Maintenance Of Social Anxiety Disorder Research Articles

Fear of Negative and Positive Evaluation as Mediators and Moderators of Treatment Outcome in Social Anxiety Disorder

IntroductionElevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined. MethodsThis sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up. ResultsCBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist – higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT. DiscussionFNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review.

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Clinical, demographic and theory-derived maintaining factors as moderators of treatment outcome in internet-delivered cognitive behavioural therapy for children and adolescents with social anxiety disorder

Internet-delivered cognitive behavioural therapy (ICBT) is an efficacious treatment for social anxiety disorder (SAD) in youth. However, we have limited knowledge about patient characteristics that may be associated with better (or worse) treatment outcome. Particularly concerning factors suggested to be involved in the maintenance of SAD (e.g., anticipatory anxiety and post-event processing). The aim of the current study was to evaluate possible predictors and moderators of the effect of ICBT in a randomised controlled trial where children and adolescents (N = 103; 10–17 years) with SAD received either ICBT or internet-delivered supportive therapy, ISUPPORT. Examined variables were pre-treatment levels of social anxiety, depression symptoms, putative maintaining factors as well as demographic variables like age and gender. Latent growth curve models were used to examine predictors and moderators of changes in youth and clinician rated social anxiety symptoms, from pre-treatment to 3-month follow-up. Baseline depression symptoms moderated the outcome, with higher depression scores being associated with greater reduction of SAD symptoms in ICBT compared to ISUPPORT. More difficulties at baseline with anticipatory anxiety, post-event processing, focus of attention and safety behaviours predicted greater reduction of SAD symptoms, regardless of treatment condition. No other clinical or demographic variable predicted or moderated the outcome. In summary, baseline depression severity may be an important moderator of ICBT, but the preliminary finding needs replication in sufficiently powered trials.

Always Saying the Wrong Thing: Negative Beliefs About Losing Control Cause Symptoms of Social Anxiety.

BackgroundIndividuals with social anxiety disorder (SAD) often report a fear that they will lose control of their emotions or report intense, unpleasant thoughts or images of uncontrollably humiliating themselves in social situations. These fears and associated beliefs that one is likely to lose control may underlie the anxiety and/or cognitive biases (e.g., self-focused attention and negative post-event processing) experienced during and following social situations. The present experiment examined whether manipulating beliefs about losing control would cause changes in symptoms of SAD.MethodsOne hundred and twenty-six undergraduate psychology students were given false feedback that they were either at high or low risk of losing control, and then completed a social interaction task with an actor. Participants rated their anxiety before and during the interaction and completed a post-event processing questionnaire 24-hours later.ResultsParticipants in the high beliefs about losing control (HLC) condition reported significantly greater subjective anxiety than those in the low beliefs about losing control (LLC) condition leading up to the social interaction task, and significantly more negative post-event processing.ConclusionResults suggest beliefs about losing control may play a causal role in the development and maintenance of SAD. These beliefs may represent a novel domain to be targeted in CBT.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10608-022-10325-w.

Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships.

ObjectiveResearchers have suggested that psychotherapy may be enhanced by the addition of 3,4‐methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder.DesignThis is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes.ResultsWe first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self‐transcendence and self‐transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors.ConclusionWe discuss how processes of change may extend beyond the MDMA dosing sessions themselves.

MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder.

Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.

The grass is always greener: Envy in social anxiety disorder

In the present study we examined envy in social anxiety disorder (SAD) and its potential role in maintaining the disorder. In addition, we examined social contexts and modes of communication that may serve as moderators of envy in SAD, and the temporal relationship between envy and anxiety in the disorder. Our sample included 88 individuals (44 with SAD and 44 without SAD) who underwent an experience sampling procedure in which participants received daily measures of emotions for 21 days. Using multilevel linear modeling we found that individuals with SAD experienced elevated envy compared to individuals without SAD and this was enhanced in social (compared to non-social) contexts. For individuals with SAD, visual modes of communication were associated with elevated envy compared to voice/text communication. Finally, envy predicted subsequent anxiety above and beyond previous anxiety and additional negative emotions. The role of envy in the psychopathology and maintenance of SAD, as well as clinical implications are discussed.

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n = 30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

Restricted Visual Scanpaths During Emotion Recognition in Childhood Social Anxiety Disorder.

