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A Cognitive Behavioral Model of Social Anxiety Disorder
Abstract
Social anxiety disorder (SAD) is one of the most common and impairing psychological disorders. To advance our understanding of SAD, several researchers have put forth explanatory models over the years, including one which we originally published almost two decades ago (Rapee & Heimberg, 1997), which delineated the processes by which socially anxious individuals are affected by their fear of evaluation in social situations. Our model, as revised in the 2010 edition of this text, is summarized and further updated based on recent research on the multiple processes involved in the maintenance of SAD.
... For individuals with SAD, this fear results in the employment of avoidance behaviors to minimize the pos-sibility of negative judgment. However, these strategies, while aimed at reducing immediate anxiety, can inadvertently result in the maintenance of the disorder over time (Heimberg et al., 2014). ...
... This result is consistent with the previous research by McBride et al. (2022) and Holas et al. (2021) The contrasting characteristics of self-compassion and SAD can be used to elucidate this result. Social anxiety involves self-criticism, avoidance, and catastro-phizing (Hofmann, 2007;Heimberg et al., 2014). Conversely, self-compassion promotes acceptance of the self, self-kindness, a balanced self-view, and acknowledging flaws as part of being human. ...
... As a result, they perceive social situations as overly threatening and overestimate the potential cost of adverse social events. Consequently, they experience excessive fear of being negatively evaluated, leading to heightened anxiety in social settings (Heimberg et al., 2014;Clark, 2005). ...
Objective: Social anxiety disorder (SAD) can negatively impact various aspects of life, incurring significant personal and societal costs. Thus, it is necessary to identify protective factors that buffer against SAD symptoms and the mechanisms underlying their mitigation. This research aims to examine the relationship between self-compassion and social anxiety symptoms among university students, specifically exploring the potential mediating effects of fear of negative evaluation (FNE) and shame. Methods: This study examined the relationships between variables through structural equation modeling (SEM) using a correlational design. The sample included 242 undergraduate, master’s, and doctoral students from Tehran’s public universities, selected via the convenience sampling method. Social phobia inventory, the self-compassion scale, the brief form of FNE scale, and the shame subscale of self-conscious affect questionnaire were used to collect data. Data analysis involved descriptive statistics and Pearson correlation via SPSS software, version 22, and SEM using AMOS software, version 22. Results: The results from analyzing the structural relationships indicated a direct negative effect of self-compassion on social anxiety symptoms, FNE, and shame. Additionally, FNE and shame had a positive effect on social anxiety symptoms directly (P<0.01). Investigating the significance of mediating variables indicated an indirect negative effect of self-compassion on social anxiety symptoms, passing through FNE and shame as mediators (P<0.01). The research model had a good fit and accounted for 59% of the variance in social anxiety symptoms. Conclusion: Based on the research results, increasing self-compassion can reduce social anxiety symptoms through both direct and indirect paths, by reducing the effect of FNE and shame.
... Gender differences in the prevalence of this disorder often indicate that social anxiety is more common among women (Leigh & Clark, 2018). Prominent psychological models that have examined the maintaining factors of SAD have identified key behavioral and cognitive factors responsible for the ongoing experience of anxiety in socially anxious individuals (Heimberg et al., 2010;Hofmann, 2007). These models have initiated extensive research that has contributed to the development of effective treatment protocols for SAD (Heimberg et al., 2010). ...
... Prominent psychological models that have examined the maintaining factors of SAD have identified key behavioral and cognitive factors responsible for the ongoing experience of anxiety in socially anxious individuals (Heimberg et al., 2010;Hofmann, 2007). These models have initiated extensive research that has contributed to the development of effective treatment protocols for SAD (Heimberg et al., 2010). Despite these models' efforts to describe the maintaining factors of SAD, they do not specifically identify the underlying causes of the disorder or how the causal factors compare to the maintaining factors in the development of the disorder. ...
... Cognitive models of social anxiety (Heimberg et al., 2010) suggest that in social situations, individuals with SAD develop false beliefs about themselves and how they are evaluated by others. These negative self-beliefs (NSB) lead to negative emotional reactivity (fear and physiological discomfort), maladaptive behaviors (social avoidance), and emotional disturbances, which in turn contribute to the maintenance and persistence of anxiety. ...
Objective: Social anxiety is characterized by the fear of being observed and judged by others in social situations. Methods and Materials: The present study aimed to investigate the relationships among early maladaptive schemas, behavioral inhibition, and social anxiety, considering the mediating role of social situation evaluation, safety behaviors, emotion regulation, social beliefs and thoughts, and self-related beliefs. This descriptive study was of a correlational type. The statistical population included all female medical students at Jundishapur University of Medical Sciences in Ahvaz. The research sample consisted of 483 female students who were selected through convenience sampling. The research instruments included the Social Phobia Inventory, the Early Maladaptive Schemas Questionnaire, the Social Situations Evaluation Scale, the Safety Behaviors Questionnaire, the Emotion Regulation Questionnaire, the Social Beliefs and Thoughts Scale, the Self-Related Beliefs Scale, and the Behavioral Inhibition Questionnaire. Findings: Data were analyzed using Pearson correlation and structural equation modeling. Fit indices indicated that the hypothetical model of the study had a good fit with the data (CFI = 0.96, IFI = 0.96, RMSEA = 0.07). The results showed that except for emotion regulation, all mediator variables affect social anxiety disorder (SAD). Conclusion: Given the role of the factors proposed in the research model, it can be utilized in designing interventions for SAD among female medical students.
... The anxiety experienced by the actor in the experiment was in line with social anxiety disorder, which is a severe psychiatric disorder characterized by persistent and overwhelming fears of one or more social or performance settings where there is potential for evaluation by others (American Psychiatric Association, 2013). Fear of negative evaluation is a key component in cognitive-behavioral models of social anxiety and has rich empirical support (Heimberg et al., 2010). ...
... The feelings of anxiety that arose were associated with the fear of the new leader's view of those who did not support him or who lost the support scheme during the campaign period. This finding supports social evaluation theory, which explains that anxiety arises from the fear of negative evaluation (Button et al., 2015;Heimberg et al., 2010;Manstead & Semin, 1981). ...
... Third, the integrated model of anxiety associated with leadership change is expected to enrich understanding of social anxiety in social evaluation theory and integrated modern emotion science. The findings of this study support social evaluation theory in that they put fear of negative evaluation as the key component that causes anxiety (Button et al., 2015;Heimberg et al., 2010;Manstead & Semin, 1981). Integrated modern emotion science is enriched through a functional account of the emotion approach. ...
Background
Leadership changes within public organizations are often associated with achieving the organization’s vision. This exploratory study examines critical incidents and the anxiety experienced by the head of the department at the local government in the context of leadership change in the public organization. It explores anxiety, which has rarely been explored in connection with leadership change, especially with regard to public organizations and countries with a high-power distance culture. Thus, it comprehensively describes the sources, course, and consequences of anxiety due to leadership change.
Methods
Critical incident technique (CIT) was used to conduct analysis because of its suitability as a theoretical framework for the exploratory nature of this research. Data were obtained through in-depth interviews from 26 informants who served as heads of departments in cities.
Results
The findings revealed the causes, course, and consequence of the anxiety experienced in response to leadership change. Political choice, culture change, policy change, fear of loss, and unaccountable financing were identified as sources of anxiety. Anxiety manifested through negative, cognitive, and behavioral reactions. The consequences were divided into in-circle, out-circle, and ambivalence-circle participation.
Conclusions
High-power distance culture causes leaders to portray hegemony with boundaries that are difficult to access as well as appear more directive to strengthen control within the organization. The integrated model presented here (causes, course, and consequences of anxiety) is expected to enrich the integrated, modern, and emotional science through a functional account of the emotional approach. Cognitive and affective reactions have a two-way relationship, wherein emotion influences cognition and cognition elicits emotion.
... Considering how the audience are perceived by the SAIs, Rapee and Heimberg, in their cognitive model of social anxiety, stated there are three symptoms that can be found in a socially anxious person, which are cognitive symptoms, behavioral symptoms, and physical symptoms (Heimberg, Brozovich, & Rapee, 2010). ...
... With these negative mental representations keep going on in almost every social situation, SAIs will start to think that it is a fact and it will begin to interfere their lives. For example, SAIs could face difficulties in maintaining a simple conversation because they are afraid that things they say may sound 'stupid' or 'uninteresting' (Heimberg, Brozovich, & Rapee, 2010). ...
... Moreover, by performing these safety behaviors, SAIs also lost the opportunity of knowing whether they can handle the situation well or not. (Heimberg, Brozovich, & Rapee, 2010). ...
Dear Evan Hansen is one of the most popular musical dramas in the contemporary Broadway scene today which has also won many awards, including Best Musical in the 2017 Tony Awards. This musical revolves around a teenager, Evan Hansen and his journey to overcome his anxiety that started on the wrong foot. Therefore, this study aims to analyze Evan’s depiction of social anxiety disorder and how he overcame it. In conducting the research, Rapee and Heimberg’s (1997) cognitive-behavioral model of anxiety is used to study the symptoms of Evan’s anxiety, which are cognitive symptoms, behavioral symptoms, and physical symptoms.
After examining the data closely, the researcher noticed that Evan’s anxiety condition appeared differently when he was with the people with no close relations and when he was with his close relations. In social situations with people with no close relations, Evan showed more symptoms of anxiety. On the other hand, in social situations with his close relations, Evan did not show much anxiety symptoms even though the situations might trigger him like what happened with the people he was not close with. From the depiction, Evan’s progress on overcoming his anxiety can also be seen from how he managed to grow closer to the people he was not close with.
... According to psychological models of social anxiety (Clark & Wells, 1995;Heimberg et al., 2010; for a review, see Wong & Rapee, 2016), such anxiety can disrupt social abilities, leading to social performance deficits and actual negative evaluation from others. One important social ability is empathy, a process that has cognitive and emotional aspects which allows an individual to know another person's emotional state (cognitive empathy) and share their emotional state (affective empathy). ...
... With the perception of social threat, elevated social anxiety is associated with hypervigilance to evaluation from others (e.g. Heimberg et al., 2010). Although hypervigilance is considered a maintaining process of social anxiety, this process of increased attention to others may also lead to increased sensitivity to the thoughts and feelings of others, and enhance empathic ability (enhancement hypothesis; see also Tibi-Elhanany & Shamay-Tsoory, 2011). ...
... Indeed, eWMT may have particular potential to regulate cognitive empathy for negative emotions and affective empathy for positive emotions in socially anxious individuals because of its ability to improve mental disengagement from task-irrelevant emotional information and processes (e.g. social anxiety symptoms, and hypervigilance to others; Heimberg et al., 2010). This in turn enables appropriate attentional processes as well as normal cognitive and affective empathic processes to occur in the social situation at hand. ...
