Levels Of Social Anxiety Symptoms Research Articles

After one year in university; a robust decrease in autistic traits reporting among autistic students.

Previous research on autistic students enrolled in university support programs has reported moderate improvement in anxiety/depression or adaptive behavior. However, alterations in autistic traits have not been examined. This longitudinal study evaluated changes in university students' autistic trait and state/trait anxiety levels. Participants were 24 neurotypically developed (ND) students with high levels of social anxiety symptoms (High SA), 30 ND students with low levels of SA symptoms (Low SA), and 41 autistic students (the primary focus of this study) residing with an ND peer student mentor as part of participating in the university's integration support program. Autism spectrum quotient [AQ and State Trait Anxiety Inventory STAI] data were collected during the first semester of two consecutive academic years (T1, T2), as well as baseline (T1) levels of social anxiety, depression, and obsessive-compulsive symptoms. Significant interaction between group and time was observed, denoting a sharp decrease (2.9 SD) from T1 to T2 in the overall autistic trait level among the autistic group (AQ "attention switching" subscale demonstrating the most robust decrease), and a moderate decrease (0.5 SD) among the high SA group. Only for the autistic students were more compulsive symptoms at T1 associated with a lesser decrease in AQ scores (T1-T2), which in turn was negatively correlated with their T1 year-end grade point average. The findings suggest that attending post-secondary education (while partaking in a support/transition program) is followed by a profound change of the individual's subjective experience of autism, characterized by a sharp decline in the level of autistic traits, particularly attention switching. This change is independent of alterations in well-being indices, such as anxiety, that are known to characterize students attending university.

Context and domain matter: the error-related negativity in peer presence predicts fear of negative evaluation, not global social anxiety, in adolescents.

Social anxiety symptoms are most likely to emerge during adolescence, a developmental window marked by heightened concern over peer evaluation. However, the neurocognitive mechanism(s) underlying adolescent social anxiety remain unclear. Emerging work points to the error-related negativity (ERN) as a potential neural marker of exaggerated self/error-monitoring in social anxiety, particularly for errors committed in front of peers. However, social anxiety symptoms are marked by heterogeneity and it remains unclear exactly what domain(s) of social anxiety symptoms are associated with ERN variation in peer presence, particularly within the adolescent period. To advance and deepen the mechanistic understanding of the ERN's putative role as a neural marker for social anxiety in adolescence, we leveraged a social manipulation procedure and assessed a developmentally salient domain of social anxiety during adolescence - fear of negative evaluation (FNE). Adolescents residing in Hanzhong, a small city in the southwestern region of mainland China, had EEG recorded while performing a flanker task, twice (peer presence/absence); FNE, as well as global social anxiety symptoms, was assessed. Overall ERN increases in peer presence. FNE specifically, but not global levels of social anxiety symptoms, predicted ERN in peer presence. These data are the first demonstration that the ERN relates to a specific domain of social anxiety in adolescents, as well as the first evidence of such relations within a non-WEIRD (Western, Educated, Industrialized, Rich and Democratic) sample. Results have important implications for theory and research into adolescent social anxiety.

Characterising Negative Mental Imagery in Adolescent Social Anxiety

BackgroundUnderstanding the role of self-imagery in the development of social anxiety in adolescence holds promise for improving intervention. Cross-sectional studies indicate that imagery characteristics are associated with social anxiety symptoms, however, prospective studies are lacking. The current study examined concurrent and prospective associations between two image characteristics, namely observer-perspective and vividness, with social anxiety symptoms in a community adolescent sample (N = 616; 53% girls; aged 11–15 years). In addition, we examined common themes in the negative social anxiety-related images.MethodsNegative self-imagery and social anxiety symptoms were assessed using questionnaires at baseline and at 4–6-month follow-up. A series of multiple linear regression analyses were performed to see if each image characteristic predicts concurrent and prospective social anxiety symptoms. Topic modelling was performed to infer key topics from verbal data.ResultsObserver-perspective and vividness significantly predicted concurrent social anxiety symptoms beyond the influence of age and gender. Observer-perspective significantly predicted prospective levels of social anxiety symptoms beyond the influence of age, gender, and baseline social anxiety and depression symptoms. Negative self-images clustered into two themes: the fear of appearing anxious and the fear of being judged or viewed as unacceptable.ConclusionsSpecific characteristics and contents of negative self-images may be particularly relevant to the development of adolescent social anxiety.

