Cognitive Model Of Social Phobia Research Articles

Prevention and Treatment of Social Anxiety Disorder in Adolescents: Protocol for a Randomized Controlled Trial of the Online Guided Self-Help Intervention SOPHIE.

Social anxiety symptoms are highly prevalent among adolescents and are associated with poor quality of life and low psychosocial functioning. If untreated, social anxiety often persists into adulthood and increases the risk for comorbid disorders. Therefore, early interventions for social anxiety to prevent negative long-term consequences are critical. However, adolescents rarely seek help and often avoid face-to-face psychotherapeutic interventions due to the perceived lack of autonomy and anonymity. Thus, online interventions represent a promising opportunity to reach adolescents who have social anxiety but do not seek help yet. This study aims to evaluate the efficacy, moderators, and mediators of an online intervention developed to reduce social anxiety in adolescents. A total of 222 adolescents aged 11-17 years with subclinical social anxiety (N=166) or with a diagnosis of social anxiety disorder (N=56) are randomly assigned to the online intervention or a care-as-usual control group. The 8-week guided online intervention is based on the Cognitive Model of Social Phobia and evidence-based online interventions for social anxiety adapted to the specific needs of adolescents. The care-as-usual group will be given access to the online intervention after the follow-up assessment. Participants are assessed at baseline, at 4 and 8 weeks post intervention, and at 3-month follow-up assessment on the primary outcome, that is, social anxiety, on secondary outcomes (eg, level of functioning, fear and avoidance, general anxiety, depression, quality of life, self-esteem, and negative effects of the intervention), on potential moderators (eg, therapy motivation, therapy expectancy, and satisfaction with the intervention), and potential mediators (eg, therapeutic alliance and adherence to the intervention). Data will be analyzed based on an intention-to-treat approach and both groups (intervention and care-as-usual) will be compared at each assessment time point. Furthermore, potential mechanisms of change and generalization of intervention effects on daily life are assessed using an ecological momentary assessment procedure that includes items on maintaining mechanisms of social anxiety, social context, and affect. Participants are prompted 3 times a day during the first 8 weeks of the study and again for 2 weeks following the follow-up assessment. Recruitment is ongoing; initial results are expected in 2024. Results are discussed considering the potential of online interventions as a low-threshold prevention and treatment option for adolescents with social anxiety and in light of current advances in dynamic modeling of change processes and mechanisms in early intervention and psychotherapy in adolescents. ClinicalTrials.gov NCT04782102; https://clinicaltrials.gov/ct2/show/NCT04782102. DERR1-10.2196/44346.

The Impact of Self-Imagery on Affective, Cognitive, and Attentional Processes in Social Phobia: A Comprehensive Literature Review of the Theoretical and Empirical Literature

Social Phobia (SP) is a psychological disorder characterised by an excessive and persistent fear of negative evaluation in social or performance situations that interferes with daily functioning. Cognitive models of SP (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the role of negative images of the self as an important factor in the maintenance of SP. While empirical research has demonstrated the link between negative self-imagery and social anxiety, many aspects of this cognitive factor are yet to be understood. Currently, there is limited research investigating the impact of different types of self-imagery and their effects on social anxiety and performance. Further research assessing the relationships between self-imagery and other maintaining processes proposed in cognitive models is also warranted. This review assesses the literature focusing on self-imagery in social anxiety, including qualitative, empirical, and preliminary treatment studies to date. Recommendations for future research and the use of imagery-based rescripting methods in the treatment of SP are also discussed.

Looking on the bright side in social anxiety: the potential benefit of promoting positive mental imagery

Current cognitive models of social phobia converge on the view that negative imagery is a key factor in the development and maintenance of the disorder. Research to date has predominantly focussed on the detrimental impact of negative imagery on cognitive bias and anxiety symptoms, while the potential benefit of promoting positive imagery has been relatively unexplored. Emerging evidence suggests however that positive imagery could have multiple benefits such as improving positive affect, self-esteem and positive interpretation bias, and enhancing social performance. The present article defends the view that combining bias induction with a repeated practice in generating positive imagery in a cognitive bias modification procedure could represent a promising area for future research and clinical innovation in social anxiety disorder.