Social anxiety may disrupt the empathic process, and well-regulated empathy is critical for navigating the social world. Two studies aimed to further understand empathy in the context of social anxiety. Study 1 compared individuals with elevated or normative social anxiety on a measure assessing cognitive and affective empathy for positive and negative emotions conveyed by other people ("targets"), completed under social threat. Relative to individuals with normative social anxiety, individuals with elevated social anxiety had greater cognitive empathy and no differences in affective empathy, regardless of emotion type. As greater cognitive empathy can be maladaptive, Study 2 tested whether this could be down-regulated. Individuals with elevated social anxiety underwent emotional working memory training (eWMT) for negative emotional information, or control training (CT). Effects on an empathy measure completed under social threat were assessed. Cognitive empathy for negative emotions decreased following eWMT but not CT, and this was only evident for those with higher pre-training working memory capacity. Cognitive empathy for positive emotions and affective empathy were not affected. Overall, social anxiety is associated with aberrant elevated cognitive empathy for negative and positive emotions, and the deviation in cognitive empathy for negative emotions can be regulated with eWMT for certain individuals.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618001196235..
... SAD is characterized by persistent fear of social situations, particularly situations where the individual feels that they may be judged, evaluated, or scrutinized (Heimberg et al., 2010). Moreover, individuals with SAD can be confronted with their fears across a wide variety of situations, including while running household errands or even interacting on social media. ...
... Models of SAD focus on describing the factors that lead to the development and maintenance of social fears. For example, Heimberg et al. (2010) posit that several cognitive processes occur when individuals with SAD encounter a social interaction. This includes negative internal representations of the self and attentional biases to external threats, both of which lead to negative judgments about one's performance and increased symptoms of anxiety. ...
... This includes negative internal representations of the self and attentional biases to external threats, both of which lead to negative judgments about one's performance and increased symptoms of anxiety. As a result of these symptoms, individuals engage in subtle and overt avoidance behaviors, which maintain fear over time (Heimberg et al., 2010). ...
... The study by Morrison et al. (2013) is an important article within this cluster, presenting an explanatory model of SA that includes aspects of information processing bias, emotion regulation, and safety behaviors (30) (Figure 11). Also of interest for this clustering is an article by Heimberg et al. (2010) entitled A cognitive behavioral model of social anxiety disorder: update and extension (31). According to the model, SA is partly caused by the individual's overperception of social expectations and goals, which produces SA, further increases preoccupation with the self, and triggers negative cognitions, as a result, they negatively anticipate social situations and engage in avoidance and safety behaviors (experiential avoidance is itself a safety behavior). ...
... The study by Morrison et al. (2013) is an important article within this cluster, presenting an explanatory model of SA that includes aspects of information processing bias, emotion regulation, and safety behaviors (30) (Figure 11). Also of interest for this clustering is an article by Heimberg et al. (2010) entitled A cognitive behavioral model of social anxiety disorder: update and extension (31). According to the model, SA is partly caused by the individual's overperception of social expectations and goals, which produces SA, further increases preoccupation with the self, and triggers negative cognitions, as a result, they negatively anticipate social situations and engage in avoidance and safety behaviors (experiential avoidance is itself a safety behavior). ...
Objective
To understand the current study of social anxiety (SA) over the past decade, and to analyze the research hot topics and frontiers in this field.
Methods
CiteSpace 6.2.R3 was used to analyze the literature on SA collected in the Web of Science Core Collection database from 2013 to 2023.
Results
A total of 9940 literature were included after the screening, and the annual publication volume showed a steady increase. The results emphasize that Zvolensky MJ, Pine DS, and Heimberg RG are important authors in the field of SA. The United States has the highest number of publications, with the University of California System contributing the most. Research hotspots include cognitive impairment, risk factors, complications, neuroimaging, and intervention strategies. SA related to the “theory of mind”, “bullying victimization”, “mobile phone”, “network analysis”, “technology”, and “satisfaction” are emerging research foci.
Conclusion
This study identifies the current situation and trends of SA research, and provides a reference for future research topics and directions.
... The regression analysis showed that an increase in fear of negative evaluation was associated with an increase in social anxiety. This result is consistent with the findings of various empirical studies (Weeks et al, 2005;Carleton et al, 2007;Iqbal & Ajmal, 2018;Heimberg et al, 2014;Liu et al, 2020;Akkuş & Tekinsav Sütcü, 2022). Fear of being evaluated negatively may lead to excessive anxiety in social situations and consequently avoidance of social situations, which may cause social anxiety symptoms (Heimberg et al, 2014). ...
... This result is consistent with the findings of various empirical studies (Weeks et al, 2005;Carleton et al, 2007;Iqbal & Ajmal, 2018;Heimberg et al, 2014;Liu et al, 2020;Akkuş & Tekinsav Sütcü, 2022). Fear of being evaluated negatively may lead to excessive anxiety in social situations and consequently avoidance of social situations, which may cause social anxiety symptoms (Heimberg et al, 2014). As stated by Akkuş (2021), avoidance of social situations is one of the most important factors in the persistence of social anxiety disorder. ...
... The researchers also noted the perspective of Heimberg et al. (2014), who emphasized the significance of anticipatory processing, physical symptoms, and post-event evaluations in understanding social anxiety. Furthermore, evidence from Alves et al. (2022) and Alomari et al. (2022) highlights how avoidance behaviors in performance settings can affect both academic outcomes and personal growth. ...
Social Anxiety is a situation where a specific student chooses to avoid social interaction, which probably can affect the academic performance of a college student. However, some students can still perform well academically based on the positive result of their General Weighted Average (GWA). Therefore, the study wants to provide new ideas if there is still a significant relationship between Social Anxiety (SA) and Academic Performance (AP) of college students to determine if it affects their studies in their Performance Situations (PS) inside an academic setting and their Interpersonal Interaction (II) on how they perceive or feel about their environment. More studies are needed on those two variables among college students. Convenience Sampling (CS) was applied to obtain a total sample of 87 BS Psychology and 23 BA Political Science. All of them are enrolled in an ongoing academic year and a total population of 110 College students of Rizal Technological University - Pasig Campus. The RTU Grading System Scale and the arbitrary scaling were utilized, and the PS and II Scale were administered through the survey method. The findings revealed that under Academic Performance, there is a significant relationship between Social Anxiety, specifically Performance Situation, and there is no significant relationship between Social Anxiety, specifically Interpersonal Interaction. The researchers of this study recommended conducting an investigation or experiment to have a deeper understanding of how a college student performs and interacts inside or outside of the classroom.
... As a consequence of the negative appraisals, changes in the processing of social situations will occur. Similarly, Rapee and Heimberg's (1997) cognitive-behavioural model of social anxiety, which was revised by Heimberg et al. (2010Heimberg et al. ( , 2014, is another wellcited model that shares features with that of Clark and Wells (1995). Their model differentiates in the perspectives of performance expectations, whereby Heimberg et al. (2014) proposes that a socially anxious individual's preoccupation with their performance is contrasted against the perceived standards that are pressured by others, rather than the standards upheld by themselves, as outlined by Clark (2005). ...
Perfectionism is widely associated with social anxiety, yet the relationship is rarely explored with consideration to the multidimensionality of perfectionism. This study investigates the potential mediating effects of the bivalent fear of evaluation (BFOE) model on the relationship between perfectionism dimensions and social anxiety, a construct that proposes the importance of both fear of negative evaluation and fear of positive evaluation in social anxiety. Our research involved 435 university students who completed a large battery of measures as part of a prior study. The results demonstrated that irrespective of valence, fear of evaluation partially mediated a positive relationship between perfectionistic concerns over mistakes and doubts about action and social anxiety, and parental pressures and social anxiety. Additionally, in line with the BFOE model, both valences of fear of evaluation partially mediated a negative indirect effect between perfectionistic order and social anxiety. In contrast, perfectionistic personal standards demonstrated a non-significant bivariate relationship with social anxiety. The study supports the BFOE model and contributes to a deeper understanding of the association between dimensions of perfectionism and social anxiety.
... It was found that the clinical implications on the SAD group were more dominant than the control (Chen et al., 2015). Specific patterns in cognitive, affective symptoms, etc. in individuals in the SAD group also show non-uniform variations between individuals (Heimberg et al., 2014). Overall, previous research revealed that social anxiety can be identified through negative anticipatory behavior and visual scanning patterns using tools such as VR or computer programs. ...
Background: A common symptom of SAD is significant impairment in interpersonal relationships that can affect various aspects of life as well as daily functioning and lead to decreased quality of life. Individuals with high social anxiety will tend to withdraw from social environments. Purpose: This can eventually lead to loneliness and depression. Therefore, early detection is needed to find a diagnosis early on and prevent the condition from worsening. This review aims to determine the clinical picture in patients with SAD and to find out the instruments that /have been used for clinical enforcement in the field. Methods: We conducted a comprehensive search for full-text articles comprising case reports, case-control studies, cohort studies, and cross-sectional studies published between January 1, 2013, and December 30, 2023. The search encompassed databases such as PubMed, ScienceDirect, SAGE, and Scopus. It's important to note that this review does not delve into other clinical conditions associated with Social Anxiety Disorder (SAD), such as anxiety and depression, as they have been addressed in separate discussions. Additionally, the identification of anxiety and depression is excluded from this review. Results: Out of 78 articles that were screened, only 56 met the eligibility criteria to be selected for further review. The initial steps that need to be taken include 1) defining the research objectives; 2) establishing inclusion criteria; 3) developing a search strategy for data retrieval or study selection; 4) collecting data; 5) assessing the quality of studies; and 6) synthesizing the results. Risk of bias was performed using FEAT principles and reviewers’ discussion. A total of 11 final articles that were reviewed showed a significant correlation between anxiety disorder and detection. Conclusion: As individuals with SAD are large in number, based on this review, early detection is required using methods used by local health regions such as through interviews or clinical symptom assessment. This aims to find cases as quickly as possible and provide appropriate interventions.
... Such negative imagery may also recur in the form of prospective images of an imminent social catastrophe (e.g., Thunnissen et al. 2022). Cognitive models of SAD (e.g., Clark and Wells 1995;Heimberg, Brozovich, and Rapee 2010) propose that negative imagery plays an important role in social anxiety persistence, as it comes with an overestimation of the actual (social) threat and increases symptoms of anxiety and avoidance behaviours (including safety behaviours). This negative impact on symptoms has been confirmed by empirical findings (e.g., Hirsch, Meynen, and Clark 2004). ...
Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative ‘flashforward’ imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1‐week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14–17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group‐based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary.
Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974
... These distorted thoughts can result in avoidance behaviors, where the individual shuns social situations to evade the expected negative outcomes. Over time, this avoidance strengthens the fear of social interactions and sustains the cycle of anxiety [43]. According to Bowlby's theory [44], children develop coping mechanisms to manage stress based on their parents' and family environment. ...
Background: The present study aims to elucidate the association between adverse childhood experiences, parental bonding, fatherhood, and social anxiety symptoms among emerging adults within an Iranian context. Methods: This prospective cross-sectional study utilized self-reported assessments to evaluate fatherhood, parental bonding, anxious thoughts, and childhood trauma. The study was administered to 242 university students exhibiting social anxiety symptoms. Among the participants, 181 (74.8%) were boys and 61 (25.2%) were girls between the ages of 18 and 29. In terms of educational background, 64.9% of them held a bachelor’s degree, and 35.1% held a master’s degree. A majority of them (84.3%) were of middle-class socio-economic status, 6.6% were of low income, and 9.1% were of high income. Results: Analysis via multiple linear regression revealed that individuals with adverse childhood experiences exhibited heightened levels of social anxiety symptoms (R2 = 0.32) compared to their counterparts without such experiences. Furthermore, fatherhood (R2 = 0.28), paternal bonding (R2 = 0.26), and maternal bonding (R2 = 0.26) were all significantly and equally associated with variance in social anxiety symptoms. The findings underscored the substantial correlation between ACEs, fatherhood, and both maternal and paternal bonding with social anxiety symptoms in adulthood. Conclusions: Accordingly, the study emphasizes the importance of thoroughly assessing the multifaceted contributors to social anxiety. Such insights are pivotal for the design and implementation of community-based preventive interventions aimed at reducing the societal burden of social anxiety disorders.
... Positive psychological capital can buffer the individual's nervousness and negative evaluation in unfamiliar situations. The social anxiety caused makes them adapt to changes in the external environment more quickly (Fu et al., 2012;Heimberg et al., 2014). This suggests that psychological capital may play an important role in alleviating social anxiety. ...
Objective
As a topic of widespread concern in the fields of mental health and public health, social anxiety has many negative impacts on the physical and mental health of contemporary college students. Therefore, this study aims to provide new ideas for solving the problem of social anxiety among college students by exploring the potential mediating role of social support and psychological capital in the relationship between physical activity and social anxiety.
Methods
A cross-sectional survey was conducted on 874 college students from five universities in Shandong Province. Various self-report tools such as physical activity rating scale, social support scale, positive psychological capital scale, and social anxiety scale were used to collect information needed for this study. Related data. Use this to conduct descriptive statistical analysis, correlation analysis, and mediation effect analysis.
Results
The results showed that physical activity was significantly positively correlated with college students’ social support (r = 0.354, p < 0.01) and psychological capital (r = 0.448, p < 0.01), and social support was significantly positively correlated with psychological capital (r = 0.556, p < 0.01), the above three are significantly negatively correlated with social anxiety (r = −0.326, −0.381, −0.432, p < 0.01); the mediation effect analysis shows that physical activity has a significant direct effect on college students’ social anxiety The effect value is −0.136, accounting for 43.31% of the total effect; social support and psychological capital both play a separate mediating role between physical activity and social anxiety among college students, with effect values of −0.064 and −0.073 respectively, accounting for the total effect. 20.38, 23.25%, and also played a chain intermediary role, with an effect value of −0.041, accounting for 13.05% of the total effect.
Conclusion
Current research shows that physical activity can not only directly reduce social anxiety among college students, but also indirectly alleviate social anxiety among college students by increasing the level of social support and psychological capital. This has important reference significance for helping college students in China and even around the world overcome social anxiety.
... Typically, CBT protocols include psychoeducation, cognitive restructuring, exposure (imaginal or in vivo), progressive muscle relaxation, social skills training and video feedback (Huppert et al. 2003). Regarding SAD and PSA, CBT protocols are adapted on the premises of cognitive models, emphasizing the relationship between dysfunctional belief systems and behavioural avoidance (Beck et al. 2005;Clark and Wells 1995;Heimberg et al. 2010;Rapee and Heimberg 1997). ...
Social anxiety disorder (SAD), i.e., fear or anxiety in social situations, is a frequent and debilitating condition that can affect various life domains. The chapter provides a brief overview of SAD and its subtype, public speaking anxiety. The second section of the discussion focuses on exposure therapy and specifically a modern mode of delivery that involves virtual reality technology. Additionally, the underlying mechanisms of exposure therapy that lead to effective treatment outcomes are being discussed. It is suggested that a better understanding of how exposure works and the underlying mechanisms involved in effective change is essential to enhancing clinical outcomes.
... In cognitive behavioral therapy, this process is referred to as cognitive distortion, Concerning more specific updating of self-related beliefs regarding one's future, depression was associated with greater tracking of negative prediction errors in the right inferior parietal lobule and inferior frontal gyrus 17 . In individuals with social anxiety, which is also characterized by negative self-beliefs 60 and often comorbid with depression 61,62 , activity in the insula mediated the effect of negative social feedback on self-belief updates 63 . Hypersensitivity to negative information in the insula has also been reported for depression 64 and has been linked to the way emotions are processed in this condition 65,66 . ...
A core symptom of major depression is maladaptive self-beliefs. These are perpetuated by negatively biased feedback processing. Understanding the neurocomputational mechanisms of biased belief updating may help to counteract maladaptive beliefs. The present study uses functional neuroimaging to examine neural activity associated with prediction error-based learning in depression and healthy controls. We hypothesized that increasing symptom burden is associated with negatively biased self-belief formation and altered neural tracking of social feedback. Results showed that a higher symptom burden was associated with forming more negative self-beliefs and more positive beliefs about others. This bias was driven by reduced learning from positive prediction errors in depression. Neural reactivity of the insula showed increased tracking of more negative self-related prediction errors. The interplay of increased neural responsiveness to negative feedback and reduced learning from positive feedback may contribute to the persistence of maladaptive self-beliefs and, thus, the maintenance of depression.
... Both implicit and explicit processes are considered valid indicators that can provide distinct insights into social anxiety (Teachman & Allen, 2007). Cognitive models have identified several implicit biases in information processing characterizing anxiety in general (Williams et al., 1997) and social anxiety specifically (e.g., Clark & Wells, 1995;Heimberg et al., 2010). Compared to non-socially anxious individuals, socially anxious individuals are more likely to interpret ambiguous social cues as negative or threatening (for a review, see Hirsch et al., 2016). ...
Purpose
Parents’ fear of negative evaluation (FNE), fear of negative child evaluation (FNCE; parents’ fear that their child is evaluated negatively by others), and self- and child-referent negative interpretation biases have been proposed to play a role in the intergenerational transmission of social anxiety. In this cross-sectional study, we tested whether parents’ self-reported FNE and self-referent interpretation bias, as well as their FNCE and child-referent interpretation bias, statistically mediated the relationship between parent social anxiety and parent-reported child social anxiety.
Methods
A total of 179 parents of 13–16-year-old adolescents completed questionnaires concerning own social anxiety, their FNE, and FNCE and their child’s social anxiety. Parents’ self- and child-referent interpretation biases were measured using scenario completion and memory recognition tasks.
Results
Parents’ FNCE partially statistically mediated the relationship between parent and child social anxiety. Parents’ FNE and their self- and child-referent interpretation biases did, however, not statistically mediate this relationship.
Conclusions
Parents’ FNCE does, but their FNE and self- and child-referent interpretation biases do not seem to play a role in the intergenerational transmission of social anxiety. Hence, parents’ FNCE might be a promising target for clinical practice while designing therapies and interventions concerning child social anxiety.
... This finding holds implications for theoretical models of social anxiety that seek to explain processes that contribute to post-event negative thinking in elevated social anxiety vulnerability. Though models have typically argued that pre-event information processing mechanisms impact postevent negative thinking, they have not identified pre-event negative expectancies as one of these processes (Clark & Wells, 1995;Heimberg, Brozovich, & Rapee, 2010;Rapee & Heimberg, 1997;Wong & Rapee, 2016). The present findings specifically identify pre-event expectancy in a pathway to post-event negative thinking that can be readily incorporated into existing models, and so refine mechanistic accounts theoretical models of social anxiety. ...
Background
Cognitive behavioral group therapy (CBGT), psychodrama (PD), and their integration (CBPT) are effective in treating social anxiety disorder (SAD). However, the processes underlying their effectiveness are not fully understood. This study investigated whether changes in cognitive biases and reductions in avoidance behaviours mediated treatment effects. For PD and CBPT we additionally hypothesized a mediation effect of increased spontaneity.
Methods
Using data of 116 SAD participants in a randomized controlled trial (RCT) with four conditions (waitlist, CBGT, PD, CBPT), we examined mediators of treatment effect. Mediation analyses with bootstrapping tested the pathways trough which active treatments (compared to waitlist) affected post-treatment effects.
Results
The analyses indicated that perceived cost of negative social events mediated CBGT and CBPT outcomes, while perceived probability mediated PD and CBPT. Spontaneity did not mediate effects in of any treatment, while avoidance mediated outcomes across all interventions. Analysis using post-treatment mediators were all significant and showed no treatment specificity.
Conclusions
Underscoring its critical role in treating SAD, avoidance emerged as a consistent mediator of treatment effects. In contrast, cognitive biases were treatment-specific: reduced costs mediated outcomes in interventions with cognitive techniques, while reduced likelihood mediated outcomes in experiential interventions.
Mental health measures used with autistic adults are often only evaluated for use with non-autistic adults, which may cause inaccurate measurement. This is important when measuring social anxiety disorder as some features overlap with social characteristics of autism. This study evaluated one self-report questionnaire measure of social anxiety disorder, the Severity Measure for Social Anxiety Disorder. The Severity Measure for Social Anxiety Disorder is based upon criteria for diagnosis of social anxiety disorder, and we aimed to understand its suitability for autistic adults. The Severity Measure for Social Anxiety Disorder was completed by 284 autistic adults and 80 non-autistic adults who were then asked five follow-up questions about ambiguous questions on the Severity Measure for Social Anxiety Disorder. We found that over half our sample of autistic adults, on at least one question, attributed their answer to something other than anxiety. Furthermore, in autistic adults, one underlying construct of social anxiety did not link their answers on the Severity Measure for Social Anxiety Disorder together, suggesting the Severity Measure for Social Anxiety Disorder might not be suited to capturing social anxiety disorder in autistic adults. To improve measurement, we rescored answers where participants said their response was due to something other than social anxiety, however, the rescored Severity Measure for Social Anxiety Disorder did not only capture social anxiety in autistic adults either. Finally, we analysed the reasons other than social anxiety autistic adults said influenced their answers. We grouped their responses into 10 categories, for example, 'fatigue', 'sensory overwhelm', and 'masking'. Overall, our findings suggest caution when using the Severity Measure for Social Anxiety Disorder with autistic adults, and the categories identified may suggest how to measure social anxiety more accurately in autistic adults.
