Cognitive Models Of Social Anxiety Research Articles

Do trait anticipatory processing, self-focused attention, and post-event processing explain the relationship between social anxiety and negative drinking motives in undergraduates?

Despite an established relationship between social anxiety (SA) and negative reinforcement drinking motives (NRDMs), relatively little is known about the factors that explain this relationship. This study explored whether three processes implicated in cognitive models of SA (anticipatory processing, self-focused attention, and post-event processing) mediated the relationship between SA and NRDMs in undergraduates. Participants (N = 180) completed self-report measures of social interaction and evaluation anxiety, anticipatory and post-event processing, self-focused attention, drinking motives, and depression. Analyses were conducted using parallel multiple-mediation analyses, which employed bootstrapping tests of significance. Most notably, results showed that the relationships between interaction/evaluation anxiety and drinking to cope with anxiety were explained by trait tendency to experience anticipatory processing and self-focused attention. The relationship between interaction anxiety and drinking to cope with depression was also explained by a tendency to engage in self-focused attention. Conversely, evaluation anxiety directly predicted drinking to cope with depression, while both interaction and evaluation anxiety directly predicted drinking to conform to peers. Overall, these findings further elucidate these relationships by suggesting that anticipatory processing and self-focused attention, but not post-event processing, explain the relationship between SA and drinking to cope with negative affect. Alternatively, these cognitive processes do not appear relevant to SA and conformity-motivated drinking.

Voluntary and Involuntary Imagery in Social Anxiety.

Negative mental imagery is ubiquitous in cognitive models of social anxiety and in the social anxiety literature. Previous research has shown that it is causal of increased anxiety, lower social performance ratings and lower implicit self-esteem. Despite its prevalence, few studies have investigated this imagery directly. This study aimed to provide an in-depth analysis of the phenomenology of negative imagery experienced by socially anxious individuals, and to compare recurrent and intrusive images with images deliberately generated by participants during the study. Thirty-eight undergraduate students screened to be above average in social anxiety scores completed a computerized imagery questionnaire adapted from previous qualitative work. Thematic analyses revealed four major image themes for intrusive images and three for deliberately generated images including interacting with others and anxiety symptoms. Most intrusive images were based on negative episodic memories and were experienced at least fortnightly. Images were primarily visual, auditory and somatic but could involve any sensory modality. Depression anxiety stress scale (DASS-21) scores were higher in participants who experienced intrusive imagery and increased with the frequency of intrusions. Emotionality was generally higher in intrusive images than generated images. The phenomenology of negative imagery experienced by socially anxious individuals is idiosyncratic and may be inherently different from images generated for use in experimental research. Theoretical and clinical implications are discussed.

Translation and Initial Validation of the Japanese Version of the Self-Beliefs Related to Social Anxiety Scale.

Cognitive models of social anxiety posit that there are several types of maladaptive beliefs responsible for persistent social anxiety. Although these beliefs are theoretically important, currently there is no validated measure of these beliefs in Japan. In the present study, we translated into Japanese a well-validated measure of these beliefs, the Self-Beliefs Related to Social Anxiety (SBSA) Scale. The psychometric properties of the scale were also examined in two nonclinical samples ( ns = 401 and 30). Using confirmatory factor analysis, the Japanese version of the SBSA was found to have a correlated three-factor structure that consisted of "conditional beliefs," "unconditional beliefs," and "high standard beliefs." In addition, the Japanese version of the SBSA and its subscales demonstrated good internal consistency reliability and test-retest reliability. The Japanese version of the SBSA also demonstrated good convergent and divergent validity. Future applications of the Japanese version of the SBSA are discussed.

Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder

BackgroundProminent cognitive models of social anxiety have consistently emphasised the importance of beliefs about the self in the aetiology and maintenance of social anxiety. The present study sought to develop and validate a new measure of core beliefs about the self for SAD, the Core Beliefs Questionnaire (CBQ). MethodsThree versions of the CBQ were developed: a Trait version (fundamental absolute statements about the self), a Contingent version (statements about the self related to a specific social-evaluative situation), and an Other version (statements about how others view the self in social-evaluative situations generally). The psychometric features of the scales were examined in clinical (n=269) and non-clinical (n=67) samples. ResultsExploratory factor analysis yielded a one factor model for all three versions of the questionnaire. Total scores differentiated individuals with SAD from individuals without a psychiatric condition, and demonstrated excellent internal consistency. The three CBQ versions had positive associations with social anxiety while controlling for depression, although zero-order correlations indicated the Trait version was more strongly related to depression than social anxiety, the Contingent version was similarly related to depression and social anxiety, and the Other version was more strongly related to social anxiety than depression. Scores on all three versions of the CBQ reduced from pre- to post-treatment and this change predicted treatment outcome. LimitationsThis is the first validation study of the CBQ. ConclusionsThis study provides initial support for the reliability and validity of the CBQ.