The Effect of Post-Event Processing on Mood, Self-Beliefs, and Interpretive Biases

Cognitive models of social phobia (e.g., Clark & Wells, 1995; Hoffman, 2007) propose that post-event processing (PEP), the act of engaging in a negatively-biased analysis of a prior social situation, contributes to the maintenance of this disorder. The current study examined the effects of engaging in a cognitive-based, abstract-evaluative form of PEP (AE-PEP) on affect and cognition in and high and low socially anxious individuals. In addition, a novel ambiguous social-interaction task was used to maximise ecological relevance. Participants engaged in either AE-PEP or distraction following a discussion group interaction. The results demonstrated that compared to distraction, high socially anxious participants that engaged in AE-PEP reported more negative affect, greater endorsement of negative self-beliefs, and greater interpretative biases. Significant effects of AE-PEP over distraction were not observed in low socially anxious individuals. The results provide support for cognitive models of social phobia, indicating that PEP is a key maintaining factor.

Are Positive Beliefs about Post-Event Processing Related to Social Anxiety?

Although positive metacognitive beliefs have been found to be associated with symptoms of depression and generalised anxiety disorder, surprisingly few studies have focused on the degree to which positive metacognitive beliefs are associated to social phobia symptoms. In response to this limitation, the primary goal of the current study was the development and validation of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ). It was anticipated that the PB-PEPQ would exhibit adequate psychometric properties. Based on a non-referred sample of 300 undergraduate students, the PB-PEPQ was found to be positively associated with measures of post-event processing and social anxiety symptoms. Further, support was found for the incremental validity of the PB-PEPQ, as the measure predicted variance in social phobia symptoms after controlling for other metacognitive variables, including positive beliefs about worry and positive beliefs about rumination. Overall, the findings may have implications for cognitive models of social phobia. Further, the current findings have possible treatment implications, as individuals with social phobia may benefit from interventions focused on the identification and modification of positive metacognitive beliefs.

Cognition, Imagery and Coping among Adolescents with Social Anxiety and Phobia: Testing the Clark and Wells Model in the Population

The Clark and Wells' cognitive model of social phobia suggests that self-focused attention, negative observer-perspective images of oneself and safety behaviours maintain anxiety in subjects with SP. Empirical research among adults supports the model, but limited evidence for it has been obtained in other age groups or in the general population. We examined automatic thoughts, imagery, safety behaviours and general coping of adolescents with social anxiety and phobia. These were elicited by a thought listing procedure in a recalled, distressing social situation. The target variables were compared between adolescents with high versus normal self-reported social anxiety (HSA/NSA) and between adolescents with clinical/subclinical SP (SP/SSP) versus no diagnosis. Adolescents with HSA reported overall negative thoughts, negative observer-perspective images and safety behaviours more frequently than adolescents with NSA. The SP/SSP group displayed the same difference, and clearer, relative to the no diagnosis group, but additionally reported negative thoughts focused more often on self. Minor differences in coping were found between the groups. The study suggests that adolescents with SP already display the negative self-focused cognitions, observer-perspective imagery and behavioural pattern found among adults with SP. Social anxiety associates with observer-perspective imagery and safety behaviours in adolescence. Adolescents with clinical social phobia report frequent negative self-focused thoughts. However, such negative cognitions focused on self do not associate to self-reported social anxiety. The cognitive model of social phobia (Clark & Wells, 1995) is applicable to adolescents.

The Fear of Others: A Pilot Study of Social Anxiety Processes in Paranoia

There is good reason to consider the role of social anxiety processes in paranoia; both the research and clinical literature indicate significant overlap between the two presentations. The aim of this study was to explore cognition and behaviour that are typically associated with social phobia, in people with paranoia, and then to draw out theoretical and clinical implications. We used a cross-sectional between-subjects design to compare participants with persecutory delusions (without social phobia), social phobia, a clinical control group with panic disorder, and a non-clinical control group. Ten to 15 people were recruited to each of four groups, with a final total of 48 participants. Each person completed measures of automatic thoughts, underlying assumptions, core beliefs and behaviour, and took part in a semi-structured interview designed to assess process (self-consciousness and attentional focus) and metacognitive beliefs. Surprisingly, measures of cognition and behaviour yielded no systematic differences between people with persecutory delusions and social phobia. People with persecutory delusions may experience overt and underlying cognition typically associated with social phobia, and behave in similar ways in response to perceived social threat. These initial results indicate: (i) that larger scale research is now warranted in order to draw firm conclusions about social anxiety processes in paranoia; (ii) more specific hypotheses to be tested; and (iii) a clinical model of paranoia, based on the cognitive model of social phobia, which might now usefully be validated.