Bu çalışmanın amacı, spor eğitimi alan z kuşağı öğrencilerinin olumsuz değerlendirilme korkuları, bireysel ve sosyal sorumluluk düzeyleri ve yaşam doyumları arasındaki ilişkinin incelenmesidir. Araştırmada ilişkisel tarama modeli kullanılmıştır. Çalışma grubunu 2023-2024 eğitim öğretim döneminde ölçüt örnekleme yöntemi ile belirlenerek spor eğitimi alan ve z kuşağı olarak değerlendirilen 128 erkek, 79 kadın olmak üzere toplam 207 öğrenci oluşturmaktadır. Öğrencilerin demografik bilgilerini belirlemek amacıyla “Kişisel Bilgi Formu” ile “Olumsuz Değerlendirilme Korkusu Ölçeği”, “Bireysel ve Sosyal Sorumluluk Ölçeği” ve “Yaşam Doyumu Ölçeği” kullanılmıştır. Verilere öncelikle normallik analizleri uygulanıp parametrik testlerin uygunlukları gözden geçirildikten sonra bağımsız iki grup karşılaştırmalarında bağımsız gruplar t-testi, değişkenler arasındaki ilişkileri belirlemek amacıyla Pearson korelasyon analizi ve basit doğrusal regresyon analizi uygulanarak veriler raporlaştırılmıştır. Elde edilen bulgular değerlendirildiğinde düzenli spor yapmanın, kendini psikolojik olarak (içe dönük-dışa dönük) tanımlamanın olumsuz değerlendirilme korkusu, sorumluluk düzeyi ve yaşam doyumunu üzerinde kısmen istatistiksel farklılıklar oluşturduğu tespit edilmiştir. Sonuç olarak düzenli spor yapan öğrencilerin sorumluluk düzeylerinin daha yüksek olduğu, kendini içe dönük olarak tanımlayan öğrencilerin olumsuz değerlendirilme korkusunun daha fazla olduğu ve kendini dışa dönük olarak değerlendiren öğrencilerin yaşam doyumlarının daha yüksek olduğu görülmüştür. Ayrıca bireysel ve sosyal sorumluluk düzeyinin yaşam doyumunu anlamlı olarak yordadığı ve bireysel ve sosyal sorumluluk düzeyinin yaşam doyumundaki varyansın %3’ünü açıkladığı tespit edilmiştir.
Social anxiety is characterized by an intense fear of judgment in social situations, yet the underlying mechanisms driving this condition remain poorly understood. One hypothesis holds that specific alterations in Theory of Mind (ToM) affect the ability to interpret others’ thoughts and emotions. Another hypothesis proposes that broader interpretive biases lead individuals to perceive social cues as overly significant, even in neutral settings. We investigated these possibilities by measuring brain activity, pupil responses, and heart rates in socially anxious individuals and matched controls as they viewed ‘Partly Cloudy’, an animated film known to engage the ToM network during specific scenes. While overall brain activity during ToM-related scenes was similar across groups, socially anxious participants exhibited reduced activation in the left posterior superior temporal sulcus (pSTS), a key area for ToM processing. Additionally, intersubject correlation analysis revealed a distinct neural response pattern in the socially anxious group, marked by uniform responses in sensory regions and heightened variability in higher-order cortical areas. This pattern persisted throughout the film and occurred without changes in heart rate or pupil responses, indicating a neural processing bias that manifests even in non-evaluative settings. These findings provide a neural basis for ToM alterations and broader interpretive biases in social anxiety, supporting cognitive-behavioral models and suggesting novel targets for intervention.
الأهداف: هدفت هذه الدّراسة إلى الكشف عن مستوى القلق الاجتمّاعي والخوف من التقييم الإيجابي والخوف من التقييم السّلبي، ومعرفة فيما إذا كان هناك فروق في مستوى هذه المُتغيّرات تُعزى لمُتغيّر الجنس. كما هدفت إلى الكشف عن العلاقة الارتباطية بين القلق الاجتمّاعي والخوف من التقييم الإيجابي والخوف من التقييم السّلبي. المنهجية: استُخدم مقياس القلق الاجتمّاعي، ومقياس الخوف من التقييم الإيجابي، ومقياس الخوف من التقييم السّلبي لتحقيق أهداف الدّراسة. تكونت عينة الدّراسة من (699) طالبٍ وطالبةٍ من طلبة الجامعة الهاشمية. النتائج: أظهرت النتائج مستوى متوسط للقلق الاجتمّاعي، والخوف من التقييم الإيجابي، والخوف من التقييم السّلبي. كما أظهرت النتائج عدم وجود فروق دالّة إحصائيًا في مستوى القلق الاجتمّاعي، والخوف من التقييم الإيجابي، ومستوى الخوف من التقييم السّلبي تُغزى لمُتغيّر الجنس. فيما أظهرت النتائج وجود علاقة ارتباطية موجبة ودالّة إحصائيًا بين القلق الاجتمّاعي والخوف من التقييم الإيجابي والخوف من التقييم السّلبي. الاستنتاجات: توصي الدّراسة بتوجيه الآباء والمُدرسين إلى استخدام الأساليب التربوية السليمة في تربية الأبناء؛ فما يعايشه الفرد داخل نطاق أسرته، أو في جامعته، من خبرات ومواقف سلبية، قد يكون لها أثر كبير في ظهور اضطراب القلق الاجتمّاعي لديهم.
Cyber victimization is a growing global concern, impacting both the physical and mental well‐being of individuals. Some empirical studies have declared that cyber victimization is considered as an important factor in the emergence of symptoms of social anxiety. Whereas other studies still show inconsistency regarding the relationship. According to the PRISMA method, the present study used a three‐level meta‐analysis to obtain reliable estimates of effect sizes and examined a range of moderators. Based on 43 studies, a total of 115 effect sizes and 41,313 participants were retrieved through systematic literature searches. The meta‐analysis revealed a statistically significant positive correlation between cyber victimization and social anxiety. Furthermore, significant moderating effects were found in the study. The correlation is stronger between cyber victimization and social anxiety in children compared to adolescents. Additionally, victims exhibited heightened fear of negative evaluation from peers (FNE) among significant social anxiety variables. Notably, effect sizes were significantly larger when social anxiety was assessed using the Social Anxiety Scale for Adolescents (SASA), as opposed to the Social Anxiety Scale for Children‐Revised (SASC‐R). The current findings contribute to a deeper understanding and underscore the importance of personalized interventions aimed at mitigating cyber victimization and preventing social anxiety.
Social anxiety disorder (SAD) and alcohol use disorder (AUD) are prevalent disorders that often co-occur. SAD onset typically precedes that of AUD, and co-occurrence of the two disorders is associated with greater symptom severity than either condition alone. This chapter reviews current evidence about psychological treatment of co-occurring SAD and AUD. While people with co-occurring SAD-AUD can benefit from single-disorder cognitive behavioral therapy (CBT) approaches (either AUD-focused or SAD-focused), treatment efficacy and long-term outcomes are negatively impacted by the co-occurring disorders. Two alternate treatment models have been tested for co-occurring SAD-AUD: (i) dual-focused treatment, and (ii) integrated treatment. In one of two trials, dual-focused CBT for SAD and AUD resulted in worse outcomes, potentially due to the demands of engaging in two separate treatments. By contrast, integrated SAD-AUD treatment involves a synthesized therapeutic protocol (delivered by one therapist) to address SAD, AUD and the inter-connection between these disorders. To date, two trials have found that integrated CBT for co-occurring SAD-AUD improved outcomes compared to AUD-focused treatment. The remainder of the chapter provides a comprehensive overview of the therapeutic strategies and clinical application of integrated CBT for co-occurring SAD and AUD. A clinical vignette illustrates the treatment, common challenges, and provides example worksheets and therapeutic dialogue.
Background
Contrary to traditional notions of emerging adulthood as a period free from parental pressures, the prolonged transition to adulthood in contemporary society implies that parental influence remains a significant factor in the lives of emerging adults. This presents a potential challenge to emerging adults, as navigating independence while managing parental expectations can result in adverse psychological outcomes. The present study examined the relationship between perceived parental expectations and fear of negative evaluation (FNE) and the mediating role of maladaptive perfectionism.
Method
This cross-sectional study was conducted on 466 emerging adults from India between 18 and 25 years old. They responded to the Perception of Parental Expectations Inventory, the Frost Multidimensional Perfectionism-Brief Scale, and the Brief Fear of Negative Evaluation–Straightforward Items Scale.
Results
Correlation analyses revealed significant, positive associations between perceived parental expectations, maladaptive perfectionism, and FNE. Findings from regression analyses indicated that increased perceptions of parental expectations and maladaptive perfectionism predicted increased levels of FNE. The relationship between perceived parental expectations and FNE was fully mediated by maladaptive perfectionism.
Conclusion
A key reason for heightened perceptions of parental expectations associated with increased FNE is that emerging adults tend to adopt unrealistic perfectionistic standards. Maladaptive perfectionism represents a vital intervention target for individuals who perceive elevated parental expectations and are at risk for FNE, offering promising avenues for promoting well-being in emerging adults.
In this paper, I elucidate how lived space is transformed in social anxiety disorder. The cognitive–behavioral framework that dominates the field conceptualizes the disorder as an intrapsychic dysfunction and sidelines concrete experience. The omnipresent sense of threat as it expresses itself “out there” in the patient’s experiential world thus remains unexplored. Looking to first-person descriptions of social anxiety, I argue that the felt presence of the Other constantly threatens the patient’s sense of autonomy and ownership of the places they inhabit. They experience others violating the boundaries of their intimate spaces and banishing them from public spaces. These experiences point to an altered mode of inhabiting space I term intersubjective overdetermination. The patient is condemned to live in the space of the Other. I compare this conceptualization to the commonplace cognitive–behavioral account. I end by discussing the treatment implications of this account of socially anxious lived space.
Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta‐analysis aimed to evaluate the possibilities and effects of imagery‐based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions ( k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta‐analyses with studies with control groups resulted in significant medium controlled effects on social anxiety ( d = −0.50, k = 10) and imagery distress ( d = −0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.
Purpose
The detrimental effects of social anxiety on college students require urgent mitigation. To explore the influencing factors and underlying mechanisms of social anxiety among college students, this study aims to examine the relationship between negative physical self and social anxiety, and the mediating effects of fear of negative evaluation and regulatory emotional self-efficacy.
Methods
The Negative Physical Self Scale, Brief Fear of Negative Evaluation Scale, Regulatory Emotional Self-Efficacy Scale, and Interaction Anxiousness Scale were administered to 924 Chinese college students. SPSS 26.0 was used for analysis, and the Bootstrap method was used to test the significance level of the mediating effect.
