Article

Social Anxiety and the Quality of Everyday Social Interactions: The Moderating Influence of Alcohol Consumption

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Abstract

Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one's ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.

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... In a survey study, college students high in social anxiety reported more positive drinking consequences in the prior month than those low in social anxiety (Villarosa-Hurlocker et al., 2018). In one of the few ESM studies on social anxiety and alcohol use, Goodman et al. (2018) found that the more socially anxious participants felt during social interactions, the worse they rated the quality of their interaction-but only when sober. When participants consumed alcohol, social anxiety was unrelated to interaction quality, sug-1 In Cooper's (1994) model, affiliation motives are referred to as "social motives." ...
... We measured three social experiences (increased sociability, strengthening and/or forming a relationship, pleasurable sexual experience) typically impaired in social anxiety (Alden & Taylor, 2010;Bodinger et al., 2002;Naragon-Gainey et al., 2009) and common expectations of alcohol use (Fromme et al., 1993). Our study builds off a small number of studies by examining positive social experiences that occur as a result of alcohol use (rather than general social interaction quality; e.g., Goodman et al., 2018), leveraging ESM to assess experiences the morning after they occur (rather than global questionnaires; e.g., Villarosa-Hurlocker et al., 2017, and using a clinical community sample of adults diagnosed with SAD (rather than undiagnosed undergraduates; e.g., Battista et al., 2012). We hypothesized that participants with SAD would more frequently report positive social drinking consequences than controls. ...
... Distress-reduction models suggest that people with anxiety disorders consume alcohol to reduce anxiety, which negatively reinforces alcohol use. However, emerging research suggests that people with SAD may also experience social rewards that positively reinforce alcohol use (Goodman et al., 2018;Villarosa-Hurlocker et al., 2018). We used daily diary methods to examine coping and affiliation motives and rewards from naturally occurring drinking episodes. ...
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People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences—namely positive social experiences—that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.
... The three items are drawn from validated social anxiety scales (e.g., brief fear of negative evaluation scale [BFNE]; Leary, 1983); the items are: "I am worried that I will say or do the wrong things" "I am worried about what other people think of me," and "I am afraid that others do not approve of me." This measure has demonstrated acceptable reliability in prior ESM studies with clinical and nonclinical (Goodman et al., 2018) samples and convergent validity via positive associations with trait social anxiety and discriminant validity via associations with experiential avoidance Kashdan & Steger, 2006). Items were rated from 1 = not at all to 7 = very much and averaged together. ...
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Judgments about the self compared to internalized standards are central to theoretical frameworks of social anxiety. Yet, empirical research on social comparisons-how people view themselves relative to others-and social anxiety is sparse. This research program examines the nature of everyday social comparisons in the context of social anxiety across 2 experience-sampling studies containing 8,396 unique entries from 273 adults. Hypotheses and analyses were preregistered with the Open Science Foundation (OSF) prior to data analysis. Study 1 was a 3-week daily diary study with undergraduates, and Study 2 was a 2-week ecological momentary assessment (EMA) study with a clinical sample of adults diagnosed with social anxiety disorder (SAD) and a psychologically healthy comparison group. In both studies, social anxiety was associated with less favorable, more unstable social comparisons. In both studies, favorable social comparisons were associated with higher positive affect and lower negative affect and social anxiety. In both studies, social comparisons and momentary affect/social anxiety were more strongly linked in people with elevated trait social anxiety/SAD compared to less socially anxious participants. Participants in Study 2-even those with SAD-made more favorable social comparisons when they were with other people than when alone. Taken together, results suggest that social anxiety is associated with unfavorable, unstable self-views that are linked to compromised well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... To minimize opportunities for scrutiny, people with SAD avoid social interactions or tolerate them with considerable distress (Moscovitch et al., 2013). Evidence suggests that socially anxious adults experience lower positive affect (PA) and higher negative affect (NA) during social interactions compared to less anxious people (Goodman, Stiksma, & Kashdan, 2018;Vittengl & Holt, 1998). However, this research has relied on between-person comparisons, where someone high in social anxiety (or with SAD) is compared to someone low in social anxiety (or absent of mental illness). ...
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Quality contact with other people serves as a reliable mood enhancement strategy. We wondered if the emotional benefits of socializing are present even for those with a psychological disorder defined by social distress and avoidance: social anxiety disorder (SAD). We conducted two ecological momentary assessment (EMA) studies and analyzed 7,243 total surveys. In both studies, community adults diagnosed with SAD and healthy controls received five surveys each day for two weeks. Consistent with research on positivity deficits in SAD, between-person analyses in both studies suggest that, on average, participants with SAD reported lower positive and higher negative affect in social and non-social situations than healthy controls. Within-person analyses, however, revealed that in both studies participants with SAD and healthy controls reported higher positive affect when with others than when alone; no differences were found for negative affect. The difference in positive affect between social and nonsocial situations was smaller for participants with SAD in Study 1, suggesting that people with SAD may experience diminished reward responding when socializing. Our results suggest that even those with a mental illness defined by interpersonal distress can and do derive positive emotions from social interactions.
