Maintenance Of Social Anxiety Research Articles

Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample

According to cognitive models, post-event processing (PEP) is a key factor in the maintenance of social anxiety. Given that decreasing PEP can be challenging for socially anxious individuals, it is important to identify potentially useful strategies. Although distraction may help to decrease PEP, the findings have been equivocal. The primary purpose of this study was to examine whether a brief distraction period immediately following a speech would lead to less PEP the next day. The secondary aim was to examine the effect of distraction following an initial speech on anticipatory anxiety for a second speech, via reductions in PEP. Participants (N = 77 undergraduates with elevated social anxiety; 67.53% female) delivered a speech and were randomly assigned to a distraction, rumination, or control condition. The following day, participants reported levels of PEP in relation to the first speech, as well as anxiety regarding a second, upcoming speech. As expected, those in the distraction condition reported less PEP than those in the rumination and control conditions. Additionally, distraction following the first speech was indirectly related to anticipatory anxiety for the second speech, via PEP. Distraction may represent a potentially useful strategy for reducing PEP and other maladaptive processes that may maintain social anxiety.

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.

Self-focused attention affects subsequent processing of positive (but not negative) performance appraisals

Background and objectivesCognitive-behavioral models highlight the conjoint roles of self-focused attention (SFA), post-event processing (PEP), and performance appraisals in the maintenance of social anxiety. SFA, PEP, and biased performance appraisals are related to social anxiety; however, limited research has examined how SFA affects information-processing following social events. The current study examined whether SFA affects the relationships between performance appraisals and PEP following a social event.. Methods137 participants with high (n = 72) or low (n = 65) social anxiety were randomly assigned to conditions of high SFA or low SFA while engaging in a standardized social performance. Subsequent performance appraisals and PEP were measured. ResultsImmediate performance appraisals were not affected by SFA. High levels of SFA led to a stronger, inverse relationship between immediate positive performance appraisals and subsequent negative PEP. High levels of SFA also led to a stronger, inverse relationship between negative PEP and changes in positive performance appraisals.. LimitationsFuture research should examine whether the current findings, which involved a standardized social performance event, extend to interaction events as well as in a clinical sample. ConclusionsThese findings suggest that SFA affects the processing of positive information following a social performance event. SFA is particularly important for understanding how negative PEP undermines positive performance appraisals..

Updating the emotional content of working memory in social anxiety

Background and objectivesCognitive accounts suggest that information processing biases have an important role in the etiology and maintenance of social anxiety (SA). Empirical evidence support this notion has been established in variety of cognitive domains. Yet, it is still not known how social anxious individuals process emotional content in working memory (WM). Maladaptive WM updating may influence emotion regulation and anxiety during social situations in SA. Thus, the aim of the present study was to explore biases when updating emotional content in SA. Methods31 participants with high SA and 34 control participants performed an emotional 2-back task. Biases were assessed by intrusion cost in reaction times, which reflects the conflict between the inhibition of irrelevant content and the activation of relevant content. ResultsResults revealed a diminished intrusion cost in reaction times for irrelevant positive content in the high, but not in the low SA group. No differences were found for negative or neutral content. LimitationsIn the present study we used an analogue sample of students with high SA rather than a true clinical sample. Further research is needed to examine WM updating in clinical population. ConclusionsThese findings suggest that individuals with SA are better at inhibiting irrelevant positive information, a maladaptive cognitive bias that may prevent positive feedback from entering the cognitive system. This cognitive bias in WM may play a role in the etiology and maintenance of SA.

The effects of interpretation bias for social events and automatic thoughts on social anxiety

Many studies have demonstrated that individuals with social anxiety interpret ambiguous social situations negatively. It is, however, not clear whether the interpretation bias discriminatively contributes to social anxiety in comparison with depressive automatic thoughts. The present study investigated the effects of negative interpretation bias and automatic thoughts on social anxiety. The Social Intent Interpretation-Questionnaire, which measures the tendency to interpret ambiguous social events as implying other's rejective intents, the short Japanese version of the Automatic Thoughts Questionnaire-Revised, and the Anthropophobic Tendency Scale were administered to 317 university students. Covariance structure analysis indicated that both rejective intent interpretation bias and negative automatic thoughts contributed to mental distress in social situations mediated by a sense of powerlessness and excessive concern about self and others in social situations. Positive automatic thoughts reduced mental distress. These results indicate the importance of interpretation bias and negative automatic thoughts in the development and maintenance of social anxiety. Implications for understanding of the cognitive features of social anxiety were discussed.