Results
Negative physical self was significantly and positively related to social anxiety in college students. Fear of negative evaluation and regulatory negative emotional self-efficacy played independent mediating roles between negative physical self and social anxiety. Fear of negative evaluation and regulatory negative emotional self-efficacy showed a bidirectional chain mediating effect between negative physical self and social anxiety.
Conclusion
This study elucidates the mechanistic pathways between negative physical self and social anxiety. The relationship between negative physical self and social anxiety is influenced by the mediating effects of fear of negative evaluation, regulatory negative emotional self-efficacy, and the bidirectional chain mediating effect of fear of negative evaluation and regulatory negative emotional self-efficacy. This finding provides a reference for policy makers and educators to develop interventions for social anxiety in college students.
Purpose
People with aphasia (PWA) often experience higher levels of anxiety and social isolation than people without aphasia. Although the presence of anxiety is appreciated in PWA, literature examining the etiology and persistent nature of anxiety in PWA is underdeveloped. Safety-seeking behaviors, or maladaptive acts used by individuals to decrease anxiety from a feared outcome, have been reported as key facilitators of long-term anxiety toward feared situations across a variety of clinical populations. The purpose of this viewpoint is to explore the concept of safety-seeking behaviors and discuss their potential relevance to the maintenance of anxiety in PWA. We further discuss the distinction between maladaptive (i.e., safety seeking) and adaptive (i.e., coping) behaviors and how this knowledge may improve the quality of clinical services for PWA.
Conclusions
The present review advocates for further exploration of the safety-seeking behaviors that are used by PWA. Until critical attention is given to this subject, clinicians may remain ill-equipped to identify and depict whether a self-management strategy is facilitative or inhibitive to PWA's communicative participation goals. Critically, a behavior that may be “maladaptive” for one individual may be “adaptive” for another. Future research should seek to identify common behavioral and cognitive strategies that PWA implement to reduce acute perceptions of anxiety. This knowledge may help facilitate holistic aphasia rehabilitation by allowing clinicians to foster conversations around behaviors that inhibit or promote successful communicative participation.
Esta revisão bibliográfica investiga a relação entre o Transtorno de Ansiedade Social (TAS) e o Transtorno do Espectro Autista (TEA) proporcionando uma compreensão simplificada e objetiva das diferenças comportamentais, neuroanatômicas e genéticas existentes entre o TAS e o TEA. Através de uma análise objetiva e simplificada em literaturas relevantes, busca-se elucidar as particularidades de cada transtorno contribuindo assim para uma maior compreensão de suas características distintivas.
Understanding the mechanisms underlying psychopathology is a central goal in clinical science. While existing theories have demonstrated high clinical utility, they have provided limited quantitative and experimentally falsifiable explanations of psychopathological mechanisms. Previous computational modelling studies have primarily focused on isolated factors, posing challenges for advancing clinical theories. To address this gap and leverage the strengths of clinical theories and computational modelling in a synergetic manner, it is crucial to develop a quantitative model that integrates major vulnerability factors within a comprehensive psychopathological model. In this study, using social anxiety disorder (SAD) as an example, we present a novel approach by combining active inference modelling, an innovative computational approach that elucidates human cognition and action, with cognitive-behavioural theory (CBT), a well-established clinical framework. This CBT-informed quantitative account integrates multiple vulnerability factors to elucidate the psychopathology of SAD. Through a series of simulations, we systematically delineate their effects on pathological behaviours. This resultant model inherits the conceptual comprehensiveness of CBT and the quantitative rigor of active inference modelling, revealing previously elusive pathogenetic pathways and enabling the formulation of specific predictions for empirical studies. Furthermore, this resultant model provides a strong theoretical foundation for precision medicine in SAD by allowing for individual differences in the symptom development trajectory. Overall, this research presents the first quantitative model of SAD that unifies major pathogenesis factors proposed by CBT. It highlights the feasibility and potential of integrating clinical theory and computational modelling to advance our understanding of psychopathology.
The current study aims to explore Substance use, Depression, Social Anxiety and Academic Achievement among University Students. The observation of substance use, Depression, Social Anxiety and educational Achievement is so essential in this cutting-edge era. The sample for the present study of 225 (95 male and 130 female) changed into decided on from exceptional universities the purposive sampling technique. A correlational research design and convenient sampling technique were to measure study variables. Adult, Academic Performance Rating Scale, depression and social anxiety scale used where to check substance use, and Drug Use Questionnaire (DAST 28) were applied. The observed findings suggest that a large tremendous courting among materials makes use of, melancholy, social tension among university students. Multiple linear regression and t-tests on sample analyses for inferential facts were additionally done to check the hypotheses. The findings confirmed a large sample uses drugs and faces mental health issues but a value of (-1.01) shows a small distinction between male and female substance use. Similarly, the t-value of-1.04 suggests a small distinction between male and female depression levels. The p-value of 0.298 showed that this distinction isn't statistically large. No distinction was found in depression ranges among male and female university students. The t-value of-1.43 represents a distinctly small distinction in social anxiety rankings among male and female students. The consequences suggest largely terrible courting among substance use and educational achievement among university students. Results additionally suggest depression and social anxiety are terribly correlated with academic achievements. Findings found that there are no large variations between male and female university students in phrases of substance use, depression, social anxiety and educational performance amongst university students. The consequences found that substance use of are slight tremendous large predictor of depression among university students. The study focuses on the significance of addressing substance use, melancholy, and social anxiety among students to enhance their academic overall performance and well-being.
Bevezetés : A szociális szorongás olyan társas helyzetekben megjelenő félelem vagy szorongás, amelyben az egyén mások figyelmének lehet kitéve. Az egyén attól fél, hogy mások negatívan ítélik őt meg, és az ebből fakadó distressz képzelt és valós szociális deficitekhez vezethet. A szorongás ezen fajtájának szubklinikai formája korábbi kutatások alapján a teljes lakosság akár negyedét is érintheti. Célkitűzés: Jelen tanulmány célja a Liebowitz Szociális Szorongás Skála magyar nyelvű adaptációja és pszichometriai mutatóinak feltárása, valamint annak megállapítása, hogy mely nemzetközileg elfogadott verzió faktorstruktúrája alkalmazható hazai mintán. Módszer: Összesen 476 fővel (350 nővel és 126 férfival) készült keresztmetszeti, kérdőíves kutatásunk során a Liebowitz Szociális Szorongás Skálát, korábbi tapasztalatra vonatkozó tételeket, és a Kognitív Érzelemszabályozás Kérdőív rövidített verzióját vettük fel. A Liebowitz Szociális Szorongás Skála pszichometriai mutatóit klasszikus (faktoranalízis) és modern (IRT-elemzés) tesztelméleti módszerrel is megvizsgáltuk. Eredmények: A Liebowitz Szociális Szorongás Skála megfelelő pszichometriai mutatókkal rendelkezik, és a kérdőív tételei jól diszkriminálnak a látens változó különböző szintjével (−1 és 3 szórás között) rendelkező személyek között. A nemzetközileg is jelenleg legszélesebb körben elfogadott faktorstruktúrát kis módosítással replikálni tudtuk. A kérdőív nagy szórástartományban megbízhatóan mér, így a szociális szorongás mértékéről a populáció nagy részében képes információt adni, az érintett személyeket képes jól kiszűrni. A kérdőív skálái ellenőrző kérdések alapján is megfelelően diszkriminálnak a kitöltők között, és a kognitív érzelemszabályozás adaptív és maladaptív stratégiáival az elvártnak megfelelő irányú (negatív, illetve pozitív) korrelációkat találtunk. Következtetések: A Liebowitz Szociális Szorongás Skála összességében magyar mintán megbízható és érvényes kérdőív. Alkalmazhatósága az átlagpopuláció szűrésénél, prevencióknál kiemelten fontos lehet.
Objectives
One-in-five people experience anticipatory anxiety that impacts engagement in socially evaluative tasks. Metacognitive strategies have the potential to interrupt maladaptive cognitive-emotional cycles and facilitate greater engagement in such tasks. This study hypothesized that brief mindfulness training would increase participants’ likelihood of approaching a socially stressful task more than a brief distraction training by way of greater state mindfulness, and that participants would endorse relevant approach or avoidance motivations for their behavior. The study used an experimental design with random assignment to one of two metacognitive strategy conditions. University students (n = 140) with low-to-high social anxiety completed a 10-min mindfulness training or an active control distraction training, followed by a modified Trier Social Stress Test. Participants were instructed to practice the strategy before preparing for the speech, and were then given a choice to approach or avoid giving the speech. SPSS PROCESS was used to examine whether state mindfulness would mediate the relationship between the mindfulness condition and greater likelihood of approaching the speech. Hypotheses regarding mindfulness as a mediator and approach/avoidance motivations for approaching or avoiding the speech both received support. Extending upon cognitive-behavioral theories, social anxiety level may predispose avoidance of social-evaluative situations, though inducing increasing state mindfulness through brief mindfulness training might help mitigate avoidance and facilitate social approach when experiencing anxious affect.
Social anxiety disorder (SAD) models highlight maladaptive attention as a maintaining factor of SAD, potentially negatively impacting how individuals with SAD engage with cognitive behavioral therapy (CBT) content in a therapist’s presence. Emotional working memory training (eWMT) has been shown to improve affective attentional control. This pilot study assessed the proposed methodology for a randomized controlled trial (RCT) to determine whether eWMT, by improving attentional control prior to internet-based CBT (iCBT), results in better CBT outcomes. The RCT would be considered feasible if the pilot study achieved rates ≥80% for eligible participants recruited, study measures completion, intervention completion, and participant retention. Results from 10 randomized participants showed rates ≥80% for recruitment of eligible participants and iCBT intervention completion. Completion of study measures, eWMT and Placebo training interventions, and participant retention were <80%. Results highlight the need to consider strategies to improve the methodology prior to the RCT.
Objective
Mindfulness is an attribute of consciousness to manage social fear avoidance and promote well-being. Social anxiety is a common psychological experience noted among the general population. Social anxiety develops during adolescence and is prevalent among college students. This study investigates the factors contributing to social anxiety - fear and avoidance of social situations of female first-year undergraduates.
Methods
The study used a survey research design. A sample of 821 first-year female undergraduate students aged between 17 and 19. Data were collected using the Liebowitz Social anxiety scale, the Five-Facet mindfulness questionnaire, A short form of the Self-compassion scale, and the Positive and Negative affect scale.
Results
Mindfulness weakens social fear and reduces the tendency to avoid social situations. Mindfulness effectively mediates the impact of self-compassion's positive affect and negative effects on social fear. Mindfulness and social fear jointly mediate the impact of self-compassion, positive affect, and negative affect on social avoidance.