... EtOH is an anxiolytic molecule at lower concentrations. In humans, for example, alcohol may be consumed to counteract acute social anxiety, and this reinforcing effect can even increase future use with EtOH acting as a "social reward" (Goodman et al. 2018). The mechanisms underlying the biphasic effects of alcohol in anxiety-related behaviors include the antagonism of glutamatergic receptors and the increase in dopamine and serotonin (5-HT) levels (Alasmari et al. 2018;Deehan et al. 2016). ...
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Taurine (TAU) is a β-amino sulfonic acid with pleiotropic roles in the brain, including the neuromodulatory activity via GABAergic and glycinergic agonism. This molecule is found at high concentrations in energy drinks and is often mixed with alcohol in beverages. Although TAU has a neuroprotective role in the brain, the putative risks of mixing TAU and EtOH are not fully understood. Here, we investigated whether TAU modulates locomotor and anxiety-like behavior in adult zebrafish by using the novel tank and light-dark tests following acute EtOH exposure at anxiogenic and anxiolytic concentrations. Zebrafish were individually exposed to water (control), TAU (42, 150, and 400 mg/L), and EtOH (0.25% (v/v) and 1% (v/v)) both independently and cotreated for 1 h. EtOH 0.25% and TAU produced U-shape anxiolytic-like behavior in the light-dark test, TAU 42 and 400 positively modulated EtOH effects, and TAU 150 exerted a protective effect. All TAU concentrations counteracted EtOH 1%-induced locomotion impairment, as well as the anxiogenic-like behavior. Finally, all TAU concentrations when given independently or cotreated with EtOH 0.25% and 1% decreased the risk assessment of the lit compartment. Principal component analyses revealed that exploration and anxiety-like responses were the main behaviors that contribute to the effects of TAU and EtOH. Overall, we demonstrate that TAU differently modulates EtOH-induced anxiolytic- and anxiogenic-like behaviors depending on the concentration, suggesting a complex mechanism underlying TAU and EtOH interactions.
... Ethanol-the psychoactive component of alcoholic beverages-can induce acute effects on individuals' cognition and behaviour (Rose and Duka 2007), commonly exhibited through disinhibited social behaviour (Freeman et al. 2010). The notion that alcohol serves as a social lubricant is pervasive (Fairbairn and Sayette 2014;Goodman et al. 2018); this attitude can be found crossculturally (MacAndrew and Edgerton 1969) and is widely reported by the general public, clinicians and researchers alike (Sayette 1993). Typically, individuals report positive alcohol expectancies (i.e. ...
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Background Motivations for alcohol consumption often focus on ethanol’s purported prosocial effects: social enhancement and reduction of socially focused anxiety. Despite substantial research supporting prosocial effects, contrary research exists demonstrating alcohol-elicited antisocial and asocial behaviours. Additionally, evidence typically fails to delineate whether alcohol-induced prosocial effects are due to alcohol expectancies or pharmacological actions of ethanol. Studies exploring ethanol’s pharmacological effects on social behaviour and factors that modulate apparent contradictory prosocial versus asocial effects are lacking. Objectives This study investigated whether factors of age, ethanol dose and social fear modulate ethanol-induced pharmacological effects on sociability and social anxiety–like avoidance. Methods Experiments examined the acute effects of ethanol doses (0, 0.25, 0.8, 1.6 g/kg; i.p.) in adult (10-week-old) and adolescent (PND 31–33) C57BL/6J male mice on social interaction using a social fear conditioning paradigm. Control experiments assessed whether ethanol-induced effects were social-specific. Results In adult mice, no specific effects of ethanol on social avoidance were observed at any dose. However, high-dose ethanol (1.6 g/kg) suppressed social approach in all adult mice. In contrast, low-dose ethanol (0.25 g/kg) alleviated social avoidance in adolescent mice and no social suppression was observed at higher ethanol doses. Thus, higher doses of ethanol impair social behaviour in adult mice, whereas lower doses specifically alleviate social anxiety–like avoidance in adolescent mice. Conclusions Age, dose and social fear are critical modulators of acute ethanol-induced pharmacological effects on social behaviour. Inconsistencies in ethanol-induced social consequences appear at least partly mediated by pharmacological interactions—not solely alcohol expectancies.
... For example, in an experience-sampling study of alcohol use among college students, momentary social anxiety was associated with worse quality social interactions when people were sober. However, when participants consumed alcohol, social anxiety was unrelated to interaction quality, suggesting that alcohol use was effective for the relief of social anxiety and obtaining social rewards that social anxiety otherwise thwarts (Goodman, Stiksma, & Kashdan, 2018). Although negative reinforcement is not itself problematic or indicative of a substance use disorder, the use of substances to relieve negative emotions is associated with incident risk of substance use disorders. ...
