Negative Social Cognitions Research Articles

Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats

BackgroundCompared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats. ObjectiveTo examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD). MethodsData from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format. ResultsNegative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed. ConclusionThe online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions.

Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice

BackgroundSudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice. ObjectiveThis study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains. MethodsThe study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood. ResultsSeventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints. ConclusionsApproximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.

Social Anxiety Symptoms in Adolescents and Young Adults Recently Diagnosed with Cancer.

Purpose: Social anxiety disorder (SAD) remains an understudied potential link between the cancer experience and adolescent and young adult (AYA) cancer survivors' poor psychosocial outcomes. We investigated the frequency and duration of, as well as factors associated with, symptoms of SAD among AYAs with cancer. Methods: This longitudinal, mixed-methods study involved online surveys (including a validated screening tool for SAD) at recruitment and 6 months later, and a structured clinical interview. Results: Twenty-eight AYAs (aged 12-30 years, <1-year postdiagnosis, 50% male) completed the first survey (M = 6 months postdiagnosis). About 32% reported clinically significant SAD symptoms. Fourteen completed the follow-up survey (M = 12 months postdiagnosis), of which 9 (62%) reported persistent or worse symptoms of SAD significantly associated with emotional distress, physical appearance concerns, negative social cognitions, and depression. Conclusion: A subset of AYAs with cancer may experience clinically significant SAD symptoms that can affect their psychosocial well-being. Further work on how to best identify and support AYAs with SAD is needed.

Cognitive and behavioural processes in adolescents with social anxiety disorder

BackgroundA better understanding of the processes that maintain social anxiety disorder (SAD) in adolescents could improve treatment outcomes. This study aimed to establish whether cognitive and behavioural processes known to be important in the maintenance of adult SAD are observed in adolescent populations and whether they are specific to SAD. MethodsWe recruited three groups of adolescents (12-18y): (1) 90 adolescents with a SAD diagnosis, (2) 58 adolescents with an anxiety disorder that was not SAD, and (3) 45 community-based adolescents. Participants completed measures of negative social cognitions, social attitudes, safety behaviours, self-focused attention, and social anxiety, anxiety, and depression symptoms. ResultsThe clinical SAD sample endorsed higher levels of negative social cognitions, attitudes, and safety behaviours compared to both control groups. Self-focused attention was higher in the clinical SAD sample compared to the anxiety clinical control group but not compared to the community control group. ConclusionsThis study provided evidence of SAD-specific mechanisms including negative social cognitions, attitudes and safety behaviours in adolescents. The study did not provide evidence of disorder-specific mechanisms of self-focused attention but this may have been due to methodological limitations. These findings indicate avenues for further research and point to the potential value of Cognitive Therapy for the treatment of adolescent SAD.

Dynamic regulatory processes among child welfare parents: Temporal associations between physiology and parenting behavior.

This study examined how temporal associations between parents' physiological and behavioral responses may reflect underlying regulatory difficulties in at-risk parenting. Time-series data of cardiac indices (second-by-second estimates of inter-beat intervals - IBI, and respiratory sinus arrhythmia - RSA) and parenting behaviors were obtained from 204 child welfare-involved parents (88% mothers, Mage = 32.32 years) during child-led play with their 3- to 7-year-old children (45.1% female; Mage = 4.76 years). Known risk factors for maltreatment, including parents' negative social cognitions, mental health symptoms, and inhibitory control problems, were examined as moderators of intra-individual physiology-behavior associations. Results of ordinary differential equations suggested increases in parents' cardiac arousal at moments when they showed positive parenting behaviors. In turn, higher arousal was associated with momentary decreases in both positive and negative parenting behaviors. Individual differences in these dynamic processes were identified in association with parental risk factors. In contrast, no sample-wide RSA-behavior associations were evident, but a pattern of increased positive parenting at moments of parasympathetic withdrawal emerged among parents showing more total positive parenting behaviors. This study illustrated an innovative and ecologically-valid approach to examining regulatory patterns that may shape parenting in real-time and identified mechanisms that should be addressed in interventions.