Background: Social anxiety disorder (SAD) has its typical onset in childhood and adolescence. Maladaptive processing of social information may contribute to the etiology and maintenance of SAD. During face perception, individuals execute a succession of visual fixations known as a scanpath which facilitates information processing. Atypically long scanpaths have been reported in adults with SAD, but no data exists from pediatric samples. SAD has also been linked to atypical arousal during face perception. Both metrics were examined in one of the largest eye-tracking studies of pediatric SAD to date.Methods: Participants were children and adolescents with SAD (n = 61) and healthy controls (n = 39) with a mean age of 14 years (range 10–17) who completed an emotion recognition task. The visual scanpath and pupil dilation (an indirect index of arousal) were examined using eye tracking.Results: Scanpaths of youth with SAD were shorter, less distributed, and consisted of a smaller number of fixations than those of healthy controls. These findings were supported by both frequentist and Bayesian statistics. Higher pupil dilation was also observed in the SAD group, but despite a statistically significant group difference, this result was not supported by the Bayesian analysis.Conclusions: The results were contrary to findings from adult studies, but similar to what has been reported in neurodevelopmental conditions associated with social interaction impairments. Restricted scanpaths may disrupt holistic representation of faces known to favor adaptive social understanding.

Emotion regulation therapy for social anxiety disorder: a single case series study.

Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.

Increased attention allocation to socially threatening faces in social anxiety disorder: A replication study

BackgroundThreat-related attention bias has been implicated in the etiology and maintenance of social anxiety disorder (SAD), with attentional research increasingly using eye-tracking methodology to overcome the poor psychometric properties of response-time-based tasks and measures. Yet, extant eye-tracking research in social anxiety has mostly failed to report on psychometrics and attempts to replicate past results are rare. Therefore, we attempted to replicate a previously published eye-tracking study of gaze patterns in socially anxious and nonanxious participants as they viewed social threatening and neutral faces, while also exploring the psychometric properties of the attentional measures used. MethodsGaze was monitored as participants freely viewed 60 different matrices comprised of eight socially-threatening and eight neutral faces, presented for 6000 ms each. Gaze patterns directed at threat and neutral areas of interest (AOIs) were compared by group. Internal consistency and test-retest reliability were also evaluated. ResultsRelative to healthy controls, socially anxious patients dwelled significantly longer on threat faces, replicating prior findings with the same task. Internal consistency of total dwell time on threat and neutral AOIs was high, and two-week test-retest reliability was acceptable. LimitationsTest-retest reliability was only examined for the control group, which had a small sample size. ConclusionIncreased dwell time on socially threatening stimuli is a reliable, stable, and generalizable measure of attentional bias in adults with social anxiety.

Beneficial Effects of Role Reversal in Comparison to role-playing on negative cognitions about Other's Judgments for Social Anxiety Disorder

Background and objectivesNegative beliefs about other's judgments play an important role in the development and maintenance of social anxiety disorder. The present experiment examined the effects of role-playing followed by role reversal compared to role-playing twice on altering these negative cognitions. MethodsThirty-six adult social anxiety patients were randomized into two conditions: a role-playing condition in which 18 participants role-played an anxiety-provoking social situation twice, or a role reversal condition in which 18 participants role-played an anxiety-provoking social situation followed by enacting the same situation using role reversal. Before the start of the experiment, patients were asked to report their negative cognitions about the other's judgments. Next, they were asked to rate the believability of these negative cognitions, as well as the probability and cost estimates of negative judgments by the other person, at three time-points: before the first block of role-playing, after the first block of role-playing, and after the second block of the experiment. ResultsResults demonstrated that role-playing followed by role reversal had a stronger effect on the most negative cognitions than role-playing twice. LimitationsThe most important limitation of the present study is that there was no control group to assess the effects of role-playing alone. Moreover, the second block of the experiment was repetitive in role-playing, however, it was a new task in role reversal. ConclusionsThe results support the hypothesis that role reversal is an effective technique that can be used to correct negative cognitions about other's judgments in SAD.

Biased Perception of Physiological Arousal in Child Social Anxiety Disorder Before and After Cognitive Behavioral Treatment.

A biased perception of physiological hyperreactivity to social-evaluative situations is crucial for the maintenance of social anxiety disorder (SAD). Alterations in interoceptive accuracy (IAc) when confronted with social stressors may play a role for SAD in children. We expected a biased perception of hyperarousal in children with SAD before treatment and, consequently, a reduced bias after successful cognitive behavioral therapy (CBT). In two centers, 64 children with the diagnosis of SAD and 55 healthy control (HC) children (both 9 to 13 years) participated in the Trier Social Stress Test for Children (TSST-C), which was repeated after children with SAD were assigned to either a 12-week group CBT (n = 31) or a waitlist condition (n = 33). Perception of and worry about physiological arousal and autonomic variables (heart rate, skin conductance) were assessed. After each TSST-C, all children further completed a heartbeat perception task to assess IAc. Before treatment, children with SAD reported both a stronger perception of and more worry about their heart rate and skin conductance than HC children, while the objective reactivity of heart rate did not differ. Additionally, children with SAD reported heightened perception of and increased worry about trembling throughout the TSST-C compared to HC children, but reported increased worry about blushing only after the stress phase of the TSST-C compared to HC children. Children with and without SAD did not differ in IAc. Contrary to our hypothesis, after treatment, children in the CBT group reported heightened perception of physiological arousal and increased worry on some parameters after the baseline phase of the TSST-C, whereas actual IAc remained unaffected. IAc before and after treatment were significantly related. Increased self-reported perception of physiological arousal may play a role in childhood SAD and could be an important target in CBT. However, further studies should examine if this is an epiphenomenon, a temporarily occurring and necessary condition for change, or indeed an unwanted adverse intervention effect.