Interpretation bias modification for youth and their parents: A novel treatment for early adolescent social anxiety

Social anxiety is the most prevalent anxiety disorder of late adolescence, yet current treatments reach only a minority of youth with the disorder. Effective and easy-to-disseminate treatments are needed. This study pilot tested the efficacy of a novel, online cognitive bias modification for interpretation (CBM-I) intervention for socially anxious youth and their parents. The CBM-I intervention targeted cognitive biases associated with early adolescents’ maladaptive beliefs regarding social situations, and with parents’ intrusive behavior, both of which have been theoretically linked with the maintenance of social anxiety in youth. To investigate the efficacy of intervening with parents and/or children, clinically diagnosed early adolescents (ages 10–15; N=18) and their mothers were randomly assigned to one of three conditions: the first targeted early adolescents’ cognitive biases related to social anxiety (Child-only condition); the second targeted parents’ biases associated with intrusive behavior (Parent-only condition); and the third targeted both youth and parents’ biases in tandem (Combo condition). The use of a multiple baseline design allowed for the efficient assessment of causal links between the intervention and reduction in social anxiety symptoms in youth. Results provided converging evidence indicating modest support for the efficacy of CBM-I, with no reliable differences across conditions. Taken together, results suggest that online CBM-I with anxious youth and/or their parents holds promise as an effective and easily administered component of treatment for child social anxiety that deserves further evaluation in a larger trial.

Laughter perception in social anxiety

BackgroundLaughter is a powerful signal of social acceptance or rejection while the fear of being embarrassed and humiliated is central in social anxiety (SA). This type of anxiety is associated with cognitive biases indicating increased sensitivity to social threat as well as with deficits in emotion regulation. Both are thought to be implicated in the maintenance of social anxiety. MethodUsing laughter as a novel stimulus, we investigated cognitive biases and their modulation through emotion regulation and cue ambiguity in individuals with varying degrees of SA (N = 60). ResultsA combination of a negative laughter interpretation bias and an attention bias away from joyful/social inclusive laughter in SA was observed. Both biases were not attributable to effects of general anxiety and were closely correlated with the concept of gelotophobia, the fear of being laughed at. DiscussionThus, our study demonstrates altered laughter perception in SA. Furthermore, it highlights the usefulness of laughter as a highly prevalent social signal for future research on the interrelations of interpretation and attention biases in SA and their modulation through emotion regulation.

They are laughing at me: cerebral mediation of cognitive biases in social anxiety.

The fear of embarrassment and humiliation is the central element of social anxiety. This frequent condition is associated with cognitive biases indicating increased sensitivity to signals of social threat, which are assumed to play a causal role in the maintenance of social anxiety. Here, we employed laughter, a potent medium for the expression of acceptance and rejection, as an experimental stimulus in participants selected for varying degrees of social anxiety to identify cerebral mediators of cognitive biases in social anxiety using functional magnetic resonance imaging in combination with mediation analysis. We directly demonstrated that cerebral activation patterns within the dorsal attention network including the left dorsolateral and dorsomedial prefrontal cortex mediate the influence of social anxiety on laughter perception. This mediation proved to be specific for social anxiety after correction for measures of general state and trait anxiety and occurred most prominently under bimodal audiovisual laughter presentation when compared with monomodal auditory or visual laughter cues. Considering the possibility to modulate cognitive biases and cerebral activity by neuropsychological trainings, non-invasive electrophysiological stimulation and psychotherapy, this study represents a starting point for a whole line of translational research projects and identifies promising targets for electrophysiological interventions aiming to alleviate cognitive biases and symptom severity in social anxiety.