... If this reluctance is due to previous substance use that itself leads to subsequent depressive symptoms (33,34), then the observed association may be confounded. However, if a decision not to drink itself limits social opportunities, potentially by enhancing the aversive effect of social anxiety (35), then alcohol would reasonably be considered causal in this association. In both cases, fewer social interactions may worsen depressive symptoms and can independently lead to subsequent depression, which probably cannot fully be captured by the social support questionnaire (36). ...
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Individuals with social phobia are at an increased risk for alcohol problems. Individuals with social phobia could increase their risk for pathological alcohol use if they drink as a means of coping with anxiety-provoking social situations. Providing a circumscribed test of this view, we evaluate the effect of alcohol on the intensity of social phobia anxiety responses. Sixty-one individuals with social phobia gave two speech challenges in front of a group (‘social anxiety challenge’), one occurring before and one after they consumed either: (a) an alcoholic drink they were told contained alcohol (‘alcohol group’), (b) a non-alcoholic drink they were told contained alcohol (‘placebo group’), or, (c) a non-alcoholic drink they were told contained no alcohol (‘control group’). Both the alcohol group and the placebo group showed greater reduction in performance anxiety from the first to the second speech challenge than did the control group. Further, there was a strong trend in the data for the alcohol group to show greater reduction in performance anxiety from the first to the second speech challenge than did the placebo group. We concluded from these findings that the pharmacologic effects of alcohol and the belief that one consumed alcohol decrease social performance anxiety in an additive fashion. These results provide direct support for the negatively reinforcing properties of alcohol and are consistent with the view that symptom reduction may motivate alcohol use among socially phobic individuals.
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To minimize the possibility of scrutiny, people with social anxiety difficulties exert great effort to manage their emotions, particularly during social interactions. We examined how the use of two emotion regulation strategies, emotion suppression and cognitive reappraisal, predict the generation of emotions and social events in daily life. Over 14 consecutive days, 89 participants completed daily diary entries on emotions, positive and negative social events, and their regulation of emotions. Using multilevel modeling, we found that when people high in social anxiety relied more on positive emotion suppression, they reported fewer positive social events and less positive emotion on the subsequent day. In contrast, people low in social anxiety reported fewer negative social events on days subsequent to using cognitive reappraisal to reduce distress; the use of cognitive reappraisal did not influence the daily lives of people high in social anxiety. Our findings support theories of emotion regulation difficulties associated with social anxiety. In particular, for people high in social anxiety, maladaptive strategy use contributed to diminished reward responsiveness.
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Background: People commonly use psychoactive substances to increase physical and psychological pleasure. Neuroadaptations in the brain's reward system coupled with changes in social functioning and networking resulting from chronic substance use impede the ability to derive pleasure from non-substance related activities. Objective: We elucidate and validate the hypothesis that treatments for substance use disorders would potentially have a stronger and broader impact by helping recipients to experience pleasure as part of an expansive focus of increasing adaptive functioning, well-being, and personal fulfillment and actualization. Method: We have organized and integrated the relatively sparse and disparate theory and research to describe a multi-stage model linking pleasure and substance use. We review research on pleasure in the context of treatment for substance use, and describe future research directions. Results: Our model integrates several independent research programs with prominent theories and models of substance dependence that together provide evidence that pleasure, or lack thereof, is a risk or protective factor for initiating, escalating and maintaining substance use and substance use disorders. Pleasure is an overlooked but potentially high-yield target of existing evidence-based treatments. Conclusion: Research is needed to investigate the relation between pleasure and substance use, and existing and newly developed treatments that have the potential to increase the pleasure. By increasing pleasure such treatments have the potential to help recipients to live fuller and richer lives. Integration of pleasure into existing treatments has compelling transdiagnostic implications for individuals at any point along a substance use severity continuum.
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Objective: This study examined the impact of coping motives for cannabis and alcohol use on the relation between social anxiety/depressive symptoms and severity of substance use for alcohol, tobacco, and cannabis among treatment-seeking smokers who also use cannabis and alcohol. Methods: The sample included 197 daily cigarette smokers (MAge 34.81 years, SD = 13.43) who reported using cannabis and alcohol. Results: Hierarchical multiple regression analyses were conducted wherein separate models were constructed for each dependent variable. Among individuals with higher social anxiety, alcohol coping motives were associated with heavier drinking, and this was more pronounced among those low in depressive symptoms. Similarly, those at greater risk for nicotine dependence were anxious individuals with lower depressive symptoms who endorse coping-oriented motives for using cannabis. Further, among those with higher social anxiety, cannabis coping motives were associated with marginally greater drinking, particularly for those high in depressive symptoms. Conclusions: The present findings support the perspective that among multisubstance users, the interplay between social anxiety, depressive symptoms, and coping-oriented motives for using one substance (e.g., cannabis or alcohol) may pose difficulties in refraining from other substances (e.g., tobacco). This observation highlights the importance of tailoring multisubstance treatments to specific needs of multiusers for whom single-substance interventions may be less effective. Findings also support previous work exploring the benefits of concurrently treating co-occurring substance use and lend credence to the perspective that motivation to use substances for coping reasons is of central theoretical and clinical relevance.