Reward Circuitry and Motivational Deficits in Social Anxiety Disorder: What Can Be Learned From Mouse Models?

Social anxiety disorder (SAD) is a common and serious psychiatric condition that typically emerges during adolescence and persists into adulthood if left untreated. Prevailing interventions focus on modulating threat and arousal systems but produce only modest rates of remission. This gap in efficacy suggests that most mainstream treatment concepts do not sufficiently target core processes involved in the onset and maintenance of SAD. This idea has further driven the development of new theoretical models that target dopamine (DA)-driven reward circuitry and motivational deficits that appear to be systematically altered in SAD. Most of the available data linking systemic alterations in DA neurobiology to SAD in humans, although abundant, remains at the level of correlational evidence. Accordingly, the purpose of this brief review is to critically evaluate the relevance of experimental work in rodent models that link details of DA function to symptoms of social anxiety. We conclude that, despite certain systematic limitations inherent in animal models, these approaches provide useful insights into human biomarkers of social anxiety including that (1) adolescence may serve as a critical period for the convergence of neurobiological and environmental factors that modify future expectations about social reward through experience dependent changes in DA-ergic circuitry, (2) females may show unique susceptibility to social anxiety symptoms when encountering relational instability that influences DA-related neural processes, and (3) separate from fear and arousal systems, the functional neurobiology of central DA systems contribute uniquely to susceptibility and maintenance of anhedonic factors relevant to human models of SAD.

Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy.

Social anxiety disorder (SAD) is a psychiatric condition that often onsets in childhood. Cognitive models underline the role of attention in the maintenance of SAD, but studies on youth populations are few, particularly those using eye tracking to measure attention. Cognitive behavioral therapy (CBT) for SAD includes interventions targeting attention, like exposure to eye contact, but the link between CBT and attention bias is largely unexplored. This study investigated attention bias in youth with SAD and the association with outcome from CBT. Latency to attend to pictures of faces with different emotions (vigilance) and latency to disengage from social stimuli (avoidance) was examined in N = 25 adolescents (aged 13-17) with SAD in relation to treatment outcome. Vigilance was operationalized as the time it took to relocate the gaze from a central position to a peripherally appearing social stimulus. The latency to disengage from a centrally located social stimulus, when a non-social stimulus appeared in the periphery, was used as a proxy for avoidance. Attention characteristics in the SAD group were compared to non-anxious (NA) controls (N = 22). Visual attention was measured using eye tracking. Participants in both the SAD and NA groups were vigilant towards angry faces, compared to neutral and happy faces. Similarly, both groups disengaged attention faster from angry faces. Adolescents with SAD who disengaged faster from social stimuli had less social anxiety after CBT. The results indicate that anxious youth display a vigilant-avoidant attention pattern to threat. However, partly inconsistent with previous research, the same pattern was observed in the NA group.

Cognitive predictors of treatment outcome for exposure therapy: do changes in self-efficacy, self-focused attention, and estimated social costs predict symptom improvement in social anxiety disorder?

BackgroundCognitions play an important role in the development and maintenance of social anxiety disorder (SAD).MethodsTo investigate whether changes in cognitions during the first six sessions of exposure therapy are associated with treatment outcome, we assessed reported self-focused attention, self-efficacy in social situations, and estimated social costs in 60 participants (Mage = 36.9 years) diagnosed with SAD who received in vivo or virtual reality exposure therapy.ResultsPatients demonstrating a greater decrease in estimated social costs during treatment reported greater improvement of their social anxiety symptoms following both forms of exposure therapy. While changes in self-focused attention and social self-efficacy during treatment were significantly associated with treatment outcome when examined individually, these changes did not significantly predict symptom improvement beyond social costs.ConclusionsChanges in estimated social costs during treatment are associated with improvement of social anxiety symptoms after exposure therapy. Future research needs to further investigate estimated social costs as a predictor in relation to other cognitive variables.Trial registrationNCT01746667; www.clinicaltrials.gov, November 2012, retrospectively registered.

