Article

High Risk, High Reward: Daily Perceptions of Social Challenge and Performance in Social Anxiety Disorder

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Abstract

Individuals with Social Anxiety Disorder (SAD) have difficulty engaging in social situations because their actions are predicated on minimizing the subjectively biased high potential for rejection. That is, individuals with SAD frequently perceive social situations as challenging, and their performance as subpar. Yet when individuals perceive themselves as succeeding in challenging situations, they typically report these situations as enjoyable and rewarding. This subjective experience of succeeding in a challenging situation has been studied as flow (Csikszentmihalyi, 1975; 2000). Thirty-three adults with SAD and 34 matched healthy controls completed a baseline assessment, along with daily and experience sampling entries for 14 days. Results were analyzed using three-level generalized linear mixed effects models, with observations nested within days, nested within participants. Although individuals with and without SAD experienced the same frequency of flow in daily life, social situations led to proportionally more flow in participants with SAD than healthy controls. Both results were unexpected, and reasons for them are explored at length. Several experiential variables (positive emotions during and importance ascribed to the event) predicted the probability of flow during each situation. These results offer intervention-relevant suggestions for how individuals may benefit from seeking out challenging situations that offer maximal rewards.

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... Although behaviors such as polite smiles, directing gaze downward, restricting speech in conversation, and speaking softly may serve to reduce anxiety in the moment, they have been associated with negative perceptions from observers and decreased willingness among peers to re-engage the individual in conversation in a lab setting, particularly in ambiguous social tasks (130)(131)(132). Perhaps the most extreme behavior in the repertoire of individuals with SAD to down-regulate anxiety is to avoid social situations altogether (133), resulting in fewer opportunities to build relationships with others and inadvertently confirming perceptions of one's lack of social value. Thus, these interpersonal deficits may both impair the development of new relationships and interfere with the development of greater intimacy and safety in existing relationships, thus perpetuating perceptions of social threat due to lack of a close and connected relationships. ...
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Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.
... "flow" states) may be likely to facilitate enjoyment and positive emotion (Csikszentmihalyi & LeFevre, 1989). Although individuals with high trait SA perceive social situations as inherently challenging, they are less likely to feel competent and successful at them, which may preclude them from experiencing positive emotions during social interactions (Blalock, Kashdan, & McKnight, 2018). Moreover, attending to potential social rewards may be particularly challenging in the aftermath of social rejection for high SA individuals, who tend to cope with challenging situations by avoiding or suppressing their emotions (Kashdan, 2007;Panayiotou, Karekla, & Panayiotou, 2014;Spokas, Luterek, & Heimberg, 2009). ...
Article
Background and objectives Prior studies have shown that people display signs of increased social approach motivation and affiliative behaviour in response to social exclusion. This response is considered an adaptive strategy that serves to repair damage to social networks and increase access to mood-enhancing social rewards. However, heightened trait social anxiety (SA) has been linked to decreased approach motivation and responsiveness to social rewards. In the current preliminary experimental study, we tested whether trait SA inhibits the expected increase in social approach following the pain of exclusion. We then tested whether diminished social approach is associated with reduced positive affect. Methods Participants played a game of Cyberball and were randomly assigned to receive significantly fewer passes (exclusion condition) or an equal number of passes (control condition) as other players. Subsequently, participants were given the opportunity to engage in an online social interaction activity with avatars they believed were other participants. Results Analyses revealed that the exclusion condition led to greater social pain than the control condition. Across conditions, greater social pain was associated with higher levels of approach motivation in anticipation of the social interaction activity, but only for individuals with lower levels of trait SA. Finally, when controlling for levels of trait SA, social pain was associated with positive affect following the social interaction activity, but only for individuals with higher levels of approach motivation. Limitations Participants consisted predominantly of female undergraduates, limiting generalizability of these data. As well, hypotheses were supported for the measure of approach motivation but not the measure of approach behaviour. Finally, this study was not powered to enable moderated mediation analyses, which would have provided the most direct test of the hypothesized model. Conclusions Heightened approach motivation in the face of social pain may facilitate increased positive affect. However, higher levels of trait SA dampen approach motivation. Future well-powered studies should use moderated mediation analyses to test the hypothesized model more parsimoniously.
... Particularly, in a group interaction, the game playing must balance the game challenge and the player's ability to overcome difficulties so that they can maintain their experience of flow (Csikszentmihalyi, 1997). However, if they feel themselves to be lacking in the ability to meet the challenge, they must eventually focus their attention on playing that game (Mogg, Philippot, & Bradley, 2004) which would generate competitive anxiety (Blalock, Kashdan, & McKnight, 2018). Consistent with the above studies, the present study indicated the negative relationship between competitive anxiety and flow as they played CRAG in a group competition. ...