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This article presents the psychometric properties of a new measure of social anxiety, the Social Anxiety Questionnaire for adults (SAQ), composed of 30 items that were developed based on participants from 16 Latin American countries, Spain, and Portugal. Two groups of participants were included in the study: a nonclinical group involving 18,133 persons and a clinical group comprising 334 patients with a diagnosis of social anxiety disorder (social phobia). Exploratory and confirmatory factor analyses supported a 5-factor structure of the questionnaire. The factors were labeled as follows: (1) Interactions with strangers, (2) Speaking in public/talking with people in authority, (3) Interactions with the opposite sex, (4) Criticism and embarrassment, and (5) Assertive expression of annoyance, disgust, or displeasure. Psychometric evidence supported the internal consistency, convergent validity, and measurement invariance of the SAQ. To facilitate clinical applications, a receiver operating characteristics (ROC) analysis identified cut scores for men and women for each factor and for the global score.
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Though social anxiety disorder and alcohol use disorders commonly co-occur, the mechanisms involved in social anxiety and hazardous drinking among college students are not well understood. The current study contributes to the emerging literature on social anxiety and college drinking as the first known study to test how positive (e.g. “I would feel at ease in social situations”) and negative (e.g. “I would make a fool out of myself”) alcohol outcome expectancies (AOE) specific to social situations (social AOE) impact the association between social anxiety and hazardous alcohol use among 718 undergraduates (61% women; Mage = 19.50, SD = 1.45; 85% White). Results supported the mediation, but not the moderation models. There were positive indirect effects of social anxiety through positive social AOE and negative indirect effects of social anxiety through negative social AOE on both hazardous drinking outcomes (i.e. alcohol consumption and alcohol problems). Findings suggest that there could be competing pathways for increasing (positive social AOE) and decreasing (negative AOE) risk for hazardous alcohol use in socially anxious college students.
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Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.
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Introduction: Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. Method: The current cross-sectional study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations among undergraduates (N=232). Results: Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. Conclusions: Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that heavy situational drinking among undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny.
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Objective: This study examined whether global drinking-to-cope (DTC) motivation moderates negative mood-drinking contingencies and negative mood-motivation contingencies at the daily level of analysis. Method: Data came from a daily diary study of college student drinking (N = 1,636; 53% female; Mage = 19.2 years). Fixed-interval models tested whether global DTC motivation moderated relations between daily negative mood and that evening's drinking and episodic DTC. Time-to-drink models examined whether global DTC motivation moderated the effects of weekly negative mood on the immediacy of drinking and DTC in the weekly cycle. Results: More evening drinking occurred on days characterized by relatively higher anxiety or anger, and students were more likely to report DTC on days when they experienced greater sadness. However, only the daily Anxiety × Global DTC Motivation interaction for number of drinks consumed was consistent with hypotheses. Moreover, students reported drinking, heavy drinking, and DTC earlier in weeks characterized by relatively higher anxiety or anger, but no hypothesized interactions with global DTC motivation were found. Conclusions: RESULTS indicate that negative mood is associated with increased levels of drinking and drinking for coping reasons among college students but that the strength of these relations does not differ by global levels of DTC motivation. These findings raise the possibility that global DTC measures are insufficient for examining within-person DTC processes. Further implications of these results are discussed, including future directions that may determine the circumstances under which, and for whom, DTC occurs.
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The balanced placebo design (BPD) has been used to understand the etiology and maintenance of alcohol consumption. The utility of this design lies in its ability to examine both actual alcohol consumption and the expectation of alcohol consumption. A meta-analysis of the BPD literature was conducted in the context of cue-reactivity, which may be characterized as an experimental phenomenon observed in studies utilizing alcohol. Sixty-four studies were obtained in literature searches and coded for type of experimental setting and cues present during the actual beverage consumption. Lab setting was a moderator for both pharmacological (alcohol) and expectancy effects with the largest effects (in the same direction) noted in natural environment labs (i.e., an easy chair and casual environment). Contrary to predictions, the bar lab produced the smallest effects. Cues present during alcohol consumption served as a moderator of pharmacological effect, with the largest effect observed when alcohol was placed on the rim of the glass. Implications of these findings for cue-reactivity studies and the treatment of alcohol abuse are discussed.