Virtual Environments Using Video Capture for Social Phobia with Psychosis

A novel virtual environment (VE) system was developed and used as an adjunct to cognitive behavior therapy (CBT) with six socially anxious patients recovering from psychosis. The novel aspect of the VE system is that it uses video capture so the patients can see a life-size projection of themselves interacting with a specially scripted and digitally edited filmed environment played in real time on a screen in front of them. Within-session process outcomes (subjective units of distress and belief ratings on individual behavioral experiments), as well as patient feedback, generated the hypothesis that this type of virtual environment can potentially add value to CBT by helping patients understand the role of avoidance and safety behaviors in the maintenance of social anxiety and paranoia and by boosting their confidence to carry out "real-life" behavioral experiments.

Social Anxiety and Social Anxiety Disorder

Research on social anxiety and social anxiety disorder has proliferated over the years since the explication of the disorder through cognitive-behavioral models. This review highlights a recently updated model from our group and details recent research stemming from the (a) information processing perspective, including attention bias, interpretation bias, implicit associations, imagery and visual memories, and (b) emotion regulation perspective, including positive emotionality and anger. In addition, we review recent studies exploring the roles of self-focused attention, safety behaviors, and post-event processing in the maintenance of social anxiety. Within each area, we detail the ways in which these topics have implications for the treatment of social anxiety and for future research. Finally, we conclude with a discussion of how several of the areas reviewed contribute to our model of social anxiety disorder.

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.

Depersonalization/derealization during acute social stress in social phobia

The present study aimed at investigating how frequently and intensely depersonalization/derealization symptoms occur during a stressful performance situation in social phobia patients vs. healthy controls, as well as testing hypotheses about the psychological predictors and consequences of such symptoms.N=54 patients with social phobia and N=34 control participants without mental disorders were examined prior to, during, and after a standardized social performance situation (Trier Social Stress Test, TSST). An adapted version of the Cambridge Depersonalization Scale was applied along with measures of social anxiety, depression, personality, participants’ subjective appraisal, safety behaviours, and post-event processing.Depersonalization symptoms were more frequent in social phobia patients (92%) than in controls (52%). Specifically in patients, they were highly positively correlated with safety behaviours and post-event-processing, even after controlling for social anxiety.The role of depersonalization/derealization in the maintenance of social anxiety should be more thoroughly recognized and explored.

Cognitive Bias Modification in Pre-adolescent Children: Inducing an Interpretation Bias Affects Self-imagery

Information processing models suggest that biased interpretation and self-imagery are implicated in the genesis and maintenance of social anxiety. Previous work has shown that inducing an interpretation bias can change the valence of self-related imagery in adults. This study extends previous findings by examining this possibility in children. The effects of manipulating interpretations concerning hypothetical social events in either a benign or a negative direction were tested by having children report on self-imagery generated during subsequent exposure to ambiguous social situations. Our results showed that children reported more negatively valenced self-imagery after prior practice in endorsing negative rather than benign interpretations for ambiguous events. Importantly, this effect was particularly pronounced in children with high levels of social anxiety. These results demonstrate that manipulating interpretive biases can result in corresponding changes in children’s self-imagery and further highlight the importance of future research on the relation among cognitive biases.

Neural response to the observable self in social anxiety disorder

Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping. Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range. Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.

Cognitive bias modification in the prevention of adolescent social anxiety

Threat-related automatic associations are assumed to play an important role in the development and maintenance of social anxiety. We tested whether threat-related automatic associations are already evident in high socially anxious adolescents, by comparing a group of adolescents (age 12-15) with subclinical levels of social anxiety (n = 170) to a group of low socially anxious adolescents (n = 193). We used a singletarget implicit association test to measure threat-related automatic associations to social cues. Results showed that indeed in high socially anxious adolescents social cues automatically elicited relatively strong threat-related associations. Supporting the relevance of differentiating between automatic and more explicit measures, both automatic and explicit associations were independently associated with adolescents’ level of self-reported social anxiety. The present pattern of findings is not only consistent with the view that automatic and more deliberate threat-related associations are both involved in the etiology of social anxiety symptoms, but also suggest that both types of associations are proper targets for early intervention programs.