The impact of high trait social anxiety on neural processing of facial emotion expressions in females

A cognitive model of social anxiety predicts that an early attentional bias leads to greater cognitive processing of social threat signals, whereas the vigilance-avoidance model predicts there will be subsequent reduction in cognitive processing. This study tests these models by examining neural responses to social threat stimuli using Event-related potentials (ERP). 19 women with high trait social anxiety and 19 women with low trait social anxiety viewed emotional expressions (angry, disgusted, happy and neutral) in a passive viewing task whilst ERP responses were recorded. The HSA group revealed greater automatic attention, or hypervigilance, to all facial expressions, as indexed by greater N1 amplitude compared to the LSA group. They also showed greater sustained attention and elaborative processing of all facial expressions, indexed by significantly increased P2 and P3 amplitudes compared to the LSA group. These results support cognitive models of social anxiety, but are not consistent with predictions of the vigilance-avoidance model.

The Maintaining Factors of Social Anxiety: A Three-Group Comparison of a Clinical Sample with Highly Socially Anxious Students and Non-Anxious Students.

Clark and Wells' (1995) cognitive model of social anxiety (CWM) explains the maintenance of social anxiety and has been used as a guide for treatment of Social Anxiety Disorder (SAD). Few studies have examined the components of the model together across different samples. This study had two distinct aims: to test the components of CWM and to examine how the variables of CWM may differ between clinical and non-clinical samples with varying levels of social anxiety. Hypothesized relationships between three groups (i.e. a clinical sample of individuals diagnosed with SAD (ClinS), n = 40; socially anxious students (HSA), n = 40; and, non-anxious students (LSA), n = 40) were investigated. Four out of five CWM variables tested were able to distinguish between highly socially anxious and non-anxious groups after controlling for age and depression. CWM variables are able to distinguish between high and low levels of social anxiety and are uniquely related to social anxiety over depression.

Generalisation of the Clark and Wells cognitive model of social anxiety to children's athletic and sporting situations

ABSTRACTResearch has shown that social anxiety generalises to sporting and athletic situations. The present study explored the applicability of the Clark and Wells model of social anxiety – and its metacognitive extension – to sport anxiety. Participants were 290 students aged 11–13 years, who completed measures of sport anxiety, social anxiety, depression and cognitive variables implicated by the model. Hierarchical regression analysis indicated that performance attitudes, performance cognitions, anticipatory and post-event processing were predictive of sport anxiety, after controlling for social anxiety and depression. In addition, the association between performance attitudes and sport anxiety was stronger at higher levels of anticipatory and post-event processing. These results suggest that the Clark and Wells cognitive model – and its metacognitive extension – is applicable to children with sport anxiety.

Consequences of anticipatory processing on cognitive symptoms of social anxiety

Anticipatory processing is an anxious style of repetitive negative thought associated with social anxiety (SA) that was proposed by Clark and Wells. Considerable research has examined factors of Clark and Wells' cognitive model of SA (e.g. attention, interpretation), but few studies have examined anticipatory processing, which is hypothesized to interact with other components in the model. In the current study, individuals high in social anxiety symptoms (HSA; N = 56) and control participants [Normal Control (NC); N = 52] engaged in an anticipation or distraction task prior to a threatened social interaction. HSAs who anticipated had higher self-focused attention than NCs who anticipated and HSAs in the distraction condition, suggesting an important relationship between anticipation and self-focus that is specific to HSAs. Those who anticipated endorsed more negative interpretations than those who engaged in distraction, regardless of SA status. However, this relationship was mediated by self-focus. Implications in the context of Clark and Wells' model and future directions are discussed.

Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

In their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the micro-level mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights - the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general - integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues’ case study by incorporating both empirical research and our own clinical anecdotes.