Sudden gains in face-to-face and internet-based cognitive therapy for social anxiety disorder

Sudden gains are large and stable decreases in clinical symptoms between consecutive therapy sessions. This work examined the frequency and possible determinants of sudden gains in Cognitive Therapy for Social Anxiety Disorder, comparing face-to-face (CT) and internet-based (iCT) formats of treatment delivery. Data from 99 participants from a randomised controlled trial were analysed. The frequency of sudden gains was high: 64% and 51% of participants experienced a sudden gain in CT and iCT respectively. Having a sudden gain was associated with lower social anxiety symptoms at posttreatment and follow-up. There was evidence of reductions in negative social cognitions and self-focused attention immediately prior to the sudden gain, contrasting with no prior reductions in depression symptoms. Ratings of session videotapes in CT showed that clients' statements indicated greater generalised learning in sessions immediately prior to gains, compared to control sessions. This may suggest a role for generalised learning in facilitating these large symptom reductions. There were no significant differences in results between the CT and iCT treatment formats, suggesting that the therapy content appears to play a more important role in determining participants’ large symptom improvements than the medium of treatment delivery.

Putting on your best face: investigating social anxiety in Instagram users

ABSTRACT Objective Socially anxious individuals may prefer social media platforms over in-person interactions. For those with high social anxiety (SA), Facebook-related tasks have been associated with anxiety, negative thoughts, and safety behaviours. However, Instagram-related research remains limited. The present study aimed to assess Instagram use alongside cognitive and behavioural processes among participants with low, medium, and high SA. We hypothesised that when using Instagram, individuals with higher SA would (1) experience more negative social cognitions, (2) report higher body image concerns, (3) endorse more safety behaviours when posting pictures, and (4) engage in more photo manipulation. Method A sample of 213 Instagram users completed an online survey and were divided into groups based on SA severity. Results The high SA group reported comparing themselves to others and being more anxious on Instagram than the low and medium SA groups. Four 3 (SA groups) x 2 (gender) ANOVAs revealed support for the first three hypotheses and that there was no interaction effect between SA and gender for all outcomes. Conclusions Results expand our understanding of how specific social media platforms may be aversive for individuals with high SA, which has important implications for conceptualising the role of safety behaviours in online interactions. KEY POINTS What is already known on this topic: Individuals with high social anxiety may prefer online social interactions. Clark and Wells’ cognitive model of social anxiety can be extended to the online social media platforms. Social anxiety may be underpinned by body image concerns. What this paper adds: Instagram users with social anxiety experienced more negative social media cognitions and reported more safety behaviours. Instagram users with social anxiety also experienced more body image concerns. Despite gender differences in photo manipulation, an associated relationship with social anxiety was not supported.

Belief in Protecting Others and Social Perceptions of Face Mask Wearing Were Associated With Frequent Mask Use in the Early Stages of the COVID Pandemic in the UK.

Face masks are now seen as a key tool in the world’s recovery from the COVID-19 pandemic. However, during the early stages of the outbreak, face mask use in the United Kingdom (UK) was significantly lower than that of countries equally impacted by the virus. We were interested to explore whether social cognitions played a role in levels of mask wearing. A cross-sectional online survey of UK adults (n=908) was conducted in July 2020. Estimated face mask use and thoughts about wearing face masks were assessed using measures developed for this study. Participants also answered questions about their general mood, social anxiety and basic demographic data. Multiple regression was used to examine factors associated with mask wearing. Participants’ estimated mask wearing was low when in public spaces, such as the park (17%) or walking on the high street (36%). However, broadly fitting with UK guidance at the time, rates were considerably higher when in situations of closer proximity to others, such as on public transport (94%), in a shop or café (62%), when speaking to somebody in an enclosed public space (67%) or in a busy area when social distancing was not possible (79%). When looking at estimated mask wearing when in proximity to others, positive social cognitions (e.g., I’ll look confident and competent wearing a mask) were associated with more wearing, whereas negative social cognitions (e.g., I’ll look anxious, I’ll look foolish) were associated with less wearing. These results remained after controlling for factors that have indicated increased risk from COVID-19 (age, gender, ethnicity, presence of a health condition or pregnancy), belief about the health benefit for others and levels of depression and social anxiety. The largest predictors of mask wearing were the amount of people believed wearing a mask would keep others safe and the presence of an underlying health condition. The study findings indicate that future public health campaigns would benefit from a focus on strengthening beliefs about the protective benefits of masks, but also promoting positive social messages about wearing in public (e.g., mask wearing means you are confident and competent).

The contribution of cognitive behavioural factors to social anxiety in Parkinson's disease.