A Cognitive Model of Social Phobia: Applicability in a Large Adolescent Sample

Clark and Wells's (1995) cognitive model of social phobia has been extensively evaluated in adults. However, very little data is available on the applicability to social anxiety in adolescence. This study examines the model's applicability in a large adolescent sample. 581 students (aged 14–20) completed questionnaires assessing social anxiety, depression, and variables of the cognitive model (namely safety behaviors, negative social cognitions and social attitudes, self-focused attention, recurrent self-images, pre- and post-event processing). The results revealed that high and low socially anxious youths differed significantly on all cognitive variables. Sequential regression analysis indicated that social attitudes, social cognitions, safety behaviors, and self-imagery were predictive for social anxiety, after controlling for depression and gender. Additionally, a path analysis model examining the relationships between the cognitive variables supported the model's applicability, yielding differential m...

The Fear of Others: A Qualitative Analysis of Interpersonal Threat in Social Phobia and Paranoia

The cognitive models indicate that people with social phobia and paranoia share a common fear of others. While we recognize clinical differences, it is likely that some of the same psychological processes contribute to the maintenance of both presentations, yet the nature and extent of these similarities and differences are not yet clearly understood. This study explored threat experiences in people with social phobia and persecutory delusions in order to elucidate these aspects of the respective cognitive models. Accounts of interpersonal threat experiences were examined in nine people with social phobia and nine people with persecutory delusions. Verbatim transcripts were analyzed using thematic analysis. Three major themes emerged from the data: participants' experience of threat, reactions while under threat, and subsequent reflections. Narrative coherence emerged as a superordinate theme. Typical fear responses were found in both groups, particularly in their reactions to threat. The key differences were in participants' perceptual experiences, ability to stand back from the threat following the event, and narrative coherence. The findings are discussed in relation to current cognitive models of social phobia and paranoia. Theoretical and clinical implications are drawn out, and highlight the need to examine attentional and metacognitive processes more closely if we are to understand the maintenance of perceived threat in these groups, and means of alleviating associated distress.

The Effects of Repeated Imagery Practice on Self-Concept, Anxiety and Performance in Socially Anxious Participants

Current cognitive models of social phobia, all stress the importance of negative self-perceptions in maintaining social anxiety (Moscovitch, 2009, Hofmann, 2007; Rapee & Heimberg, 1997; Clark & Wells, 1995). In some models, (Clark & Wells, 1995) negative self-perceptions are embodied in the form of a visual image. In this study, 58 socially anxious participants were assigned to either a positive (n =19) or a negative (n =19) self-imagery condition and we tested the impact of repeated imagery practice on self-concept (self-esteem and self-concept clarity), and on anxiety and performance in a conversation with a stooge. Participants in each condition practiced holding either a positive or a negative self-image in mind over eight days while at the same time imagining themselves in a series of increasingly challenging social situations. After the final imagery practice, participants took part in a conversation with a stooge. We hypothesised that repeated practice with a positive image would produce higher levels of self-esteem, more self-concept clarity, and would lead to less anxiety and better ratings of performance than holding a negative image. The hypotheses were partially supported. Positive self- imagery practice led to higher self-esteem ratings and higher self-concept clarity on a computerised measure of self-concept clarity, but not on a self-report measure. Positive self-imagery practice also produced better performance ratings in the social test (in both subjective and objective assessments of performance) and a trend towards reduced anxiety. The results are discussed in relation to Conway and Pleydell-Pearce's (2000) self-memory model and the clinical implications are considered.

Self-perception and rumination in social anxiety

The present study examined the relationship between perceptions of performance and post-event processing (PEP) following task feedback in individuals with social phobia and matched control participants. Groups of high and low socially anxious participants engaged in a structured 5-min conversation in groups of four people. Following the conversation, false feedback (given in the form of either high scores or moderate scores) was given and self-appraisals of performance, levels of positive and negative mood, and levels of PEP were assessed. Results showed that participants' perceptions of their own performance and levels of positive affect significantly predicted the degree to which they engaged in negative rumination about the task. The moderate score condition was found to be detrimental for socially anxious individuals’ self-appraisals and PEP, whereas controls showed no significant difference in self-appraisal and PEP, regardless of feedback. The results are discussed in relation to current cognitive models of social phobia and both treatment implications and directions for future research are explored.

Biased Perception and Interpretation of Bodily Anxiety Symptoms in Childhood Social Anxiety

Cognitive models of social phobia (SP) and empirical evidence in adults suggest that affected individuals overestimate arousal symptoms such as heart rate (HR) during social stress and worry about their visibility in public. To date, little is known about these aspects in childhood social anxiety, an important precursor of the disorder. We assessed perception of—and worry about—HR visibility, actual HR, and subjective anxiety during public speaking in high socially anxious (HSA; n = 20) and low socially anxious (LSA; n = 20) Caucasian children, aged 10 to 12 years. Symptom visibility was manipulated by making a nonveridical HR feedback tone audible only to the participant (private condition, HR sounds via headphone) or to participant and observers (public condition, HR sounds via speakers). Further, we assessed interoceptive accuracy in a heartbeat counting task. As expected, HSA children perceived their HR as higher than LSA children in both private and public conditions despite similar actual HR and comparable interoceptive accuracy. Public feedback led to more worry about HR visibility only in HSA but not in LSA children. Biased perception and interpretation of bodily anxiety symptoms during social stress manifests early in social anxiety and might therefore play a crucial role in the aggravation of social anxiety and the development of SP. We discuss implications for current theory, clinical practice, and prevention.