Developing a Brief Version of the Social Thoughts and Beliefs Scale (STABS) Using Item Response Theory

Cognitions play a central role in the maintenance of social anxiety disorder (SAD). The aim of the present study was to develop a brief version of the social thoughts and beliefs scale (STABS) that can be used in clinical trials and experience sampling studies in which multiple repeated measures (e.g., weekly or daily measurements) are utilized. Our sample (n = 361) included both individuals diagnosed with SAD (n = 108) and non-anxious controls (n = 253). We used item response theory analyses to examine items of the STABS and kept only items which differentiated between 4 levels of SAD-related cognitions between the 5th and 95th percentiles of scores. This strategy resulted in a brief, seven-item scale—the mini-STABS. We then compared the mini-STABS with the full-length, 21-item STABS, as well as examined convergent and divergent validity for the brief measure. Results indicated that the mini-STABS was highly correlated with the 21-item STABS, and demonstrated similar patterns of associations with convergent and divergent measures compared to the 21-item STABS. These findings suggest that the mini-STABS is a psychometrically sound brief version of the STABS that provides similar information using fewer items. Implications for assessment of SAD are discussed.

Development and validation of a measure of maladaptive social-evaluative beliefs characteristic of social anxiety disorder in youth: The Report of Youth Social Cognitions (RYSC).

Recent research has started to examine the applicability of influential adult models of the maintenance of social anxiety disorder (SAD) to youth. This research is limited by the lack of psychometrically validated measures of underlying constructs that are developmentally appropriate for youth. One key construct in adult models of SAD is maladaptive social-evaluative beliefs. The current study aimed to develop and validate a measure of these beliefs in youth, known as the Report of Youth Social Cognitions (RYSC). The RYSC was developed with a clinical sample of youth with anxiety disorders (N = 180) and cross-validated in a community sample of youth (N = 305). In the clinical sample, the RYSC exhibited a 3-factor structure (negative evaluation, revealing self, and positive impression factors), good internal consistency, and construct validity. In the community sample, the 3-factor structure and the internal consistency of the RYSC were replicated, but the test of construct validity showed that the RYSC had similarly strong associations with social anxiety and depressed affect. The RYSC had good test-retest reliability overall, although the revealing self subscale showed lower temporal stability which improved when only older participants were considered (age ≥9 years). The RYSC in general was also shown to discriminate between youth with and without SAD although the revealing self subscale again performed suboptimally but improved when only older participants were considered. These findings provide psychometric support for the RYSC and justifies its use with youth in research and clinical settings requiring the assessment of maladaptive social-evaluative beliefs. (PsycINFO Database Record

Does Exposure Therapy Lead to Changes in Attention Bias and Approach-Avoidance Bias in Patients with Social Anxiety Disorder?

Cognitive biases have been suggested to play a crucial role in the etiology and maintenance of social anxiety disorder (SAD). The aim of the present study was to investigate the effects of exposure therapy on attention- and approach-avoidance bias in SAD. In a randomized controlled trial, we compared changes from pre- to posttreatment in both biases in patients receiving stand-alone exposure therapy to a waiting-list control condition comprising 60 participants (Mage = 36.9 years) with SAD with heterogeneous social fears. Before and after treatment, attention bias was assessed using the dot probe task and approach-avoidance bias using the approach avoidance task. Results revealed that pre- to posttreatment changes in attention bias and approach-avoidance bias in exposure therapy did not significantly differ from changes in the waiting-list condition. Limitations and potential implications of the current results are discussed.

Attentional biases to threat in social anxiety disorder: time to focus our attention elsewhere?

ABSTRACTBackground: Cognitive models propose that attentional biases to threat contribute to the maintenance of social anxiety disorder (SAD). However, the specific characteristics of such biases are still object to debate.Objectives: The current study aimed to disentangle effects of trait and state social anxiety on attention allocation towards social stimuli.Methods: Participants with SAD (n = 67) and healthy controls (n = 62) completed three visual search tasks while their eye movements were recorded. Half of the participants in each group were randomly assigned to a state anxiety induction.Results: Contrary to our predictions, neither trait nor state social anxiety was associated with a facilitated attention to or a delayed disengagement from threat. However, participants with SAD did show reduced fixation durations for threatening stimuli, indicating an avoidance of threat. Induction of state anxiety led to an increased distractibility by threat.Conclusions: We suggest that attention allocation in SAD is characterized by an avoidant rather than a vigilant attentional bias. Accordingly, our results contradict previous results that associate SAD with facilitated attention to threat and existing approaches to modify attentional biases, that aim to decrease attention towards threatening stimuli.