Social anxiety is prevalent in idiopathic Parkinson's disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson's disease, where disease severity and motor symptoms might also influence the experience of social anxiety. This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson's disease. Using a cross-sectional design, 124 people with Parkinson's disease completed self-report questionnaires including measures of Parkinson's disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression. The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not. Social anxiety in Parkinson's disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson's disease.

Social anxiety and online social interaction

ABSTRACT Objective: Clark and Wells cognitive model of social anxiety has significant empirical support and has informed evidence-based treatments for Social Anxiety Disorder. However, to date, research for this model is related to face-to-face social interactions. Considering the increased rates of Internet use and social media worldwide, this study aimed to examine the utility of this model regarding online social interactions, the role of Internet use as an avoidance strategy for face-to-face interactions, and the relationship between social anxiety, online social interactions, and wellbeing. Method: A 109 individuals were recruited via social media to complete a battery of self-report questionnaires assessing social anxiety and Internet use. Results: The findings support the cognitive model of Social Anxiety Disorder and lend support to its relevance in online social interactions. Furthermore, we found that individuals with a high level of social anxiety experience fewer negative social cognitions, less fear of negative evaluation, and prefer online social communication compared to face-to-face communication. However, social anxiety was not significantly associated with Internet use. In contrast to previous research, online social interaction was related to poorer wellbeing regardless of social anxiety. Conclusion: These findings suggest that Internet use and social anxiety related to online social interactions may be important areas for mental health assessment. Despite study limitations, our findings encourage future research in this area. KEY POINTS What is already known about this topic: Social Anxiety Disorder is a prominent and chronic mental health problem. Clark and Wells (1995) cognitive model of social anxiety has significant empirical support for face-to-face interactions. Social Anxiety Disorder is associated with problematic Internet use. What this topic adds: Key aspects of the cognitive model for social anxiety were supported for online social situations. Individuals with social anxiety may be less likely to experience negative social cognitions and fear of negative evaluation while socialising online. Social anxiety symptoms are associated with a preference for online social interaction and Internet use as an avoidance strategy.

Cognitive predictors of adolescent social anxiety

BackgroundIdentifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social anxiety. Despite social anxiety typically starting in adolescence, prospective studies examining these cognitive processes in youth are lacking. The current study examined prospective associations between these five cognitive processes and social anxiety in a sample of 614 participants (53% girls; aged 11–14 years). MethodsPsychological processes, social anxiety symptoms, and depressive symptoms were assessed using self-report questionnaires at two time points. ResultsNegative social cognitions, safety behaviours, self-focused attention, and post-event processing predicted prospective levels of social anxiety over and above the effect of baseline levels of social anxiety. When these process variables were entered together in a regression model, three of them were independently associated with prospective social anxiety. Neither pre- nor post-event processing independently predicted later social anxiety over and above the effects of other psychological process variables. ConclusionsThe findings indicate that these psychological processes are promising targets for treatment in adolescent social anxiety.

Prolonged Exposure and Sertraline Treatments for Posttraumatic Stress Disorder Also Improve Multiple Indicators of Social Functioning.

Trauma survivors with posttraumatic stress disorder (PTSD) frequently also suffer from difficulties in social functioning that range across emotional, cognitive, and environmental domains. A detailed evaluation of the differential impacts of effective PTSD treatments on social functioning is needed. Men and women (N = 200) with chronic PTSD received 10 weeks of prolonged exposure (PE) or sertraline in a randomized clinical trial and were followed for 24 months. A secondary data analysis examined changes in social functioning with regard to fear of intimacy; receipt of social support; and distress, avoidance, and negative cognitions in social situations. Effects were examined between treatments over time, controlling for baseline functioning. There were large, durable improvements across all indices. Compared to sertraline, PE was more efficient at reducing fear of intimacy and distress from negative social cognitions by posttreatment, ds = 0.94-1.14. Patients who received sertraline continued to improve over the course of follow-up, ds = 0.54-1.17. The differential speed of therapeutic effects may argue for more direct mechanisms in cognitive behavioral interventions versus cascade effects in serotonin reuptake inhibitors. Notably, both treatments produced substantial social benefits for trauma survivors with social functioning difficulties, and effect sizes were comparable to typical reductions in PTSD, depression, and anxiety.