Adaptive behavior and psychiatric symptoms in university students with ASD: One-year longitudinal study

In recent years, more young adults with ASD are attending post-secondary education, and several support programs have been proposed for this population. However, research regarding the long-term effects of university enrollment on outcomes among students with ASD is scarce. This study examined adaptive behavior and psychiatric symptoms during the first semester of two consecutive academic years (T1, T2) among 39 students with ASD, 29 students without ASD and high levels of social anxiety symptoms (High SA), and 32 students without ASD and low levels of SA symptoms (Low SA). Students with ASD participated in a university support program and resided with a peer mentor student without ASD, which encouraged social interaction. At T1, students with ASD reported lower levels of adaptive behavior and higher levels of social anxiety and obsessive-compulsive symptoms compared to the other groups. However, at follow-up (T2), significantly higher conceptual adaptive skill levels (specifically communication skills) and significantly lower depression symptom levels from T1 were reported only among students with ASD. The levels of social anxiety and obsessive-compulsive symptoms at T1 were negatively associated with adaptive functioning a year later (T2). Implications regarding adults with ASD attending university are discussed.

Social phobic beliefs mediate the relationship between post-event processing regarding the worst socially aversive experience and fear of negative evaluation

The experience of socially aversive events is proposed to be a critical etiological factor in the development of social anxiety symptoms even though the experience itself is also common among healthy individuals. Rather than the event itself, accompanying factors such as maladaptive processing might be associated with higher levels of social anxiety symptoms. One-hundred-seventy-four individuals participated in this online-survey comprising questionnaires regarding social anxiety symptoms and retrospective reports concerning maladaptive processing of the worst socially aversive event. Structural equation modelling was used to analyze the hypothesized mediation of maladaptive processing and fear of negative evaluation by intrusive re-experiencing and social phobic beliefs. The positive association between retrospectively evaluated maladaptive processing after the worst socially aversive event and fear of negative evaluation was mediated by social phobic beliefs but not by intrusive re-experiencing. These results point towards the relevance of further investigating processing strategies after socially aversive events as a potential influencing factor for SAD development.Trial registration.The trial was registered at the German Clinical Trial Register (DRKS00021502) on June 3rd, 2020.

Unpacking Social Avoidance and Substance Use in Social Anxiety: Does Extraversion Explain Behavior Variability?

Social anxiety is characterized by heightened fear and anxiety associated with social situations, resulting in the use of avoidance behaviors. Contemporary models suggest that some individuals with social anxiety may choose to completely avoid social situations, while others may seek social connections and interactions and utilize avoidance behaviors such as substance use as a means of distress tolerance, while engaging in these situations. Our aim is to test a theoretical model whereby extraversion could help to explain the heterogenous nature of social anxiety in relation to these behaviors. Lower levels of extraversion have been commonly associated with withdrawal behaviors and higher levels of extraversion have been associated with behaviors commonly enacted in social situations. Understanding factors which predict the use of one behavior over another is imperative to the conceptualization and successful treatment of patients with social anxiety. A sample of 195 college students completed self-report measures and a 10-day experience sampling diary with five diary signals each day. Participants were asked to rate their current negative emotions and behaviors during each diary signal. Using a multilevel modeling approach, we tested the association between social anxiety symptoms and negative affect predicting engagement in substance use or social avoidance and tested whether extraversion moderated this association. Negative affect was included as a covariate given the established associations between elevations in negative affect predicting both behaviors. Results indicated that higher levels of social anxiety symptoms and negative affectivity increased the probability of social avoidance and substance use, and extraversion was a significant predictor for only substance use. Moderation analysis indicated that extraversion moderated the relationship between social anxiety and substance use, suggesting a stronger positive relationship between substance use and social anxiety for individuals higher in extraversion. However, extraversion was not a significant moderator between social anxiety and social avoidance. Overall, the findings suggest that extraversion could be a key factor predicting the use of substances amongst individuals with social anxiety and may need further consideration in treatment.