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Research shows that multiple factors influence college drinking, from an individual's genetic susceptibility to the positive and negative effects of alcohol, alcohol use during high school, campus norms related to drinking, expectations regarding the benefits and detrimental effects of drinking, penalties for underage drinking, parental attitudes about drinking while at college, whether one is member of a Greek organization or involved in athletics, and conditions within the larger community that determine how accessible and affordable alcohol is. Consequences of college drinking include missed classes and lower grades, injuries, sexual assaults, overdoses, memory blackouts, changes in brain function, lingering cognitive deficits, and death. This article examines recent findings about the causes and consequences of excessive drinking among college students relative to their non-college peers and many of the strategies used to collect and analyze relevant data, as well as the inherent hurdles and limitations of such strategies.
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Experiential avoidance (EA), the tendency to avoid internal, unwanted thoughts and feelings, is hypothesized to be a risk factor for social anxiety. Existing studies of experiential avoidance rely on trait measures with minimal contextual consideration. In two studies, we examined the association between experiential avoidance and anxiety within real-world social interactions. In the first study, we examined the effect of experiential avoidance on social anxiety in everyday life. For 2 weeks, 37 participants with Social Anxiety Disorder (SAD) and 38 healthy controls provided reports of experiential avoidance and social anxiety symptoms during face-to-face social interactions. Results showed that momentary experiential avoidance was positively related to anxiety symptoms during social interactions and this effect was stronger among people with SAD. People low in EA showed greater sensitivity to the level of situational threat than high EA people. In the second study, we facilitated an initial encounter between strangers. Unlike Study 1, we experimentally created a social situation where there was either an opportunity for intimacy (self-disclosure conversation) or no such opportunity (small-talk conversation). Results showed that greater experiential avoidance during the self-disclosure conversation temporally preceded increases in social anxiety for the remainder of the interaction; no such effect was found in the small-talk conversation. Our findings provide insight into the association between experiential avoidance on social anxiety in laboratory and naturalistic settings, and demonstrate that the effect of EA depends upon level of social threat and opportunity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Article
In this theoretical paper, it is argued that social anxiety arises from the activation of an evolved mechanism for dealing with intra-species (conspecific) threat, a mechanism which has played a vital role in the evolution of social groups. A model is developed showing how this “agonic” mode of defense, working through the psychological systems of appraisal and coping, leads the socially anxious to perceive others as hostile dominants, to fear negative evaluation from them and to respond, at one level of the disorder, by appeasement and submissive behavior, and at a more severe level of the disorder, by more primitive actions such as escape or avoidance. A further theme put forward is that the socially anxious person appears unable to recruit another evolved mechanism for social relating called the “hedonic” mode, in which social groups are structured in terms of cooperation, equality, and mutual support. Some therapeutic implications of these concepts are explored.
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Abstract The high comorbidity of alcohol use disorders (AUD) and social anxiety disorder (SAD) is often explained by excessive drinking in social situations to self-medicate social anxiety. Indeed, the motive to drink alcohol to lower social fears was found to be elevated in socially anxious persons. However, this social anxiety specific motive has not been directly investigated in primarily alcohol dependent individuals. We explored social anxiety, the motivation to drink alcohol in order to cope with social fears, and social anxiety as a consequence of drinking in AUD with and without comorbid SAD. Male AUD inpatients with (AUD+SAD group, N=23) and without comorbid SAD (N=37) completed a clinical interview and a questionnaire assessment. AUD+SAD patients reported higher levels of depression and an elevated motive to drink due to social anxiety but did not experience more social fears as a consequence of drinking. Previous results concerning alcohol drinking motives in order to relieve social fears could be replicated in a clinical AUD sample. Additionally, our findings suggest comorbid AUD+SAD patients to be more burdened regarding broader psychopathological symptoms. Thus, accessibility to SAD-specific screening and treatment procedures may be beneficial for primary AUD patients.
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Many college students use alcohol, and most of these students experience problems related to their use. Emerging research indicates that socially anxious students face heightened risk of experiencing alcohol-related problems, although the extant research on alcohol use and social anxiety in this population has yielded inconsistent findings. This meta-analysis was conducted to examine the relationship between social anxiety and alcohol variables in college students. A literature search was used to identify studies on college students that included measures of social anxiety and at least one of the alcohol variables of interest. All analyses were conducted using random effects models. We found that social anxiety was negatively correlated with alcohol use variables (e.g., typical quantity and typical frequency), but significantly positively correlated with alcohol-related problems, coping, conformity, and social motives for alcohol use, and positive and negative alcohol outcome expectancies. Several moderators of effect sizes were found to be significant, including methodological factors such as sample ascertainment approach. Given that social anxiety was negatively related to alcohol use but positively related to alcohol-related problems, research is needed to address why individuals high in social anxiety experience more problems as a result of their alcohol use. Avoidance of social situations among socially anxious students should also be taken into account when measuring alcohol use. The primary limitation of this study is the small number of studies available for inclusion in some of the analyses.