Change processes in cognitive therapy for social anxiety disorder delivered in routine clinical practice

Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings. To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cognitive Therapy for SAD (total N = 271). Three process variables (self-focused attention, negative social cognitions, and depressed mood) were examined using multilevel structural equation models. Significant indirect effects were observed for all three variables in both samples, with negative social cognitions showing the strongest percent mediation effect. 'Reversed' relationships, where social anxiety predicted subsequent process variable scores, were also supported. The findings suggest the processes of change in this treatment may be similar between research trials and routine care.

Combating Loneliness With Nostalgia: Nostalgic Feelings Attenuate Negative Thoughts and Motivations Associated With Loneliness.

Loneliness is difficult to overcome, in part because it is associated with negative social cognitions and social motivations. We argue that nostalgia, a positive emotional experience that involves reflecting on cherished memories, is a psychological resource that regulates these maladaptive intrapsychic tendencies associated with loneliness. We tested this hypothesis across 4 studies. Study 1 examined whether nostalgia mitigates the inverse relation between loneliness and social confidence. Studies 2, 3, and 4 examined nostalgia’s potential to mitigate the inverse relation between loneliness and approach-oriented social goals and intentions. The results provided support that nostalgia mitigates reduced social confidence and low approach-oriented social goals/intentions associated with loneliness. The associations between loneliness and reduced social confidence, and loneliness and less approach-oriented social goals/intentions, respectively, were found to be weaker as a function of nostalgia. This weakening appeared to be due to nostalgia’s positive effect on social confidence and approach-oriented social goals/intentions, respectively, particularly at high levels of loneliness.

Perfectionism and Loneliness: The Role of Expectations and Social Hopelessness in Daily Life

Introduction: Research suggests that social disconnection is one pathway that explains why perfectionists have higher negative mental health outcomes. However, thus far research has not examined the role that perfectionists' expectations, about their social world, plays in explaining social disconnection. The current study examined whether negative expectations about future social events and social hopelessness explained the relations between socially prescribed perfectionism (SPP), self-oriented perfectionism (SOP), and social disconnection. Method: The current study used experience sampling methodology (ESM) with 145 participants to test multilevel structural equation models examining whether negative expectations and social hopelessness mediated the relation between SPP (as well as SOP) and loneliness at the following time point. Results: Results indicate that having negative expectations for future social interactions and feeling socially hopeless explains the relation between SPP and loneliness both when loneliness was measured concurrently and loneliness measured later in the day. Having lower levels of social hopelessness explained the relation between SOP and loneliness when loneliness was measured concurrently and later in the day. Discussion: Findings suggest that SPP and SOP are differently associated with cognitions about social interactions and relationships in daily life, which in turn explains variations in loneliness. Results indicate that targeting socially prescribed perfectionists’ negative social cognitions in treatment may be effective for reducing loneliness.

The Association Between Social Isolation and Health: An Analysis of Parent–Adolescent Dyads from the Family Life, Activity, Sun, Health, and Eating Study

We examined the relationship between social isolation and health among parents and their adolescent children. Data came from the 2014 Family Life, Activity, Sun, Health, and Eating Study (FLASHE), a cross-sectional internet study from the National Cancer Institute. Parents and their adolescent children (ages 12–17) completed surveys about demographics, physical activity, and diet; analyses include all dyads in which at least one member provided information for any of the analyzed variables (N = 1851). Actor Partner Interdependence Models in Mplus with demographic covariates tested whether parent and adolescent perceived social isolation (2 items from the UCLA Loneliness Scale) were associated with each person’s self-reported health. Most dyads included a mother (38% mother–daughter, 36% mother–son). Most parents were non-Hispanic White (69%), married/partnered (77%), and reported household income below $100,000 (79%). Both social isolation and self-reported health were significantly correlated between parents and their adolescent children (Pearson correlation = .38 for isolation, .32 for health). There were negative associations between parent isolation and parent health, adolescent isolation and adolescent health, and parent isolation and adolescent health (all ps < .05), but no association between adolescent isolation and parent health. The finding that parents’ social isolation was linked to lower self-reported health not only for themselves but also for their adolescent children highlights the importance of addressing social isolation in clinical social work practice. Family interventions, or interventions to reduce adults’ negative social cognitions or promote social connections, may improve health for both adults and their adolescent children.

Growing Apart: A Longitudinal Assessment of the Relation Between Post-traumatic Growth and Loneliness Among Combat Veterans.