Body Concept and Quality of Life in Patients with Idiopathic Dystonia.

Patients with dystonia experience unusual postures and disfigurement. The aim of the study was to examine changes in the body concept in relation to quality of life and severity of dystonia. Our cohort consisted of 20 patients with idiopathic dystonia resistant to medical therapy who were planned for pallidal deep brain stimulation. The results were compared to 25 healthy controls. The patients were assessed with Frankfurt Body Concept Scale, Short Form 36 (SF-36) Health Survey, Hamilton Depression Scale, Beck Depression Inventory, Social Phobia Inventory and Social Interaction Anxiety Scale. The disease severity was evaluated with Burke–Fahn–Marsden Dystonia Rating Scale and Toronto Western Spasmodic Torticollis Rating Scale. Patients with dystonia had a significantly impaired body concept in eight out of nine subscales in comparison to healthy controls. The differences were most pronounced for the subscales general health, body care, physical efficacy, sexuality and physical appearance (p < 0.001). Furthermore, all eight subscales of SF-36 exhibited significantly lower values in patients with dystonia compared to controls. We also found significant positive correlations between SF-36 and body concept subscales. Impairment of body concept was not associated with disease severity or levels of social anxiety symptoms. However, there was a significant association between self-rated depression and disease severity. Our patients suffered from increased depression and social anxiety symptoms except social interaction anxiety. We conclude that patients with dystonia have significant body concept impairment that interferes with quality of life in both physical and emotional domains. Future studies should focus on assessing these symptoms after adequate therapeutic management of motor symptoms.

Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions.

Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD. The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children. We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis. SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis. Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Impact of social anxiety and social context on college students’ emotion regulation strategy use: An experience sampling study

Socially anxious individuals typically select more avoidant emotion regulation (ER) strategies than non-anxious individuals, contributing to interpersonal difficulties. The present study utilized smartphone-delivered experience sampling over 14 days to assess how actual and desired social situations predicted reports of ER strategy use in 115 undergraduate students with varying levels of social anxiety symptoms. After controlling for multiple comparisons, results indicated that higher (vs. lower) baseline social anxiety symptoms predicted endorsing at least one of the available eight ER strategies relatively more often than reporting no strategy use, in the context of high negative affect. We did not find the hypothesized positive relationship between social anxiety symptoms and endorsements of avoidant- (e.g., expressive suppression) versus engagement-oriented (e.g., cognitive reappraisal) ER strategies in the context of high negative affect. However, state social desire interacted with trait social anxiety at high negative affect to predict the use of an ER strategy, although the simple effects analyses at high and low levels of social desire were not statistically reliable. Collectively, our results demonstrate the importance of considering both trait-level social anxiety symptoms and in-the-moment social context when studying ER strategy selection. The importance of assessing intrinsic motivational goals and beliefs in the context of ER strategy use is also discussed.

Personality Trait Interactions in Risk for and Protection against Social Anxiety Symptoms

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18–50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

The Role of Shame and Self-Criticism in Social Anxiety: A Daily-Diary Study in a Nonclinical Sample

We sought to explore the daily association between shame and self-criticism, and the extent to which this association varies as a function of social anxiety symptoms. Fifty-nine undergraduate students completed a measure of social anxiety symptoms at a baseline meeting and then completed measures of shame experienced during significant social interactions and self-criticism following those interactions twice daily for 10 days. Social anxiety symptoms predicted more shame during daily social interactions and more self-criticism following them. Additionally, shame predicted subsequent self-criticism. This relationship was moderated by levels of social anxiety symptoms, such that those with higher levels of social anxiety symptoms exhibited high levels of self-criticism following daily social interactions characterized by both high and low shame, whereas those with lower levels of social anxiety symptoms showed high levels of self-criticism only after interactions with high levels of shame. These findings are consistent with the notion that self-criticism may serve as a regulatory coping method when experiencing shame, and that social anxiety difficulties are related to an inflexibly high level of self-criticism.

