The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia?

Myriam Rudaz,Michelle G Craske,Jürgen Margraf,Eni S Becker,Thomas Ledermann,Daimei Sasayama

doi:10.1371/journal.pone.0180298

Abstract

Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.

Highlights

Social anxiety disorder and specific phobia are the most common lifetime anxiety disorders with prevalence rates in the United States estimated to be as high as 10.7 and 15.6 percent, respectively [1]
The means of clinical severity in women with a baseline social anxiety disorder and specific phobia were above the clinical cut-off of 4, providing further evidence that these individuals can be considered to be clinically severe
The current study aimed to examine the mechanism by which circumscribed avoidance behavior contributes to the maintenance of general anxiety in women with a baseline social anxiety disorder and a baseline specific phobia

Summary

Introduction

Social anxiety disorder and specific phobia are the most common lifetime anxiety disorders with prevalence rates in the United States estimated to be as high as 10.7 and 15.6 percent, respectively [1]. For Europe, these estimates were in the range of 1.9 to 13.7 percent for social anxiety disorder and 7.7 to 15.3 percent for specific phobia [2, 3]. Social anxiety disorder frequently emerges in adolescence or early adulthood and specific phobia in childhood [4,5,6].

Objectives

Methods

Results

Conclusion