Abstract
Current cognitive models of social anxiety disorder (SAD) in adults indicate that negative self-images play a pivotal role in maintaining the disorder. However, little is known about the role of negative imagery in the maintenance of social anxiety for children and young people. We systematically reviewed studies that have investigated the association between imagery and social anxiety in children and young people. Four databases were searched for ‘social anxiety’ and related terms (including ‘social phobia’ and ‘performance anxiety’) combined with ‘imagery’, ‘representation*’, and ‘observer perspective’. The nine studies that met the inclusion criteria provided some evidence that children and young people with higher social anxiety report more negative, observer’s perspective images, and some evidence to support the cognitive models of SAD’s conceptualisation of imagery. Only two studies included samples with pre-adolescent children. The literature is limited by a number of methodological issues, including inconsistencies in, and a lack of good psychometric measures for, imagery in children and young people. More conclusive evidence is needed to develop significant and robust conclusions.
Highlights
Social anxiety disorder (SAD) is one of the most common mental health problems (Kessler et al 2005a, b), has an early age of onset and an estimated prevalence in children and young people of between 3 and 10% (Merikangas et al 2010; Wittchen and Fehm 2003)
If the mean age of participants was reported without the range, the age was determined using an assumption of normality that the sample mean age plus 3 standard deviations equalled less than 25; (iv) There was a measure of social anxiety symptoms or diagnosis; (v) There was a measure of the experience of imagery; (vi) It was possible to extract data for an association between social anxiety and imagery
Three studies investigated the association between imagery perspective and social anxiety symptoms and the findings suggested that observer’s perspective is associated with higher symptom ratings (Hignett and Cartwright-Hatton 2008; Ranta et al 2014; Schreiber and Steil 2013)
Summary
Social anxiety disorder (SAD) is one of the most common mental health problems (Kessler et al 2005a, b), has an early age of onset (median age = 13 years; Kessler et al 2005a, b) and an estimated prevalence in children and young people of between 3 and 10% (Merikangas et al 2010; Wittchen and Fehm 2003). SAD during childhood and adolescence presents a risk for further mental health problems (e.g. depression and substance abuse) as an adult (Stein and Stein 2008). These considerations highlight the importance of effective, early intervention. It will be important to better develop an understanding of the SAD-specific maintenance processes that should be targeted to optimise treatment outcomes for children and young people with SAD (Halldorsson and Creswell 2017)
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