Semantic Priming and Interpretation Bias in Social Anxiety Disorder

Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening is involved in maintaining symptoms of social anxiety. Researchers have used several methodologies to assess interpretation bias in social anxiety, including homographs (i.e., words with two meanings, e.g., chicken-poultry and chicken-scared). In the current study, we examined the effects of priming in 21 individuals with social anxiety disorder and 21 non-anxious control participants. All participants completed a homograph priming paradigm. In this task, participants see a fixation cross followed by a homograph prime. This homograph is then followed by related or unrelated neutral, physical, or social threat target words examining the priming effect of the homograph on the target. As hypothesized, for non-threat targets, we obtained the typical priming effect in all participants. Moreover, we found that individuals with social anxiety disorder were slower to respond to related social threat targets compared to unrelated social threat targets when these targets were preceded by socially relevant homographs. These data suggest that individuals with social anxiety disorder inhibit social threat meaning of ambiguous primes perhaps due to a vigilance-avoidance pattern of threat relevant information.

Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review

Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.

The Relation Between Social Anxiety and Audience Perception: Examining Clark and Wells’ (1995) Model Among Adolescents

Clark and Wells' cognitive model of social anxiety proposes that socially anxious individuals have negative expectations of performance prior to a social event, focus their attention predominantly on themselves and on their negative self-evaluations during an event, and use this negative self-processing to infer that other people are judging them harshly. The present study tested these propositions. The study used a community sample of 161 adolescents aged 14-18 years. The participants gave a speech in front of a pre-recorded audience acting neutrally, and participants were aware that the projected audience was pre-recorded. As expected, participants with higher levels of social anxiety had more negative performance expectations, higher self-focused attention, and more negative perceptions of the audience. Negative performance expectations and self-focused attention were found to mediate the relationship between social anxiety and audience perception. The findings support Clark and Wells' cognitive model of social anxiety, which poses that socially anxious individuals have distorted perceptions of the responses of other people because their perceptions are coloured by their negative thoughts and feelings.

Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts

Cognitive models state that cognitions are organized hierarchically, so that the underlying schemas affect behavior via more automatic, superficial cognitive processes. This study aimed to demonstrate that early maladaptive schemas predict anxious automatic thoughts, and to show that such automatic thoughts act as mediators between schemas and prospective changes in social anxiety symptoms. The study also examined an alternative reverse model in which schemas acted as mediators between automatic thoughts and social anxiety. A total of 1052 adolescents (499 girls and 553 boys; Mage=13.43; SDage=1.29) completed measures of early maladaptive schemas, socially anxious automatic thoughts, and social anxiety symptoms at Times 1, 2, and 3. The results revealed bidirectional longitudinal relationships among schemas and automatic thoughts that were consistent in content (e.g., the disconnection/rejection schemas and automatic thoughts of negative self-concept). Furthermore, the automatic thoughts of anticipatory negative evaluation by others at Time 2 mediated the relationship between the other-directedness schemas at Time 1 and social anxiety symptoms at Time 3. These findings are consistent with hierarchical cognitive models of social anxiety given that deeper schemas predict more surface-level thoughts. They also support that these more surface-level thoughts contribute to perpetuating schemas. Finally, results show that early maladaptive schemas of the other-directedness domain play a relevant role in the development and maintenance of social anxiety.

Comparing Fear of Positive Evaluation to Fear of Negative Evaluation in Predicting Anxiety from a Social Challenge

This study compared FNE and FPE scales in predicting anxious responding to a social challenge. 101 undergraduate participants completed a social manipulation requiring them to deliver a 3 minute videotaped speech they believed would be rated by faculty judges. Participants then received bogus positive, negative, or no feedback and were informed they were selected to present their speech directly to the panel of judges. FNE was the strongest predictor of state anxiety following the initial speech task, while FNE and FPE predicted somatic response to this task. Regardless of feedback type, FPE was a significant predictor of anxiety during the second speech task. Results are consistent with an overall cognitive model of social anxiety and suggest that FPE and FNE are distinct predictors of anxiety the under specific conditions.

Post-Evaluative Biases Toward Somatic Stimuli and Cardiovascular Responses in Social Anxiety

Cognitive models of social anxiety emphasize the role of an attentional shift toward cues related to somatic state in social anxiety. We examined attentional biases to somatic cues and cardiovascular reactivity in response to a social evaluative task. Participants performed an impromptu speech during which they received standardized negative evaluative comments. Participants then completed a dot-probe task with social evaluative, somatic, and anger-related words. Blood pressure (BP) and heart rate (HR) were assessed in 1-minute intervals during baseline, the speech task, and the dot-probe task. Despite the fact that a high social anxiety group reported higher levels of anxiety, high and low social anxiety groups did not differ in their speech task-evoked BP or HR responses. Furthermore, the high social anxiety group, compared to the low social anxiety group, exhibited greater attentional biases to somatic words, suggesting greater attention directed toward information pertinent to somatic arousal.