Cognitive therapy for social phobia: issues from the Beck's model

Social anxiety has been defined as the result of complex bio-psycho-social responses with evolutive, biological, affective and cognitive components. These responses are evidenced when the individual faces threat of criticism and negative evaluation by others as well as control loss, leading to social and personal clinically significant impairment. There are abundant social phobia explanatory models, from which many are based on underlying psychological processes (attentional, motivational, perceptual), which has demonstrated empirically valid interventions, such as Cognitive Therapy of A. T. Beck and colleagues (Clark & Beck, 2010). This paper aims to provide a brief overview of a current cognitive model of social phobia based on information processing model that involves the theoretical model, the evaluation and psychotherapy suggested plan. Finally, this review examines available empirical evidence about of cognitive therapy and its advantages recognized by the scientific community compared to other psychotherapies regarding control groups, research methodologies and limitations.

Self-evaluation, social and cognitive performance in children with social phobia

Cognitive models of Social Phobia (SP) assume that SP is not only associated with negative self-evaluation but also with impaired actual social and cognitive performance. However, relatively little is known about these aspects in children with SP. In our study, we investigated whether children with SP show differences in self-evaluation, as well as in social and cognitive performance during a social-evaluative situation. Therefore, a group of children aged 8 to 12 years with SP (DSM-IV; n = 35) and healthy control (HC) children (n = 35), individually matched by sex and age, was exposed to the Trier Social Stress Test for Children (TSST-C). After the speech task and the math task of the TSST-C, children were asked to evaluate their performance. In addition, observers rated their social performance on different dimensions as well as their cognitive performance. Results showed that children with SP evaluated their performance worse than HC children but did not differ in observer-rated nervous behaviors, micro social skills and cognitive performance. Borderline significant group differences could only be found in observer-rated global impression, illustrating that children with SP may differ from HC children during social stress mainly due to being perceived as having a less positive and friendly social appearance.

Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: An experimental study

Cognitive models of social phobia (SP) assume that following social evaluative stress, individuals with SP engage into dysfunctional post-event processing (PEP), a detailed negative review of the past event. While previous research has already shown, that children with high levels of social fears suffer from more frequent negative PEP, it remains unclear how stable PEP is across time in this age group and whether it leads to degraded self-appraisals of performance. Therefore in the present study we exposed a group of high (HSA) and low socially anxious children (LSA; both n = 20), aged 10–12 years, to a social evaluative situation and assessed negative and positive PEP as well as self-rated performance at 2.5 h and one week after the task. Our results revealed that HSA children reported more negative PEP than LSA children, independent of levels of depression. Moreover, negative PEP was related to measures of social anxiety and performance ratings within the tasks. Only the performance ratings in HSA children worsened over the course of the following week and were related to more negative PEP. Thus, these results speak for the high clinical relevance dysfunctional PEP may have for the maintenance of social fears already in childhood.

The Causal Role of Attentional Bias for Threat Cues in Social Anxiety: A Test on a Cyber-Ostracism Task

Cognitive models of social phobia postulate that attentional biases for threat play an important role in the maintenance of this disorder (e.g., Clark 2001). Consistent with this idea, studies have demonstrated that training social phobics to attend to non-threatening stimuli results in clinical benefits (Amir et al. in J Abnorm Psychol 117:860–868, 2008). However, no study has directly examined the causal status of selective attentional bias in social phobia. The present study explicitly investigated this issue. We used an experimental design similar to MacLeod et al. (J Abnorm Psychol 111:107–123, 2002), which involved two consecutive experimental phases: an attentional bias induction phase and a stress phase. During the attentional bias induction, participants completed modified versions of a dot-probe task; for half of the participants the task was designed to induce a biased attentional response for faces expressing disgust, for the other half, the task induced no bias. Then, all participants were exposed to a task inducing social rejection. Results indicate that the induction of an attentional bias for threatening information resulted in increased anxiety during social rejection. Implications for cognitive models of social phobia are discussed.