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Chapter
Research on Flow and StressDesign of the StudyResults: The Phenomenology of Flow and StressRegulation of Moods by Emotional CulturesConclusion and DiscussionReferences
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Media enjoyment is theorized by synthesizing empirical literature from uses and gratifications with Csikszentmihalyi's flow theory. This article argues that enjoyment of media results from a flow experience realized when media message content balances with individual ability to interpret that message. Further, it theorizes that media experience, along with individual differences in cognitive abilities, facilitates or prevents flow state in media users. Therefore, it is a balance between individual differences in cognitive abilities and media message challenges that explains enjoyment of media use. The authors offer the case of video game usage as an exemplar, and examples of cognitive tasks are provided and linked to game genre content.
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The purpose of this study was to examine whether engaging in flow promoting activities would lead to increased positive affect (PA). Participants in this study consisted of 57 undergraduate university students who participated in order to receive extra credit in a psychology class. The randomly assigned high flow induction group performed a flow activity for 1 h, and filled out the PANAS and Flow State Scale 2 before and after the activity. The low flow induction group performed a low flow activity for the same amount of time and filled out both questionnaires as well. Findings indicated that participants in the high flow condition reported higher increases in PA and flow than those in the low flow condition, and that change in flow mediated the relationship between group and change in PA.
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This study attempted to show how autotelic people who live in a non-Western culture feel, behave, and think in their daily lives. Using a sample of 315 Japanese college students, a series of correlation analyses were conducted between the frequency of flow experience as an indicator of autotelic personality and a broad range of well-being measures. A distribution analysis revealed that on average Japanese college students experienced flow more than a “few times a year,” but less than “once a month.” In the examination of relations between flow and well-being measures, autotelic Japanese college students, or those who experienced flow more often in their daily lives, were more likely to show higher self-esteem and lower anxiety, use active coping strategies more often and use passive coping strategies less often, as compared to their less autotelic counterparts. They were more likely to report active commitments to college life, search for future career, and daily activities in general. They also reported more Jujitsu-kan, a Japanese sense of fulfillment, and greater satisfaction with their lives. Implications of these findings are discussed in terms of what experiencing flow means and what effects flow potentially has for college students in a non-Western culture. KeywordsFlow experience-Autotelic personality-Culture-Well-being-Japanese college students
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Anxiety-related responding and skill deficits have historically been associated with performance-based anxiety disorders such as social phobia. Prominent cognitive-behavioral models of social phobia have typically deemphasized skill deficits and focused more on the effects of negative cognition on social performance. Considering that empirical accounts of the relation between social skill and social performance are generally modest, the impact of skill deficits on the development and maintenance of performance inadequacies may be relatively neglected in theoretical paradigms in this area. A second problem that has plagued social skill research is the misuse of the term skill deficit as a synonym for performance deficit. In response to these issues, we utilize the multilevel framework of psychological behaviorism to offer a more parsimonious account of the relation between anxiety and skill in social phobia. We argue that this integrated model assimilates contemporary accounts of social phobia and uniquely expands upon them by delineating the unique and cumulative effects of skill and anxiety on social performance. We further suggest that this model resolves existing theoretical incompatibilities, facilitates improved patient-treatment matching, and shows promise as a guiding framework for empirical research.
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Past research has suggested that Csikszentmihalyi's flow theory describes a state that should be supportive of a student's learning. This paper reports on research that uses the constructs of flow to explore learning in an online environment. An experiment was carried out in which students worked through a learning sequence in the physics domain that had varying degrees of interactivity. Their interactions and flow states were monitored throughout the learning task. The experimental data suggest that flow can be more usefully regarded as a process rather than just an overall state. This process is represented by flow-paths that plot each student's progress through challenge-skill space. Some flow patterns are identified that relate to the learning outcomes of the students. While there is some conflict between this process representation and outcome measures for flow, this flow-path portrayal has provided fresh insights into students' interactions in online learning environments.
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The aim of the current study was to examine the role of satisfaction-with-event as a mediator in the relations between flow and life satisfaction based on the bottom-up theory (Andrews and Withey in Social indicators of well-being: Americans' perceptions of life quality. Plenum, New York, 1976; Lee et al. in J Macromarketing 22(2): 158-169, 2002). Four hundred and thirty-four participants with a mean age of 35.60 (SD = 11.76) were recruited from the audience of a "Cirque du Soleil" acrobatics show, performed in Taiwan in 2009. Participants completed the flow scale (Csikszentmihalyi in Flow: the psychology of optimal experience. Harper & Row, New York, 1990), a satisfaction-with-event scale (Lin and Hsu in Mark Rev 3(4): 497-528, 2008), and a satisfaction-with-life scale (Diener et al. in J Pers Assess 49:71-75, 1985) immediately after viewing the show. Structural equation modeling was conducted to examine our hypothesis that satisfaction-with-event levels would fully mediate the relationship between flow and overall life satisfaction. Results supported our prediction and are discussed in terms of bottom-up theory. Implications of the study are also provided for the leisure managers.