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This paper discusses factors that might affect vulnerability to social anxiety and clinically significant social phobia. The paper begins by describing the "cognitive signature" of socially anxious individuals as illustrated by studies on attentional, memory, and interpretation/judgement biases. These studies collectively suggest that socially anxious individuals and those with social phobia tend to interpret so- cial information in negative ways, likely contributing to the maintenance of social anxiety over time. The paper then reviews factors that might influence the develop- ment of this cognitive style, including temperament, early attachment, and factors related to family, peers, and other life events. Implications for prevention and treatment of social anxiety and social phobia are also discussed.
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The majority of definitions, research studies, and treatment programs that focus on social anxiety characterize the prototypical person with the disorder as shy, submissive, inhibited, and risk averse. This stereotype, however, has been challenged recently. Specifically, a subset of people with social anxiety who are aggressive, impulsive novelty seekers deviate from that prototype. People with this atypical profile show greater functional impairment and are less likely to complete or fare well in treatment compared with inhibited socially anxious people. The difference between these two groups of people with social anxiety cannot be explained by the severity, type, or number of social fears, nor by co-occurring anxiety and mood disorders. Conclusions about the nature, course, and treatment of social anxiety may be compromised by not attending to diverse behaviors and self-regulatory styles. These concerns may be compounded in neurobiological and clinical studies of people with social anxiety problems that rely on smaller samples to make claims about brain patterns and the efficacy of particular treatments.
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It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH). Support for one aspect of the SMH was found; individuals with social phobia use alcohol to reduce anxiety. Support for the second premise, that alcohol actually reduces social anxiety, was less conclusive.
Article
We frequently try to appear less emotional than we really are, such as when we are angry with our spouse at a dinner party, disgusted by a boss’s sexist comments during a meeting, or amused by a friend’s embarrassing faux pas in public. Attempts at emotion suppression doubtless have social benefits. However, suppression may do more than change how we look: It also may change how we think. Two studies tested the hypothesis that emotion suppression has cognitive consequences. Study 1 showed that suppression impaired incidental memory for information presented during the suppression period. Study 2 replicated this finding and further showed that suppression increased cardiovascular activation. Mediational analyses indicated that physiological and cognitive effects were independent. Overall, findings suggest that emotion suppression is a cognitively demanding form of self-regulation.
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Social phobia has become a focus of increased research since its inclusion in DSM-III. However, assessment of social phobia has remained an underdeveloped area, especially self-report assessment. Clinical researchers have relied on measures that were developed on college populations, and these measures may not provide sufficient coverage of the range of situations feared by social phobic individuals. There is a need for additional instruments that consider differences in the types of situations (social interaction vs. situations involving observation by others) that may be feared by social phobics and between subgroups of social phobic patients. This study provides validational data on two instruments developed by Mattick and Clarke (1989): the Social Interaction Anxiety Scale (SIAS), a measure of anxiety in social interactional situations, and the Social Phobia Scale (SPS), a measure of anxiety in situations involving observation by others. These data support the use of the SIAS and SPS in the assessment of individuals with social phobia.
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The development and validation of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) two companion measures for assessing social phobia fears is described. The SPS assesses fears of being scrutinised during routine activities (eating, drinking, writing, etc.), while the SIAS assesses fears of more general social interaction, the scales corresponding to the DSM-III-R descriptions of Social Phobia—Circumscribed and Generalised types, respectively. Both scales were shown to possess high levels of internal consistency and test–retest reliability. They discriminated between social phobia, agoraphobia and simple phobia samples, and between social phobia and normal samples. The scales correlated well with established measures of social anxiety, but were found to have low or non-significant (partial) correlations with established measures of depression, state and trait anxiety, locus of control, and social desirability. The scales were found to change with treatment and to remain stable in the face of no-treatment. It appears that these scales are valid, useful, and easily scored measures for clinical and research applications, and that they represent an improvement over existing measures of social phobia.
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The person-situation debate is coming to an end because both sides of the debate have turned out to be right. With respect to momentary behaviors, the situation side is right: Traits do not predict, describe, or influence behavior very strongly; the typical individual's behavior is highly variable; and a process approach is needed to explain that variability. With respect to trends (e.g., a person's typical way of acting), however, the person side of the debate is right: Traits predict and describe behavior very well over long stretches of time, behavior is highly stable, and a trait approach is needed to explain differences between people. Thus, proponents of both sides are right and should continue to conduct fruitful research, and both viewpoints are necessary for a full understanding of personality. The next exciting steps in personality psychology will include integrating these two approaches in the same research paradigm.