Conclusion
Mindfulness is the awareness and acceptance of the feelings, thoughts and sensations attached to self and its possible reciprocity with social surroundings to mitigate fear—self-compassion and positive emotional affect augment, and negative emotional affect attenuate mindfulness. Results analysis highlights the mediation of mindfulness on social anxiety, self-compassion, positive affect, and negative affect.
Social anxiety disorder is one of the most prevalent anxiety disorders. There is a need to develop brief, virtual, single-session interventions targeting constructs associated with social anxiety, such as anxiety sensitivity social concerns (ASSC). ASSC is the maladaptive belief about consequences arising from observable symptoms of anxious arousal. This study was designed to evaluate the initial acceptability and feasibility of a brief ASSC reduction program (Brief Observable Anxiety Sensitivity Treatment [BOAST]) which included a single clinician-led intervention session followed by a two-week ecological momentary intervention (EMI), delivered via mobile app. Participants (N = 36) were adults with elevated ASSC who were randomly assigned to receive BOAST (n = 19) or a waitlist control (n = 17). The trial was prospectively registered at clinicaltrials.gov (NCT04859790). Results supported the acceptability of BOAST with mixed findings for feasibility. Feasibility metrics for the EMI component were below pre-defined thresholds; however, there was evidence that homework completion was associated with symptom reduction. Preliminary efficacy metrics indicated that participants in the BOAST condition had large reductions in ASSC and one measure of social anxiety at 1-month follow-up. This study provides preliminary support for the acceptability of BOAST and elucidates avenues for future clinical and research efforts.
Background
Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student’s sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors.
Objective
This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way.
Methods
To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus.
Results
In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of –2 to +2) and had a high completion rate (>97%).
Conclusions
This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class.
Trial Registration
OSF Registries osf.io/4ca68 http://osf.io/4ca68
The correlation between social anxiety, as measured by the Social Phobia Scale, and negative post-event processing of socially distressing events, as measured by a diary record, was studied in a sample of 62 undergraduate students (mean age 27.98 yrs) during a 1-wk period. Of the participants, 55 individuals reported the experience of at least 1 socially distressing event during this time; only 24 of the participants, however, reported distressing events of a negative-evaluational character during the recording week. Although the Social Phobia Scale did not correlate with post-event processing of socially distressing events in general, it showed moderate to strong correlations with post-event processing of negative-evaluational events both on the same day and on the following day. Furthermore, the degree of negative post-event processing that was reported the same day was strongly predictive of the degree of such processing that was reported the following day. The results confirm that negative post-event processing is a real phenomenon with regard to socially distressing situations, and that high social anxiety is associated with higher degrees of such post-event processing of negative-evaluational events. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Based on a theory of objective self awareness three experiments were conducted with undergraduates to test the hypothesis that self-focused attention can alter self esteem levels. In Experiments I and II subjects were exposed either to the sound of their own voices or to the sound of another's voice, and while listening to the tape-recording they filled out a self esteem measure. Consistent with the theory, subjects whose attention was focused upon themselves by means of exposure to their own tape-recorded voices showed lower self esteem than subjects who heard another's voice. The impact of the self awareness manipulation on self esteem was greatest when it was first introduced. In Experiment III the variable of positive-negative feedback on a fictitious personality trait was added to the self-focused attention variable. An interaction resulted such that self-focused attention lowered self esteem given negative feedback, while there was a tendency toward the opposite result given positive feedback.
This study examined the effects of anticipatory processing on a subsequent speech in high and low socially anxious participants. Forty participants (n = 20 in each group) gave two speeches, one after no anticipatory processing and one after 10-minutes of anticipatory processing. In anticipatory processing, high socially anxious participants were more anxious, and experienced more negative and unhelpful self-images than low socially anxious participants did. However, both groups rated memories of past speeches as having a somewhat helpful effect on their speech preparation. High socially anxious participants tended to use the observer perspective more in the anticipated speech, while, in the unanticipated speech, they might have been switching between observer and field perspectives. Low socially anxious participants tended to use the field perspective in both speeches. High and low socially anxious participants reported better speech performances after the anticipated, compared to after the unanticipated speech. Results suggest that anticipatory processing may have both positive and negative effects on socially anxious individuals' cognitive processing and performance before and during a speech.
Cognitive-behavioral models (Clark & Wells, 1995; Rapee & Heimberg, 1997) and recent research suggest that individuals with social phobia (SP) experience both images (Hackmann, Surawy, & Clark, 1998) and memories (Coles, Turk, Heimberg, & Fresco, 2001; Wells, Clark, & Ahmad, 1998) of anxiety-producing social situations from an observer perspective. The current study examines memory perspective for two role-played situations (speech and social interaction) at multiple time points (immediate and 3 weeks post) in 22 individuals with generalized SP and 30 non-anxious controls (NACs). At both time points, SPs recalled the role-plays from a more observer/less field perspective than did NACs. Further, over time, the memory perspective of SPs became even more observer/less field while the memory perspective of NAC remained relatively stable.
Previous research has shown that patients with social phobia often experience negative, observer-perspective self-images when in anxiety-provoking social situations [Hackmann, A., Clark, D. M., & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38, 601–610]. The present experiment investigated whether negative images play a role in the maintenance of social anxiety. High and low socially anxious individuals (n = 40 in each group) were asked to give a speech in front of a camera. Half of the samples were instructed to hold in mind a negative, observer-perspective self-image during the speech, whereas the other half held a positive image of themselves. High socially anxious participants in the negative imagery condition perceived more bodily sensations, rated specific aspects of their performance unfavourably, and rated the self-image as a more accurate reflection of the self, compared to high socially anxious individuals in the positive imagery condition. For the low socially anxious individuals there was no significant difference between the two imagery conditions on measures of anxiety and performance. These results support the hypothesis that negative self-imagery may be involved in the maintenance of social anxiety.
We propose a cognitive model of social anxiety-related submission based upon psycho-evolutionary accounts of social anxiety
and depression and present results of two studies supporting this model. We tested a confirmatory factor model consisting
of three latent lower-order factors (fear of negative evaluation, fear of positive evaluation, and depressive cognitions),
all of which load onto a single latent higher-order submissive cognitions factor. In essence, we propose that the symptoms associated with social anxiety and depression (in part) served adaptive
functions for coping with social threats in the ancestral environment and that the cognitive symptoms associated with these
disorders may function collectively as integrated components of a social anxiety-related submission mechanism. Confirmatory
factor analysis indicated that the hypothesized model fit well. A score derived from the submissive cognitions factor correlated
strongly with social anxiety-related measures and less strongly with measures of generalized anxiety/worry in Studies 1 and
2. Furthermore, this submissive cognitions score correlated in the expected direction with self-report measures of social
comparison, negative affect, and positive affect in Study 2, and mediational analyses indicated that submissive cognitions may mediate the relationship between social comparison and
submissive behaviors. Findings from both studies provide support for the proposed model.
Recent research has indicated that individuals with social interaction anxiety make biased interpretations of positive social interactions, with greater general apprehension in response to such events and more negative predictions about the future. There has also been some preliminary evidence for a second facet of interpretation bias, namely a failure to accept others' positive reactions at face value, but this has so far not been adequately studied.
The present study developed a new measure of this "discounting" dimension and utilized a nonclinical sample of undergraduate students to provide an initial analysis of the scale.
Results provide early support for the psychometric properties of our scale, and indicate that discounting mediates the relationship between social interaction anxiety and low positive affect, over and above the previously studied aspect of positive event interpretation bias.
The implications for treatment interventions and further research are discussed.
People with higher social anxiety tend to reveal less information about themselves in interactions with strangers, and this appears to be part of a self-protective strategy adopted in situations in which the risk of negative evaluation is judged to be particularly high. This research examined whether a similar style of communication may be adopted by people with higher social anxiety in their close relationships, and whether it may be associated with decrements in the quality (support, depth, conflict) of these relationships. Over 300 people from the community completed a series of online questionnaires measuring social anxiety and depression, and disclosure in and quality of their close friendships and romantic relationships. After controlling for levels of depression, social anxiety was associated with a paucity of disclosure in both romantic relationships and close friendships in females, but not males. There was an indirect association between higher social anxiety and lower relationship quality (lower support, with a trend towards greater conflict) via lower self-disclosure in women's romantic relationships, but not their close friendships. Addressing disclosure in the context of close relationships may assist socially anxious women to develop more fulfilling and harmonious close relationships.
Studies in clinical and community samples have documented that social anxiety disorder is common, disabling, and costly. It reduces educational attainment and job success, and thus it may undermine economic self-sufficiency. The authors examined whether social anxiety disorder was an obstacle to successful employment in a longitudinal epidemiological study of women receiving welfare in an urban Michigan county. The hypothesis that social anxiety disorder would predict reduced work attainment was examined.
Psychiatric diagnoses were established with the Composite International Diagnostic Interview-Short Form. The authors conducted a linear fixed-effects regression analysis for survey data with 609 respondents who completed at least the third wave of the Women's Employment Study in order to explore obstacles to employment among mothers on welfare.
Analyses demonstrated that compared with respondents without social anxiety disorder, those with this disorder worked fewer months. The impact of social anxiety disorder was independent of and more striking than the effects of depression.
By undermining efforts to obtain or maintain employment, social anxiety disorder poses a significant, unrecognized impediment to efforts to reduce welfare reliance and to help recipients achieve economic self-sufficiency. Because recipients may lose benefits if they fail to enter the workforce rapidly and if they exceed time limits for support, those with social anxiety disorder are at risk of extreme economic hardship. Improved access to effective treatments in this population could have significant public health and economic benefits.
The goals of this study were to delineate the courses of social phobia and to determine whether the course of generalized and specific social phobia differed. In the Harvard/Brown Longitudinal Study of Anxiety Research Project, 66 specific and 74 generalized social phobic subjects were identified for whom adequate course data were available. These subjects had been followed prospectively with a standardized follow-along measure of psychopathology. The probability of remission was calculated for each individual group and both groups combined. Demographics were the same for both groups except that the specific social phobia group had a marginally higher mean score on the Global Assessment Scale. Complete remission for the combined group was not different from that for either subgroup and was 0.11 at 65 weeks. Social phobia appears to be a disorder with considerable long-term morbidity. Surprisingly, both subtypes took a comparably long time to remit and were similar in their high level of psychosocial dysfunction.
Patients with generalized social phobia (N = 32; 16 men, 16 women) and nonclinical control participants (N = 32; 16 men, 16 women) took part in a social interaction that was manipulated to be successful or unsuccessful. Participants rated their ability, perceptions of others' standards, social goals, and emotional responses before and after the interactions. As predicted, the successful social interaction produced a somewhat negative response in patients with social phobia. Social success led to self-protective social goals, negative emotional states and perceptions that others would expect more in future interactions. These results indicate that positive social events may not be processed in a way that leads to a revision of negative self- and social judgments in patients with social phobia.