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We developed a smartphone technology to sample people’s ongoing thoughts, feelings, and actions and found (i) that people are thinking about what is not happening almost as often as they are thinking about what is and (ii) found that doing so typically makes them unhappy.
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Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.
Article
A few recent studies have found evidence showing that social anxiety is associated with diminished positive affect and elevated anger. However, prior work has relied on trait self-report measures of global positive mood or anger. In this preliminary study, we examined how trait social anxiety relates to moment-to-moment positive and angry emotional states as people navigate through their natural environment in a given day. Of additional interest was whether any associations were limited to social situations or were evident more broadly in non-social situations as well. For 14 days, 38 non-clinical community adults carried electronic diaries to assess their experience of positive emotions, anger, and their current social context and activity. Participants were randomly prompted up to four times per day, leading to 1702 observations. Results showed that social anxiety was associated with less time spent feeling happy and relaxed and more time spent feeling angry throughout the day. In general, people felt happier when they were with other people compared to being alone. Interestingly, people with relatively higher levels of social anxiety reported fewer and less intense positive emotions and greater anger episodes across social and non-social situations.
Article
The authors examined intensely engaging (i.e., flow) experiences in the context of college coursework to gain a better understanding of their antecedents and outcomes. College students (N=137) completed a Web-based survey that assessed (a) flow experiences; (b) academic work characteristics including role clarity, professor support for autonomy, and feedback; and (c) psychological and physical health. The authors found that flow completely mediated the relation between academic work characteristics and psychological well-being. They also found that flow had an indirect effect through psychological well-being on physical health. These findings suggest restructuring academic work to be clear and autonomous and giving ample feedback opportunities to facilitate intense student engagement and mental and physical wellness.
Article
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.
Article
This study examined the nature of impairment of functioning in persons with social phobia and assessed the validity of two new rating scales for describing impairment in social phobia. In 32 patients with social phobia and 14 normal control subjects, impairment was assessed using the Disability Profile and the Liebowitz Self-Rated Disability Scale, new instruments designed to provide clinician- and patient-rated descriptive measures of current and lifetime functional impairment related to emotional problems. Validity of the new scales was assessed by measuring internal consistency, comparing scores for patients and controls, and comparing scores with those on standard measures of disability, social phobia symptoms, and social support. More than half of all social phobic patients reported at least moderate impairment at some time in their lives, due to social anxiety and avoidance, in areas of education, employment, family relationships, marriage/romantic relationships, friendships/social network, and other interests. Social phobic patients were rated more impaired than normal controls on nearly all items on both measures. Both scales were internally consistent, with Cronbach's alpha coefficients for lifetime and current disability subscales in the range of .87 to .92. Significant positive correlations of scores on the new scales with scores on coadministered standard scales of social phobia symptoms and disability demonstrated concurrent validity. Disability was not significantly correlated with measures of social support. Social phobia is associated with impairment in most areas of functioning, and the new scales appear useful in assessing functional impairment related to social phobia.
Article
This article investigates the effects that perceived challenges and skills in activities have on the quality of everyday life experience. Based on flow theory it was predicted that quality of daily experience would depend on the challenge experienced and skill required in specific situations, as well as on the balance between challenge and skill. The Experience Sampling Method (ESM) was used on a sample of 208 talented adolescents to measure daily variations in four dimensions of experience (concentration, wish to do the activity, involvement, and happiness) in four contexts (in school, with relatives, with friends, and in solitude). The four dimensions of experience were regressed on the predictors challenges, skills, and their absolute difference expressing the balance/imbalance of challenges and skills. Hierarchical linear modeling, explained in detail herein, was conducted on a 1-week sample of experiences. Findings confirm the prediction of flow theory that the balance of challenges and skills has a positive and independent effect on the quality of experience. Yet some differences of parameter estimates were found between dimensions of experience and between social contexts. These heterogeneities call for a further improvement of the flow model.
Article
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.
Article
The current paper presents a model of the experience of anxiety in social/evaluative situations in people with social phobia. The model describes the manner in which people with social phobia perceive and process information related to potential evaluation and the way in which these processes differ between people high and low in social anxiety. It is argued that distortions and biases in the processing of social/evaluative information lead to heightened anxiety in social situations and, in turn, help to maintain social phobia. Potential etiological factors as well as treatment implications are also discussed.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
The relation between social anxiety and hedonic activity remains poorly understood. From a self-regulatory perspective, we hypothesized that socially anxious individuals experience diminished positive experiences and events on days when they are unable to manage socially anxious feelings adequately. In this 21-day experience-sampling study, we constructed daily measures of social anxiety and emotion regulation. Greater dispositional social anxiety was associated with less positive affect and fewer positive events in everyday life. Among individuals defined as socially anxious from their scores on a global self-report measure of social anxiety, the number of positive events was lowest on days when they both were more socially anxious and tended to suppress emotions and highest on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on the days when they were both least socially anxious and most accepting of emotional experiences. Possible clinical implications are discussed.