The Relationship Among Self-Efficacy, Negative Self-Referent Cognitions, and Social Anxiety in Children: A Multiple Mediator Model

Evidence suggests that general self-efficacy, an individual's beliefs about his global abilities, and social self-efficacy, an individual's beliefs in his ability to navigate social situations, are strongly connected to levels of social anxiety. Negative self-statements, also known as negative self-referent cognitions, have also been linked with levels of social anxiety. Although self-efficacy and negative self-statements have been shown to be important variables in the phenomenology and maintenance of social anxiety in children, they have yet to be examined in conjunction with one another. The purpose of this study was to examine the relationship between negative self-referent cognitions and self-efficacy and to examine both general self-efficacy and social self-efficacy as mediator variables in the relationship between negative self-statements and social anxiety. Results were based on a sample of 126 children ages 11 to 14years. A significant association between negative self-statements and both general self-efficacy and social self-efficacy was established. Results also indicated that general self-efficacy fully mediated the relationship between negative self-statements and social anxiety; however, contrary to hypotheses, social self-efficacy did not mediate the relationship between negative self-statements and social anxiety. Implications and future recommendations are discussed.

Threat-related automatic associations in socially anxious adolescents

Threat-related automatic associations are assumed to play an important role in the development and maintenance of social anxiety. We tested whether threat-related automatic associations are already evident in high socially anxious adolescents, by comparing a group of adolescents (age 12–15) with subclinical levels of social anxiety (n=170) to a group of low socially anxious adolescents (n=193). We used a single-target implicit association test to measure threat-related automatic associations to social cues. Results showed that indeed in high socially anxious adolescents social cues automatically elicited relatively strong threat-related associations. Supporting the relevance of differentiating between automatic and more explicit measures, both automatic and explicit associations were independently associated with adolescents’ level of self-reported social anxiety. The present pattern of findings is not only consistent with the view that automatic and more deliberate threat-related associations are both involved in the etiology of social-anxiety symptoms, but also suggest that both types of associations are proper targets for early intervention programs.

Post-event processing and physiological arousal in social anxiety

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

Drinking Motives as Mediators of Social Anxiety and Hazardous Drinking Among College Students

Although social anxiety (SA) and alcohol use disorders commonly co-occur, the relationship between these variables in college populations has been inconsistent. The present study tested the hypothesized model that negatively reinforcing, but not positively reinforcing, drinking motives (or reasons for drinking) would mediate the association between SA and three aspects of hazardous drinking (quantity/frequency, consequences, and dependence symptoms) in an ethnically diverse sample of college drinkers (N = 817; mean age = 19.9 years, range = 18–29). Structural equation modeling (SEM) results using the asymmetrical distribution of products test indicated that coping motives partially mediated the relationship between SA and negative consequences and dependence symptoms but not the quantity/frequency outcome. Contrary to the hypothesized model, conformity motives did not mediate the association between SA and hazardous drinking. As expected, positive reinforcement motives did not mediate the SA–hazardous drinking association. Multigroup SEM analyses revealed that the mediation models did not differ for men (n = 215) and women (n = 602). Overall, the present findings support extant research and theoretical models regarding the mediating role of coping motives in the relationship between SA and problem drinking, suggesting a potential pathway for the development and maintenance of SA and alcohol use disorder comorbidity. Such findings could contribute to improved intervention programs by targeting coping drinking motives and building coping skills.

Social anxiety in adolescents: the effect of video feedback on anxiety and the self‐evaluation of performance

A negative self-generated image is thought to play a role in the development and maintenance of social anxiety. Video feedback (VF) is an effective therapeutic technique for correcting this distorted image with adults during stressful social tasks. This study investigated the effectiveness of VF with adolescents. Thirty-six highly socially anxious adolescents (13 to 17-year-olds) were randomly assigned to one of two groups: VF or no VF. Both groups gave two brief speeches to a video camera. Self-rated measures of anticipatory anxiety, predicted performance and actual performance during the speeches were completed at several time points. The speeches were also rated by two independent observers. Adolescents who received VF, in comparison with control participants, developed more positive appraisals of their performance during the first speech. Predictions of their performance on the second speech also improved, and a reduction in state anxiety was observed. Furthermore, a more positive appraisal of performance was generalized to the second speech. The independent observers could not distinguish between the participants who received VF and those who did not. When used with socially anxious adolescents, VF may be a beneficial therapeutic technique in correcting a distorted self-perception of performance, reducing anxiety prior to entering a stressful social task and enhancing predictions of performance for future tasks.