Lack of a Benign Interpretation Bias in Social Anxiety Disorder

Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69–93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741–756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799–825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135–1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxiety disorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD.

P01-162 - How do patients with social phobia manage interpersonal distance during social interactions ?

Personal space is the area individuals maintain around themselves into which others cannot intrude without arousing discomfort. This concept is potentially relevant in clinical psychiatry, especially in the context of disorders associated with social anxiety or social cognition disorders. Consistent with this idea, some rare studies have shown that personal space managing and interpersonal distance setting is disturbed in schizophrenic and bipolar patients. However, surprisingly, there is no data on personal space in social phobia. In this study, we aimed to investigate the characteristics of personal space in patients with social phobia using immersive and interactive virtual environments. Overall, the more the level of anxiety the more subjects leave space between themselves and others. The detailed results are discussed in the frame of cognitive models of social anxiety.

Learning to re-appraise the self during video feedback for social anxiety: Does depth of processing matter?

Video feedback (VF) with cognitive preparation (CP) has been widely integrated into cognitive-behavioral therapy (CBT) protocols for social anxiety disorder (SAD) due to its presumed efficacy in improving negative self-perception. However, previous experimental studies have demonstrated that improvements in negative self-perception via VF+CP do not typically facilitate anxiety reduction during subsequent social interactions – a troubling finding for proponents of cognitive models of social anxiety. We examined whether VF+CP could be optimized to enhance participants’ processing of corrective self-related information through the addition of a post-VF cognitive review (CR). Sixty-eight socially anxious individuals were randomly assigned to perform two public speeches in one of the following conditions: a) exposure alone (EXP); b) CP+VF; and c) CP+VF+CR. Those in the CP+VF+CR condition demonstrated marginally significant reductions in anxiety from speech 1 to speech 2 relative to those who received EXP – an improvement not shown for those in the CP+VF condition. Furthermore, only those who received CP+VF+CR demonstrated significant improvements in self-perception and performance expectations relative to EXP. Decreases in anxiety among participants who received CP+VF+CR relative to EXP were fully mediated by improvements in self-perception. Implications are discussed in the context of cognitive models of social anxiety and mechanisms of exposure-based learning.

The Fear of Positive Evaluation Scale: Psychometric properties in a clinical sample

Cognitive models of social anxiety suggest that fear of negative evaluation (FNE) is the central cognitive dimension underlying the disorder. The Fear of Positive Evaluation Scale (FPES; Weeks, Heimberg, & Rodebaugh, 2008) was recently developed to assess an additional cognitive dimension purported to underlie social anxiety disorder (SAD), but its psychometric properties have yet to be examined in clinical populations. The present study, with 133 treatment-seeking patients, examined the applicability of the FPES with a clinical sample. Results indicated that the FPES was factorially distinct from a measure assessing FNE, and patients with SAD (n=51) had higher mean scores on the FPES than patients with other anxiety disorders (n=82). The FPES also showed adequate reliability (internal consistency), good convergent and discriminant validity, acceptable criterion-related validity in predicting social interaction anxiety symptoms, and appropriate sensitivity to treatment. The FPES appears to have good psychometric properties and is a promising new assessment tool for better understanding SAD.

Exploring the Effect of Alcohol on Post-Event Processing Specific to a Social Event

Inconsistent findings regarding the relationship between social anxiety and alcohol use suggest that further research is needed to explore how alcohol affects various components of social anxiety. Post-event processing, or rumination after social events, is an element of cognitive models of social anxiety that is related to increased levels of social anxiety. The goal of the current study was to explore the interrelationships among social anxiety, post-event processing, and alcohol use. A sample of 208 university students completed online questionnaires to assess their levels of trait social anxiety and trait depression as well as their alcohol consumption at a specific social event. Participants then completed questionnaires to assess levels of post-event processing specific to the social event they attended. Results revealed that the amount of alcohol individuals consumed at the event predicted increased levels of post-event processing above and beyond levels of trait social anxiety and depression. As such, drinking may lead to increased post-event processing in student samples.