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Simple slopes, regions of significance, and confidence bands are commonly used to evaluate interactions in multiple linear regression (MLR) models, and the use of these techniques has recently been extended to multilevel or hierarchical linear modeling (HLM) and latent curve analysis (LCA). However, conducting these tests and plotting the conditional relations is often a tedious and error-prone task. This article provides an overview of methods used to probe interaction effects and describes a unified collection of freely available online resources that researchers can use to obtain significance tests for simple slopes, compute regions of significance, and obtain confidence bands for simple slopes across the range of the moderator in the MLR, HLM, and LCA contexts. Plotting capabilities are also provided.
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In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) issued a report entitled A Call to Action: Changing the Culture of Drinking at U.S. Colleges. Data on the magnitude of college drinking problems in 1998 to 1999 were reported. From 1999 to 2005, the proportion of college students aged 18-24 who drank five or more drinks on a single occasion in the past month increased from 41.7 percent to 45.2 percent. The proportion who drove under the influence of alcohol increased from 26.1 percent to 29.2 percent. Higher percentages of 21- to 24-year-olds engaged in those behaviors than 18- to 20-year-olds, and between 1999 and 2005 the percentage increased among 21- to 24-year-olds but not among those aged 18-20. From 1998 to 2005, unintentional alcohol-related injury deaths increased 3 percent (from 1,442 to 1,825) per 100,000 college students aged 18-24. Alcohol misuse by college students often harms other people through traffic crashes and sexual/other assaults. Research regarding ways to reduce college drinking problems has shown that individual-oriented interventions, particularly screening and brief motivational counseling interventions, social norms interventions, environmental policy changes such as the minimum legal drinking age of 21 and drinking-and-driving laws, and comprehensive college-community programs, can reduce college drinking and related morbidity and mortality. There is a growing need for colleges and surrounding communities to implement interventions shown through research to reduce alcohol misuse among college-aged people.
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Objective: To present nationally representative data on 12-month and lifetime prevalence, correlates and comorbidity of social anxiety disorder (SAD) among adults in the United States as determined by the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Design: Face-to-face survey. Setting: The United States. Participants: Adults (aged 18 and over) residing in households and group quarters (N = 43,093). Main outcome measures: Prevalence and associations of SAD with sociodemographic and psychiatric correlates and Axis I and II disorders. Results: The prevalence of 12-month and lifetime DSM-IV SAD was 2.8% (95% CI = 2.5 to 3.1) and 5.0% (95% CI = 4.6 to 5.4), respectively. Being Native American, being young, or having low income increased risk, while being male, being of Asian, Hispanic, or black race/ethnicity, or living in urban or more populated regions reduced risk. Mean age at onset of SAD was 15.1 years, with a mean duration of 16.3 years. Over 80% of individuals with SAD received no treatment, and the mean age at first treatment was 27.2 years. Current and lifetime SAD were significantly related to other specific psychiatric disorders, most notably generalized anxiety, bipolar I, and avoidant and dependent personality disorders. The mean number of feared social situations among individuals with SAD was 7.0, with the majority reporting anxiety in performance situations. Conclusions: Social anxiety disorder was associated with substantial unremitting course and extremely early age at onset. Social anxiety disorder often goes untreated, underscoring the need for health care initiatives geared toward increasing recognition and treatment. Comprehensive evaluation of patients with SAD should include a systematic assessment of comorbid disorders, and novel approaches to the treatment of comorbid SAD are needed.
Article
The utility of trait social anxiety and alcohol expectancies in predicting increased alcohol consumption under socially stressful conditions was investigated. Forty-two male and 42 female undergraduates participated in a 2-day study, serving as their own controls. In each session, participants consumed their preferred alcoholic beverage during a 30-min drinking period. The lst session established baseline consumption under nonstressful conditions, while in the 2nd session, participants drank while anticipating the required delivery of a speech. Measures of social anxiety and alcohol expectancies were completed. Participants consumed more absolute alcohol during the stressful session, but those with high trait social anxiety and men expecting alcohol to increase assertiveness were most likely to show this effect. These findings suggest specificity in the connection between individual characteristics and stress-induced drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study investigated self-reported state (anxiety, physical symptoms, cognitions, internally focused attention, safety behaviors, social performance) and trait (social anxiety, depressive symptoms, dysfunctional self-consciousness) predictors of post-event processing (PEP) subsequent to two social situations (interaction, speech) in participants with a primary diagnosis of social anxiety disorder (SAD) and healthy controls (HC). The speech triggered significantly more intense PEP, especially in SAD. Regardless of the type of social situation, PEP was best predicted by situational anxiety and dysfunctional cognitions among the state variables. If only trait variables were considered, PEP following both situations was accounted for by trait social anxiety. In addition, dysfunctional self-consciousness contributed to PEP-speech. If state and trait variables were jointly considered, for both situations, situational anxiety and dysfunctional cognitions were confirmed as the most powerful PEP predictors above and beyond trait social anxiety (interaction) and dysfunctional self-consciousness (speech). Hence, PEP as assessed on the day after a social situation seems to be mainly determined by state variables. Trait social anxiety and dysfunctional self-consciousness also significantly contribute to PEP depending on the type of social situation. The present findings support dysfunctional cognitions as a core cognitive mechanism for the maintenance of SAD. Implications for treatment are discussed.