At times, people keep their emotions from showing during social interactions. The authors' analysis suggests that such expressive suppression should disrupt communication and increase stress levels. To test this hypothesis, the authors conducted 2 studies in which unacquainted pairs of women discussed an upsetting topic. In Study 1, one member of each pair was randomly assigned to (a) suppress her emotional behavior, (b) respond naturally, or (c) cognitively reappraise in a way that reduced emotional responding. Suppression alone disrupted communication and magnified blood pressure responses in the suppressors' partners. In Study 2, suppression had a negative impact on the regulators' emotional experience and increased blood pressure in both regulators and their partners. Suppression also reduced rapport and inhibited relationship formation.
Patients with social phobia report experiencing negative images of themselves performing poorly when in feared social situations. The present study investigates whether such negative self-imagery (based on memory of past social situations) contaminates social interactions. High socially anxious volunteers participated in two conversations with another volunteer (conversational partner). During one conversation, the socially anxious volunteers held in mind a negative self-image, and during the other they held in mind a less negative (control) self-image. As predicted, when holding the negative image the socially anxious volunteers felt more anxious, reported using more safety behaviours, believed that they performed more poorly, and showed greater overestimation of how poorly they came across (relative to ratings by the conversational partner). Conversational partners rated the socially anxious volunteers' performance as poorer in the negative image condition. Furthermore, the conversation was contaminated since both groups of participants rated its quality as poorer in the negative image condition.
The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.
Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.
Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.
These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.
Two studies sought to elucidate the components of emotion and its dysregulation and examine their role in both the overlap and distinctness of the symptoms of 3 highly comorbid anxiety and mood disorders (i.e., generalized anxiety disorder, major depression, and social anxiety disorder). In Study 1, exploratory factor analyses demonstrated that 4 factors--heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotions, and maladaptive management of emotions--best reflected the structure of 4 commonly used measures of emotion function and dysregulation. In Study 2, a separate sample provided support for this 4-factor model of emotion dysregulation. Poor understanding, negative reactivity, and maladaptive management were found to relate to a latent factor of emotion dysregulation. In contrast, heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality. Finally, the 4 components demonstrated both common and specific relationships to self-reported symptoms of generalized anxiety disorder, major depression, and social anxiety disorder.
A theory of emotional imagery is described which conceives the image in the brain to be a conceptual network, controlling specific somatovisceral patterns, and constituting a prototype for overt behavioral expression. Evidence for the hypothesis that differentiated efferent activity is associated with type and content of imaginal activity is considered. Recent work in cognitive psychology is described, which treats both the generation of sensory imagery and text comprehension and storage as examples of the processing of propositional information. A similar propositional analysis is applied to emotional imagery as it is employed in the therapeutic context. Experiments prompted by this view show that the conceptual structure of the image and its associated efferent outflow can be modified directly through instructions and through shaping of reports of image experience. The implications of the theory for psychopathology are considered, as well as its relevance to therapeutic behavior change.
Cognitive-behavioral theorists have proposed that fear of negative evaluation (FNE) is the core feature of social anxiety (Clark & Wells, 1995; Rapee & Heimberg, 1997). However, emerging evidence supports the notion that fear of evaluation in general is important in social anxiety, including fear of positive evaluation (FPE) as well as negative evaluation (e.g., see Weeks, Heimberg, & Rodebaugh, 2008; Weeks, Heimberg, Rodebaugh, & Norton, 2008). The purposes of the present study were to test several new hypotheses related to this expanded conceptualization of social anxiety, as well as to replicate the two-factor structural model consisting of separate factors for fears of positive and negative evaluation originally reported by Weeks, Heimberg, and Rodebaugh, et al. (2008). The present findings further support FPE and FNE as distinct latent constructs. FPE and FNE related similarly to social anxiety but demonstrated unique relationships with several social anxiety-related constructs and emerged as distinct from several discriminant constructs with strong thematic overlap to FPE/FNE. The findings from the present study provide additional support for the hypothesis that fear of evaluation in general is important in social anxiety.
This paper reports two experiments which examined the effect of manipulating the informational structure of fear-provoking mental images on physiological arousal. The subjects, females with fear of rats selected on the basis of self-report and behavioural indices of fear, after training in stimulus imagination, response imagination or no-training, underwent a laboratory session in which they were requested to imagine scenes from scripts of different propositional structure and different emotional content while their heart rate and skin resistance were recorded. The results of both experiments showed that Training in response imagination, independently of Type of script, produced higher heart rate activation during the description or imagination of fear-provoking scenes than Training in stimulus imagination. This effect was only detected when the no-training group was excluded from the analysis. The results are discussed in relation to Lang's bio-informational theory of emotional imagery.
Cognitive-Behavioral Models of Social Anxiety Disorder Since its recognition as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, third edition (American Psychiatric Association, 1980), social anxiety disorder (SAD, also known as social phobia) has received increasing attention in the field of psychology as a complex, debilitating disorder that, left untreated, is often unremitting. In the last few decades, many theorists have contributed significantly to our understanding of this disorder, subsequently informing approaches to treatment. In this chapter, we review and compare aspects of the two preeminent cognitive behavioral models of SAD, as well as more recently proposed models of SAD.
This study examined the effect of three variables held to influence heart rate response during imagery-related text processing: mode of processing, content of text, and inclusion of response information in the text. Sixty-four undergraduates imagined and silently repeated fearful and neutral sentences in a paradigm designed to allow for self-initiation of sentence processing. Fear sentences either included or did not include information about bodily responses in the image. Heart rate accelerated more during fear imagery than during neutral imagery or silent repetition of either type of sentence. Inclusion of response information in fear material did not increase heart rate response to imagery, but did affect self-report in the predicted direction. Heart rate waveform prior to the sentence tasks indicated pre-processing of fearful material. The results were discussed in relation to a bio-informational theory of imagery, which asserts that emotional imagery accesses the same centrally-mediated response program as is evoked in the target reality context, and thus occasions measurable activity in the appropriate effectors.
This study tested D. M. Clark and A. Wells’ (1995) proposition that negative post-event rumination is produced by negative self perceptions formed by socially phobic individuals during anxiety-provoking events. A socially phobic group and a nonanxious control group performed an impromptu speech, and appraised their performance immediately afterwards. One week later, participants were assessed as to how frequently they had had negative thoughts about the speech, how much they engaged with these thoughts, how distressing these thoughts were, and how much control they felt they had over the thoughts. The socially phobic group engaged in more negative rumination than controls on each of these levels, and perceived their performance as worse than controls immediately after the speech. Perception of performance was found to mediate the relationship between social anxiety and post-event rumination, providing support for Clark and Wells’ model.
Current theories predict that following a social–evaluative performance, people high in social anxiety will ruminate about the negative features of the event and, in turn, will show a bias toward recalling the negative aspects of the event. In this study participants presented an impromptu speech and were then provided with half positive and half negative feedback on their performance. A free-recall task was used to test immediate recall for the feedback. Participants returned 1 week later and were again tested on recall for the feedback as well as completing a questionnaire indicating the extent to which they engaged in both positive and negative rumination regarding the speech task during the preceding week. Evidence for a negative memory bias in the high socially anxious group (HI) was found at both times, however this negative bias did not increase over time. The hypothesis that the HI group would spend more time than the low socially anxious group ruminating over perceived negative aspects of the speech task was also supported. Social anxiety and depression scores were both uniquely associated with negative rumination, however when controlling for depression the Group Rumination–Valence interaction became nonsignificant. The HI group did engage in greater levels of overall rumination however, even when depression scores were statistically controlled. There was no significant relationship shown between negative recall bias and negative rumination.
There is considerable evidence that anxiety is associated with a cognitive bias favouring the processing of threat-related information. Bower's (1981) network model attributes this bias to the enhanced availability of mood congruent information from memory. However, certain experimental tasks do not reveal such a bias, when this effect is strongly predicted by the model. We note that all tasks which have demonstrated such mood congruent processing effects in anxious subjects share the requirement that these subjects must assign priorities to simultaneously available, and differentially valenced, alternative processing options. This feature has been consistently lacking in those paradigms we have found insensitive to the influence of anxiety. It is therefore suggested that anxiety is associated with the assignment of high processing priorities to threat-related options, rather than with the facilitated availability of threat-related information from memory. This proposal was experimentally tested using a lexical decision task, which is sensitive to the accessibility of information from memory, under conditions which either do or do not introduce the requirement to assign priorities to alternative processing options. The results indicate that the facilitated processing of threat related stimulus words, shown by generalised anxiety patients, does indeed appear to reflect a bias in the assignment of processing priorities, rather than the enhanced availability of this information from memory.
This study examined changes in post-event processing (PEP), metacognitions, and symptoms of social anxiety and depression following cognitive behavioral group therapy for social phobia (N = 61). Social anxiety, depression symptoms and PEP all significantly reduced following treatment. Reductions in PEP were associated with reductions in symptoms of social anxiety, but not depression. Metacognitions were also less strongly endorsed following treatment, with the exception of positive metacognitions. Interestingly, however, changes in metacognitions were generally associated with reductions in depression and not social anxiety. Theoretical and clinical implications as well as future research directions are discussed.
From an emotion regulation framework, generalized anxiety disorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among individuals with GAD and delineate which aspects of emotion dysregulation are specific to GAD or common to GAD and another mental disorder (social anxiety disorder). Individuals with GAD reported greater emotion intensity and fear of the experience of depression than persons with social anxiety disorder and nonanxious control participants. Individuals with social anxiety disorder indicated being less expressive of positive emotions, paying less attention to their emotions, and having more difficulty describing their emotions than either persons with GAD or controls. Measures of emotion differentiated GAD, social anxiety disorder, and normal control groups with good accuracy in a discriminant function analysis. Findings are discussed in light of theoretical and treatment implications for both disorders.
Individuals with social anxiety preferentially attend to threatening social information during and following social events. As such, cognitive models predict that social anxiety should be associated with biases in the recall of social events. However, initial experimental studies examining this assumption either failed to find such biases or found only weak evidence for an autobiographical memory bias. The current review examines an emerging line of evidence offering support for the role of an autobiographical memory bias in the development and maintenance of social anxiety. The review begins by examining current theoretical approaches to autobiographical memory before looking at empirical studies that have examined differences between socially anxious and non-anxious individuals in the recall of autobiographical memories. Specific memory biases include properties of social-threat memories, the imagery associated with these memories, and the cognitive processing styles that have been found to either facilitate or inhibit the recall of emotional memories. Limitations in methodologies used to study retrieval of memories and the implications of findings for future research are discussed.