Impaired fear recognition and social anxiety symptoms in adolescence.

This study represents the first examination of adolescent anxiety in relation to peer emotion recognition, rather than adult emotion recognition. Additionally, we examine potential mechanisms for the development of Social Anxiety in females. Facial emotion recognition (FER) is important for accurate social cognition, which is impaired in individuals with various disorders, including anxiety disorders. Social anxiety often onsets during adolescence, is observed more commonly in females, and is often associated with FER difficulties. Given the importance of peer interaction during adolescence, and some evidence that FER may differ as a function of the stimuli (adolescent or adult faces), we sought to study FER in relation to social anxiety symptoms using stimuli portraying adolescent faces. Male and female adolescents (N=64) completed an online survey in which they rated 257 child and adolescent emotional faces and completed a self-report measure of social anxiety symptoms. We examined differences in emotion recognition (e.g., fear, anger, sadness) between individuals with high and low levels of social anxiety symptoms. Adolescents with high social anxiety symptoms were more likely to have problems correctly identifying fearful expressions (90.55% accuracy) compared to adolescents with low social anxiety symptoms (96.00% accuracy; t = 2.375, p = .021, d = 0.594), and this effect was observed exclusively in female adolescents. The observed sex difference in accurate identification of fearful faces in relation to social anxiety could suggest a potential mechanism for social anxiety development in adolescent females.

Clarification to Brook and Willoughby (2016).

Reports an error in "Social anxiety and alcohol use across the university years: Adaptive and maladaptive groups" by Christina A. Brook and Teena Willoughby (Developmental Psychology, 2016[May], Vol 52[5], 835-845). In the article, Figures 1 and 2 and Tables 1, 2, 3, and 4 were inadvertently designated as supplemental material. The figures and tables are present in the erratum. (The following abstract of the original article appeared in record 2016-13161-001.) University/college can be a challenging time as students face developmental tasks such as building new social networks and achieving academically. Social anxiety may be disadvantageous in this setting given that social situations often include drinking and individuals with social anxiety tend to self-medicate through alcohol use. However, findings are mixed as to whether the association between social anxiety and alcohol use is positive or negative. To clarify the nature of this association, we used a person-centered longitudinal analysis to identify student groups based on levels of social anxiety symptoms and alcohol consumption. Undergraduates (N = 1132, 70.5% female, Mage = 19.06 at Time 1) enrolled in university completed a survey assessing social anxiety and alcohol use over 3 years, and psychosocial functioning and emotion coping behaviors at Time 1. Two out of 5 groups were identified with higher levels of social anxiety, 1 with moderately low alcohol use, and the other with moderately high alcohol use. Both groups reported higher levels of general anxiety, depressive symptoms, behavioral inhibition, emotional reactivity, daily hassles, and lower levels of social ties at Time 1 than the 3 groups with lower levels of social anxiety. Furthermore, the social anxiety-alcohol use group reported significantly lower academic grades and was more likely to endorse problematic emotion coping behaviors (e.g., self-injury) than the social anxiety-low alcohol use group. These results not only help explain the mixed findings in the literature but indicate that 1 group of socially anxious students may be particularly vulnerable to negative adjustment difficulties. (PsycINFO Database Record

Social anxiety and alcohol use across the university years: Adaptive and maladaptive groups.