Post-event processing and physiological arousal in social anxiety

Event Abstract Back to Event Post-event processing and physiological arousal in social anxiety Kiho Kim1* 1 Chung-Ang University, Seoul, South Korea Individuals with social anxiety ruminate for hours or even day over their perceived social failures, a process known in the cognitive model of social phobia as post-event processing (PEP) (Clark & Wells, 1995). PEP is unproductive and theoretically maintains anxiety, possibly through the rehearsal and elaboration of negative social memories. Despite this theoretical emphasis, to date, PEP has not been studied extensively in the context of social anxiety. Therefore, the purpose of this study is to investigate the relationship between social anxiety and PEP. To examine this relationship, changes in skin conductance level of 19 individuals with high social anxiety (HSA) and 21 individuals with low social anxiety (LSA) were measured during a social anxiety-inducing task. The task consisted of a 4-min social interaction with two unknown confederates: ‘1-min self-introduction’, and ‘3-min conversation about ideal type’. Prior to the task, a baseline skin conductance level was assessed, and after the task, participants were given a five minutes recovery period. Also, PEP was measured using post-event rumination scales and memory bias tests after a recovery period. Results indicated that HSA shows significantly higher skin conductance level than LSA during the task and a recovery period. These findings suggest that compared to LSA, HSA may show not only increased physiological arousal levels during social anxiety-inducing period but also delayed recovery from it. Also, HSA shows a higher probability to PEP than LSA. These results provide an empirical support for the idea that PEP would play a crucial role in the development or maintenance of social anxiety. These findings may provide valuable information regarding the treatment of individuals with social anxiety. Keywords: Neuropsychiatry, social anxiety Conference: XI International Conference on Cognitive Neuroscience (ICON XI), Palma, Mallorca, Spain, 25 Sep - 29 Sep, 2011. Presentation Type: Poster Presentation Topic: Poster Sessions: Neuropsychiatric Applications Citation: Kim K (2011). Post-event processing and physiological arousal in social anxiety. Conference Abstract: XI International Conference on Cognitive Neuroscience (ICON XI). doi: 10.3389/conf.fnhum.2011.207.00119 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 17 Nov 2011; Published Online: 25 Nov 2011. * Correspondence: Dr. Kiho Kim, Chung-Ang University, Seoul, Seoul, South Korea, kihohere@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Kiho Kim Google Kiho Kim Google Scholar Kiho Kim PubMed Kiho Kim Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Heartbeat perception in social anxiety before and during speech anticipation

According to current cognitive models of social phobia, individuals with social anxiety create a distorted image of themselves in social situations, relying, at least partially, on interoceptive cues. We investigated differences in heartbeat perception as a proxy of interoception in 48 individuals high and low in social anxiety at baseline and while anticipating a public speech. Results revealed lower error scores for high fearful participants both at baseline and during speech anticipation. Speech anticipation improved heartbeat perception in both groups only marginally. Eight of nine accurate perceivers as determined using a criterion of maximum difference between actual and counted beats were high socially anxious. Higher interoceptive accuracy might increase the risk of misinterpreting physical symptoms as visible signs of anxiety which then trigger negative evaluation by others. Treatment should take into account that in socially anxious individuals perceived physical arousal is likely to be accurate rather than false alarm.

Negative Interpretation Bias Mediates the Effect of Social Anxiety on State Anxiety.

Cognitive models of social anxiety predict that interpretation bias mediates the relationship between level of social anxiety and state anxiety in response to social-evaluative threat. We tested this prediction in 67 socially anxious undergraduates. Participants completed self-report measures of social anxiety and interpretation bias, and two days later they completed an impromptu speech. Mediational analyses supported the hypothesis that interpretation bias mediates the effect of social anxiety on state anxiety in response to the speech. This relationship was specific to negative interpretation of ambiguous social scenarios. The current findings support cognitive models of social phobia and add to the empirical base supporting the role of interpretation bias in social anxiety.

Why is the Self Important in Understanding and Treating Social Phobia?

Current cognitive models of social phobia all agree that the self plays a key maintaining role in the disorder. However, all of these models use a relatively limited conceptualisation of the self. The author proposes a tripartite approach in which theories of the self are grouped into three broad categories: content, structure, and process. Content refers to knowledge and information about the self, structure to the way that information is organised, and process to the ways in which individuals attend to and regulate the self. Structure has been largely neglected to date, and the author outlines ways in which the structural organisation of self-knowledge could contribute to social anxiety. High social anxiety is associated with low clarity about the self and with more uncertainty about self-judgments. Structure interacts with content, and in the final part of the article potential interactions among imagery, self-concept, and self-structure are discussed.