Research suggests that individuals with social phobia fear positive social events and interpret them in a negative fashion that serves to maintain anxiety. To better elucidate the nature and role of interpretation of positive events in social phobia, two studies were conducted. Study 1 examined symptom and cognitive correlates of negative interpretation of positive social events. Participants with DSM-IV diagnosed generalized social phobia (GSP) completed a measure of interpretation of positive social events (IPES) in relation to a range of symptom and cognition measures of social anxiety. Results indicated that perfectionism and a measure tapping interpersonal fears associated with social anxiety were significantly predictive of IPES scores. Study 2 examined IPES scores in clinical participants with GSP, obsessive compulsive disorder (OCD), panic disorder with or without agoraphobia (PD/A), generalized anxiety disorder (GAD), and non-anxious controls. Results indicated that individuals with GSP scored higher on the IPES than those with PD/A, GAD and controls, but did not differ from OCD. These findings suggest that negative interpretation of positive events is a distinct and characteristic feature of social phobia with significant associations with other cognitive risk factors for the disorder.
Cognitive models of social anxiety suggest that fear of negative evaluation (FNE) is the central cognitive dimension underlying the disorder. The Fear of Positive Evaluation Scale (FPES; Weeks, Heimberg, & Rodebaugh, 2008) was recently developed to assess an additional cognitive dimension purported to underlie social anxiety disorder (SAD), but its psychometric properties have yet to be examined in clinical populations. The present study, with 133 treatment-seeking patients, examined the applicability of the FPES with a clinical sample. Results indicated that the FPES was factorially distinct from a measure assessing FNE, and patients with SAD (n=51) had higher mean scores on the FPES than patients with other anxiety disorders (n=82). The FPES also showed adequate reliability (internal consistency), good convergent and discriminant validity, acceptable criterion-related validity in predicting social interaction anxiety symptoms, and appropriate sensitivity to treatment. The FPES appears to have good psychometric properties and is a promising new assessment tool for better understanding SAD.
According to cognitive theories, safety-seeking behaviors are crucial in both the maintenance and management of social anxiety. In order to facilitate assessment of these behaviors the Subtle Avoidance Frequency Examination (SAFE) was developed. Three factors emerged from the SAFE, which appeared to reflect active "safety" behaviors, subtle restriction of behavior, and behaviors aimed at avoiding or concealing physical symptoms. The SAFE demonstrated strong internal consistency, good construct validity and the ability to discriminate between clinical and non-clinical participants. In addition, the SAFE was responsive to the effects of treatment. Given its excellent psychometric properties, the SAFE may be useful to further investigate the role of safety strategies in social anxiety and to assess treatment outcomes.
Recent evidence suggests that social anxiety disorder is best characterized as having a dimensional latent structure.
In this study, we examined the latent structure of two cognitive components of social anxiety, fear of negative evaluation (FNE) and fear of positive evaluation (FPE), in a large undergraduate sample. Two taxometric procedures (MAMBAC, Mean Above Minus Below a Cut and MAXEIG, MAXimum EIGenvalue) were performed with indicator sets drawn from self-report measures of FNE and FPE.
Taxometric analyses, as well as comparison analyses utilizing simulated dimensional and taxonic datasets, yielded converging evidence that both FNE and FPE have a dimensional latent structure.
Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia.
Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population-based prospective study (n=4,789). Costs related to health service uptake, patients' out-of-pocket expenses, and costs arising from production losses were calculated for the reference year 2003. The costs for people with social phobia were compared with the costs for people with no mental disorder.
The annual per capita total costs of social phobia were euro 11,952 (95% CI=7,891-16,013) which is significantly higher than the total costs for people with no mental disorder, euro 2957 (95% CI=2690-3224). When adjusting for mental and somatic co-morbidity, the costs decreased to euro 6,100 (95% CI=2681-9519), or 136 million euro per year per 1 million inhabitants, which was still significantly higher than the costs for people with no mental disorder. The costs of subthreshold social phobia were also significantly higher than the costs for people without any mental disorder, at euro 4,687 (95% CI=2557-6816).
The costs presented here are conservative lower estimates because we only included costs related to mental health services.
The economic costs associated with social phobia are substantial, and those of subthreshold social phobia approach those of the full-blown disorder.
Selected sociodemographic and clinical features of social phobia were assessed in four US communities among more than 13,000 adults from the Epidemiologic Catchment Area study. Rates of social phobia were highest among women and persons who were younger (age, 18 to 29 years), less educated, single, and of lower socioeconomic class. Mean age at onset was 15.5 years, and first onsets after the age of 25 years were uncommon. Lifetime major comorbid disorders were present in 69% of subjects with social phobia and usually had onset after social phobia. When compared with persons with no psychiatric disorder, uncomplicated social phobia was associated with increased rates of suicidal ideation, financial dependency, and having sought medical treatment, but was not associated with higher rates of having made a suicide attempt or having sought treatment from a mental health professional. An increase in suicide attempts was found among subjects with social phobia overall, but this increase was mainly attributable to comorbid cases. Social phobia, in the absence of comorbidity, was associated with distress and impairment, yet was rarely treated by mental health professionals. The findings are compared and contrasted with prior reports from clinical samples.
32 generalized social phobic outpatients and 32 matched nonclinical control subjects participated in a dyadic 'getting acquainted' interaction with an experimental assistant who engaged in either positive or negative social behavior. The accuracy of social phobics' and control subjects' perceptions of themselves and their partners were compared in the two conditions. Relative to observers' ratings, the social phobics displayed a negative bias in their appraisals of some, but not all, aspects of their social performance. These results suggested that social phobics may have particular difficulty gauging the nonverbal aspects of their social behavior. The phobics discounted their social competence to the same extent in the positive interaction, where their behavior was more skillful, as in the negative interaction. The social phobics were also less accurate than nonclinical controls in their appraisals of their partners, however, these phobic subjects displayed a positive bias when appraising their partner's performance.
The person's perception of his or her quality of life has been neglected in studies of mental health in general and anxiety disorders in particular. However, the judgement of the impact of a mental disorder based on symptomatic distress while ignoring one's overall quality of life is incomplete. In the present study, we examined social phobic patients' judgments of their satisfaction with various domains of life they deem important using the Quality of Life Inventory (QOLI; Frisch, unpublished). Social phobics judged their overall quality of life lower than Frisch's (unpublished) normative sample. Quality of life was inversely associated with various measures of severity of social phobia (especially social interaction anxiety), functional impairment, and depression. It was not, however, related to performance anxiety or trait anxiety. Quality of life also varied across combinations of subtype of social phobia and the presence/absence of avoidant personality disorder, and as a function of marital status. Patients showed significant improvement in quality of life scores after completion of cognitive-behavioral group therapy for social phobia.
This study describes the natural course of social phobia as recalled by a sample of nonclinical subjects and explores, using qualitative research methods, perceived risk factors and factors that may cause changes in its course. Thirty-nine respondents with a lifetime diagnosis of social phobia were interviewed using a semistructured interview schedule based on DSM-IV criteria. Four main lifetime patterns emerged: a slight worsening of social phobic symptoms over time, no change, slight improvement and complete remission. Thirty-eight percent of the sample was in remission at the time of interview. The mean age of onset was 12.8 +/- 4.1 years. The average duration of illness was 29.0 +/- 12.7 years. Factors perceived by respondents to precipitate social phobia, using contract analysis, were family and school environment, onset of adolescence, low self-esteem, temperament and poverty. Factors perceived to improve symptoms were building self-esteem, exposure, determination, maturity and counseling. Factors perceived to worsen symptoms were avoidance, exposure to negative attention and comorbid disorders.
Clark and Wells' (1995): 'A cognitive model of social phobia'. In Social phobia: Diagnosis, assessment, and treatment (pp. 69-93), R. G. Heimberg, M. R. Liebowitz, D. A. & F. R. Hope (eds.); cognitive model of social phobia proposes that social phobics generate a negative impression of how they appear to others. This impression often occurs in the form of an image from an "observer" perspective in which social phobics can see themselves as if from another person's vantage point. This study investigated the specificity of the observer perspective among patients with social phobia, agoraphobia, and blood/injury phobia. All participants were asked to recall and imagine a recent anxiety-provoking social situation and a non-social/non-anxiety-provoking situation, and rate their perspective for each. Consistent with predictions only patients with social-evaluative concerns (social phobics and agoraphobics) reported observer perspectives for anxiety-provoking social situations. Only social phobics showed a significant shift from an observer to a field perspective across the two conditions. The clinical implications of these findings are briefly discussed.
This study explored the ways in which people interpret visible physical symptoms of anxiety. A group of participants with social phobia (SP) and a nonclinical control (NCC) group completed either the Actor version or the Observer version of the Symptom Interpretation Scale (SIS), designed for the purposes of this study. The SIS asks participants to rate the extent to which each of eight interpretations is a likely explanation for a number of visible symptoms of anxiety. On the Actor version of the SIS, participants are asked to judge how their own anxiety symptoms are interpreted by others. On the Observer version of the SIS, participants are asked how they typically interpret anxiety symptoms that they notice in others. When participants were asked about anxiety symptoms that they themselves exhibit, people with social phobia were more likely than nonclinical controls to think that others interpreted these symptoms as being indicative of intense anxiety or a psychiatric condition and were less likely to think that others interpreted these symptoms as being indicative of a normal physical state. Data also suggested that people with social phobia have a more flexible cognitive style when asked to interpret anxiety symptoms exhibited by others than when asked about how others view their own anxiety symptoms. These findings are discussed in the context of recent psychological models of social anxiety and social phobia.
Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through one's own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients' attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.
Previous research has shown that, unlike non-anxious individuals, people with social phobia fail to generate non-threatening inferences when ambiguous social information is first encountered (i.e. 'on-line'; Hirsch and Mathews Journal of Abnormal Psychology, 109 (2000) 705-712). Patients with social phobia also report negative self-imagery in social situations, while individuals without high social anxiety do not. The negative self-imagery in social phobia may prevent the generation of non-threatening inferences. If so, then training non-anxious individuals to hold in mind a negative self-image should remove the 'on-line' non-threat inferential bias normally evident in this population. In the present study, low anxious volunteers were allocated to negative image training or a control task that did not manipulate self-imagery. Following negative image training, or the control task, volunteers read descriptions of job interviews and at certain points during the text performed lexical decisions. Some decisions were made after ambiguous text that could have been interpreted in both a threatening and a non-threatening manner. In a baseline condition, decisions were made following the text for which there was only one possible inference (either threat or non-threat). The results for the control group replicated earlier findings of a non-threat inferential bias for non-anxious individuals. In contrast, and as predicted, non-anxious volunteers who were trained to hold a negative image in mind lacked any non-threatening inferential bias, and also experienced higher levels of state anxiety.