University/college can be a challenging time as students face developmental tasks such as building new social networks and achieving academically. Social anxiety may be disadvantageous in this setting given that social situations often include drinking and individuals with social anxiety tend to self-medicate through alcohol use. However, findings are mixed as to whether the association between social anxiety and alcohol use is positive or negative. To clarify the nature of this association, we used a person-centered longitudinal analysis to identify student groups based on levels of social anxiety symptoms and alcohol consumption. Undergraduates (N = 1132, 70.5% female, Mage = 19.06 at Time 1) enrolled in university completed a survey assessing social anxiety and alcohol use over 3 years, and psychosocial functioning and emotion coping behaviors at Time 1. Two out of 5 groups were identified with higher levels of social anxiety, 1 with moderately low alcohol use, and the other with moderately high alcohol use. Both groups reported higher levels of general anxiety, depressive symptoms, behavioral inhibition, emotional reactivity, daily hassles, and lower levels of social ties at Time 1 than the 3 groups with lower levels of social anxiety. Furthermore, the social anxiety-alcohol use group reported significantly lower academic grades and was more likely to endorse problematic emotion coping behaviors (e.g., self-injury) than the social anxiety-low alcohol use group. These results not only help explain the mixed findings in the literature but indicate that 1 group of socially anxious students may be particularly vulnerable to negative adjustment difficulties. (PsycINFO Database Record

The Temporal Sequence of Social Anxiety and Depressive Symptoms Following Interpersonal Stressors During Adolescence.

Social anxiety and depressive symptoms dramatically increase and frequently co-occur during adolescence. Although research indicates that general interpersonal stressors, peer victimization, and familial emotional maltreatment predict symptoms of social anxiety and depression, it remains unclear how these stressors contribute to the sequential development of these internalizing symptoms. Thus, the present study examined the sequential development of social anxiety and depressive symptoms following the occurrence of interpersonal stressors, peer victimization, and familial emotional maltreatment. Participants included 410 early adolescents (53% female; 51% African American; Mean age =12.84 years) who completed measures of social anxiety and depressive symptoms at three time points (Times 1-3), as well as measures of general interpersonal stressors, peer victimization, and emotional maltreatment at Time 2. Path analyses revealed that interpersonal stressors, peer victimization, and emotional maltreatment predicted both depressive and social anxiety symptoms concurrently. However, depressive symptoms significantly mediated the pathway from interpersonal stressors, peer victimization, and familial emotional maltreatment to subsequent levels of social anxiety symptoms. In contrast, social anxiety did not mediate the relationship between these stressors and subsequent depressive symptoms. There was no evidence of sex or racial differences in these mediational pathways. Findings suggest that interpersonal stressors, including the particularly detrimental stressors of peer victimization and familial emotional maltreatment, may predict both depressive and social anxiety symptoms; however, adolescents who have more immediate depressogenic reactions may be at greater risk for later development of symptoms of social anxiety.

Children of Few Words: Relations Among Selective Mutism, Behavioral Inhibition, and (Social) Anxiety Symptoms in 3- to 6-Year-Olds.

Children with selective mutism (SM) fail to speak in specific public situations (e.g., school), despite speaking normally in other situations (e.g., at home). The current study explored the phenomenon of SM in a sample of 57 non-clinical children aged 3–6 years. Children performed two speech tasks to assess their absolute amount of spoken words, while their parents completed questionnaires for measuring children’s levels of SM, social anxiety and non-social anxiety symptoms as well as the temperament characteristic of behavioral inhibition. The results indicated that high levels of parent-reported SM were primarily associated with high levels of social anxiety symptoms. The number of spoken words was negatively related to behavioral inhibition: children with a more inhibited temperament used fewer words during the speech tasks. Future research is necessary to test whether the temperament characteristic of behavioral inhibition prompts children to speak less in novel social situations, and whether it is mainly social anxiety that turns this taciturnity into the psychopathology of SM.

Pre-treatment social anxiety severity moderates the impact of mindfulness-based stress reduction and aerobic exercise.