Book
While most books on missing data focus on applying sophisticated statistical techniques to deal with the problem after it has occurred, this volume provides a methodology for the control and prevention of missing data. In clear, nontechnical language, the authors help the reader understand the different types of missing data and their implications for the reliability, validity, and generalizability of a study’s conclusions. They provide practical recommendations for designing studies that decrease the likelihood of missing data, and for addressing this important issue when reporting study results. When statistical remedies are needed--such as deletion procedures, augmentation methods, and single imputation and multiple imputation procedures--the book also explains how to make sound decisions about their use. Patrick E. McKnight's website offers a periodically updated annotated bibliography on missing data and links to other Web resources that address missing data.
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We examined the association between social anxiety and interpersonal functioning. Unlike prior research, we focused specifically on close relationships, given the growing evidence of dysfunction in these relationships among people with psychopathology. We proposed that social anxiety would be associated with specific interpersonal styles. One hundred sixty-eight young adults with a range of social anxiety symptoms were interviewed regarding symptom severity, interpersonal styles, and chronic interpersonal stress. Results indicated that higher levels of social anxiety were associated with interpersonal styles reflecting less assertion, more conflict avoidance, more avoidance of expressing emotion, and greater interpersonal dependency. Moreover, lack of assertion and overreliance on others mediated the association between social anxiety and interpersonal stress. Associations held controlling for depressive symptoms. Implications of these findings for interpersonally oriented conceptualizations of social anxiety disorder are discussed.
Article
This review critically discusses the empirical evidence for information-processing biases in social phobia. Distortions in attention, interpretation, and memory processes are analyzed as they apply to individuals with social phobia. The literature provides evidence for a specific attentional bias towards socially threatening stimuli and a specific interpretational/judgment bias towards self-relevant social information. However, there is little evidence to suggest that social phobia is associated with a memory bias for socially threatening stimuli. Furthermore, the relationship between the empirical evidence from information processing studies and the cognitive model of social phobia by Clark and Wells (1995) will be discussed.
Article
The current study examined aspects of communication and intimacy between people with social phobia and their romantic partners. Forty-eight individuals with social phobia and 58 community controls completed a series of questionnaires to measure self-disclosure, emotional expression and levels of intimacy within their romantic relationships. Participants with social phobia reported less emotional expression, self-disclosure and intimacy than controls, even after controlling for a diagnosis of mood disorder. The group differences did not differ significantly by gender. A continuous measure of social anxiety also correlated significantly with the three relationship measures and these associations held for emotional expression and self-disclosure after controlling for levels of dysphoria. People with social phobia report reduced quality within their romantic relationships, which may have implications for impairment, social support and ultimately maintenance of the disorder.
Article
Individuals with elevated social anxiety appear particularly vulnerable to experiencing alcohol-related problems; yet we know little about factors that may account for this relationship. One possibility is that socially anxious individuals hold beliefs about the impressions they make on others while drinking and these beliefs play an important role in their drinking behaviors. The present study used exploratory factor analysis among participants with clinically elevated social anxiety (n=166) to develop a measure, the Social Impressions while Drinking Scale (SIDS), to assess beliefs regarding others' impressions of drinking behaviors that may be particularly relevant to socially anxious individuals. A valuations scale was also developed to assess the importance of each belief. Empirically-derived subscales were identified with adequate reliability. Among socially anxious participants, the Gregarious and Sexual Facilitation subscales were uniquely related to drinking problems and frequency respectively. Individuals with clinically meaningful social anxiety achieved higher scores on all SIDS subscales compared to those with lower social anxiety (n=166). Several SIDS scales mediated the relations between social anxiety group status and drinking problems (Interaction Fears, Observation Fears, Aggression, Gregariousness). Results highlight the importance of examining beliefs specific to high-risk populations in assessing their alcohol-related behaviors.
Article
This study examined gender differences among persons with lifetime social anxiety disorder (SAD). Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093), a survey of a representative community sample of the United States adult population. Diagnoses of psychiatric disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The lifetime prevalence of SAD was 4.20% for men and 5.67% for women. Among respondents with lifetime SAD, women reported more lifetime social fears and internalizing disorders and were more likely to have received pharmacological treatment for SAD, whereas men were more likely to fear dating, have externalizing disorders, and use alcohol and illicit drugs to relieve symptoms of SAD. Recognizing these differences in clinical symptoms and treatment-seeking of men and women with SAD may be important for optimizing screening strategies and enhancing treatment efficacy for SAD.