervention for SAD. However, additional studies and longer-term follow-ups are needed.
Article
Purpose This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? Method Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. Results Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. Conclusions Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed.
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Thesis
p>Social phobia is a common and disabling disorder. The cognitive model of social phobia by D.M. Clark and A. Wells (1995) proposes four maintenance factors for social anxiety. One of these factors involves the construction of an impression of the self as a social object using interoceptive information, which can be formed into a visual image of self, seen as if from another person's viewpoint. This image is usually negative, and thus maintains anxiety. Evidence exists that the observer perspective is used more by socially anxious individuals, but there is no clear evidence for its effects on thinking, anxiety, behaviour and social performance. Theory and evidence from the social psychological literature on self-focused attention suggest that the observer perspective, itself a form of self-focused attention, would impact negatively on these factors. The current study tested the effects of the observer perspective in an experimental situation. The results indicate that high socially anxious individuals were negatively affected by the observer perspective in comparison to its opposite, the field perspective, supporting the proposition of Clark and Wells (1995) that it contains distorted negative information. Low socially anxious individuals, contrary to the predictions of this study, were unaffected by the observer perspective. Clinical implications of these findings are discussed.</p
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A variety of studies have linked mood disorders to a ruminative style of thinking, particularly involving events and happenings from the past. When an individual’s early expectations of life are not met, depression may follow. In existential terms, depression may be linked to an individual failing to embrace the potentialities afforded by freedom. Post-event rumination, usually involving shorter time frames, has also been linked to social anxiety disorder, with individuals thinking over social encounters and how these were interpreted by others. Finally, regret and shame over early happenings can be involved in a range of pure obsessions, illness anxiety disorder and related conditions. It will be argued that all of these phenomena can be understood in existential terms and that this analysis is more in keeping with the way clients express their difficulties than typical cognitive and behavioural formulations.
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