We examined whether social anxiety severity at pre-treatment would moderate the impact of mindfulness-based stress reduction (MBSR) or aerobic exercise (AE) for generalized social anxiety disorder. MBSR and AE produced equivalent reductions in weekly social anxiety symptoms. Improvements were moderated by pre-treatment social anxiety severity. Mindfulness-based stress reduction (MBSR) and aerobic exercise (AE) are effective in reducing symptoms of social anxiety. Pre-treatment social anxiety severity can be used to inform treatment recommendations. Both MBSR and AE produced equivalent reductions in weekly levels of social anxiety symptoms. MBSR appears to be most effective for patients with lower pre-treatment social anxiety symptom severity. AE appears to be most effective for patients with higher pre-treatment social anxiety symptom severity.

Social anxiety symptoms and drinking behaviors among college students: the mediating effects of drinking motives.

The impact of social anxiety on negative alcohol-related behaviors among college students has been studied extensively. Drinking motives are considered the most proximal indicator of college student drinking behavior. The current study examined the mediating role of drinking motives in the relationship that social anxiety symptoms have with problematic (alcohol consumption, harmful drinking, and negative consequences) and safe (protective behavioral strategies) drinking behaviors. Participants were 532 undergraduates who completed measures of social anxiety, drinking motives, alcohol use, harmful drinking patterns, negative consequences of alcohol use, and protective behavioral strategy use. Our results show that students with higher levels of social anxiety symptoms who were drinking for enhancement motives reported more harmful drinking and negative consequences, and used fewer protective behavioral strategies. Thus, students who were drinking to increase their positive mood were participating in more problematic drinking patterns compared with students reporting fewer social anxiety symptoms. Further, conformity motives partially mediated the relationship between social anxiety symptoms and negative consequences. Thus, students with more symptoms of social anxiety who were drinking in order to be accepted by their peers were more likely than others to experience negative consequences. Clinical and research implications are discussed.

Do Higher Self-Reports of Social Anxiety Translate to Greater Occurrence of Social Anxiety Disorder in Asian Americans Compared to Caucasian Americans?

This study was designed to clarify the discrepancy between data showing higher self-reported levels of social anxiety in Asian Americans (Horng, 2004; Okazaki, 1997, 2000, 2002) but lower lifetime prevalence rates of social anxiety disorder (SAD) in Asian Americans compared to Caucasian Americans (Hwu, Yeh, & Chang, 1989; Lee et al., 1990b; Takeuchi et al., 1998). Results revealed that based on responses on the self-report Social Phobia Inventory (SPIN), Asian Americans endorsed higher levels of social anxiety symptoms and were more likely to meet a threshold for "high social anxiety," using the diagnostic cutoff score of 19 or higher on the SPIN. However, when clinician-formulated diagnoses were assigned, there was no evidence for significant differences in the prevalence of SAD in Asian Americans versus Caucasian Americans. Explanation of the results, their implications, limitations, and future directions are discussed.

Linear association between social anxiety symptoms and neural activations to angry faces: from subclinical to clinical levels

Social anxiety disorder (SAD), which is characterized by the fear of being rejected and negatively evaluated, involves altered brain activation during the processing of negative emotions in a social context. Although associated temperament traits, such as shyness or behavioral inhibition, have been studied, there is still insufficient knowledge to support the dimensional approach, which assumes a continuum from subclinical to clinical levels of social anxiety symptoms. This study used functional magnetic resonance imaging (fMRI) to examine the neural bases of individual differences in social anxiety. Our sample included participants with both healthy/subclinical as well as clinical levels of social anxiety. Forty-six participants with a wide range of social anxiety levels performed a gender decision task with emotional facial expressions during fMRI scanning. Activation in the left anterior insula and right lateral prefrontal cortex in response to angry faces was positively correlated with the level of social anxiety in a regression analysis. The results substantiate, with a dimensional approach, those obtained in previous studies that involved SAD patients or healthy and subclinical participants. It may help to refine further therapeutic strategies based on markers of social anxiety.