The aftermath of war-related trauma may entail psychological devastation and is typically accompanied by various deleterious phenomena. These include, but are not limited to, high rates of loneliness. However, trauma may also result in positive outcomes such as personal, spiritual, and relational prosperity, which are typically considered under the conceptual framework of post-traumatic growth (PTG). PTG may theoretically contribute to either loneliness amelioration (e.g., via increasing one’s appreciation of close relationships) or exacerbation (e.g., by increasing one’s sense of undergoing experiences that others do not share). Loneliness, on the other hand, may potentially hinder PTG by fostering negative social cognitions and behaviors, or otherwise lead to personal growth. The relations between the two phenomena, however, have yet to be investigated. Filling this gap, the current study examined the aforementioned potentialities by utilizing an autoregressive cross-lagged modeling strategy (ARCL) with a cohort of 260 Israeli combat veterans assessed 30, 35, and 42 years after their participation in the 1973 Yom Kippur War. Results indicated that higher rates of PTG were consistently related to higher rates of loneliness both cross-sectionally and longitudinally. Loneliness, however, did not longitudinally predict PTG rates. It is suggested that these findings may be understood in light of the observation that veterans’ loneliness is primarily related to the experience of being experientially out of sync with people who have not endured war experiences. It is suggested that this experiential loneliness may include not only the negative but also the positive ramifications of undergoing such traumas (i.e., PTG). We, therefore, argue that while PTG may include authentic positive transformations it may also lead to more negative ramifications, and these should be identified and addressed by researchers and clinicians alike. Thus, as study limitations are acknowledged, clinical implications, and future research directions are suggested.

The Role of Performance Quality in Adolescents' Self-Evaluation and Rumination after a Speech: Is it Contingent on Social Anxiety Level?

Cognitive behavioural therapy (CBT) has relatively poor outcomes for youth with social anxiety, possibly because broad-based CBT is not tailored to their specific needs. Treatment of social anxiety in youth may need to pay more attention to negative social cognitions that are considered a key factor in social anxiety development and maintenance. The aim of the present study was to learn more about the role of performance quality in adolescents' cognitions about their social performance and, in particular, the moderating role social anxiety plays in the relationship between performance quality and self-cognitions. A community sample of 229 participants, aged 11 to 18 years, gave a speech and filled in questionnaires addressing social anxiety, depression, expected and self-evaluated performance, and post-event rumination. Independent observers rated the quality of the speech. The data were analysed using moderated mediation analysis. Performance quality mediated the link between expected and self-evaluated performance in adolescents with low and medium levels of social anxiety. For adolescents with high levels of social anxiety, only a direct link between expected and self-evaluated performance was found. Their self-evaluation was not related to the quality of their performance. Performance quality also mediated the link between expected performance and rumination, but social anxiety did not moderate this mediation effect. Results suggest that a good performance does not help socially anxious adolescents to replace their negative self-evaluations with more realistic ones. Specific cognitive intervention strategies should be tailored to the needs of socially anxious adolescents who perform well.

The Effects of Tryptophan on Everyday Interpersonal Encounters and Social Cognitions in Individuals with a Family History of Depression.

Background:Individuals with a family history of depression show subtle abnormalities in the processing of social stimuli. This could negatively affect their interpersonal functioning and contribute to their depression risk. Repeated administration of the serotonin precursor tryptophan has previously been shown to increase agreeable behavior and reduce quarrelsome behavior in irritable people, who are also considered at risk for depression.Methods:To examine the effects of tryptophan on social functioning in individuals with a family history of depression, 40 men and women with at least one first-degree relative with depression received tryptophan (1g three times a day) and placebo for 14 days each in a double-blind crossover design and recorded their social behavior and mood during everyday interpersonal encounters. Participants also provided daily ratings of their positive and negative cognitions concerning their social functioning.Results:Tryptophan improved mood. Unexpectedly, tryptophan increased quarrelsome behavior and reduced agreeable behavior, specifically during interactions at home. The behavioral effects of tryptophan were not moderated by mood or by the interaction partner. Negative social cognitions were lower when tryptophan was given second and lower during placebo when placebo was given second.Conclusion:Overall, tryptophan may not alter social behavior in individuals with a family history of depression as it does in irritable people. However, the behavioral effects of tryptophan at home might be seen as a way for individuals with a family history of depression to achieve more control. Over time, this may positively influence the way they feel and think about themselves in a social context.

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

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