Non-anxious Control Participants Research Articles

Reduction of anxiety symptoms during systemic family therapy results in a concurrent improvement of cognitive performance: a study on people with high anxiety

ABSTRACT Difficulties in various cognitive functions are common observations in people experiencing anxiety. However, limited research has investigated the effects of psychotherapy on abnormal cognitive functioning. This study assessed whether psychotherapy-related reductions of anxiety result in improvements of cognitive functioning as well. Fifty-four participants with high self-reported anxiety, divided into two experimental groups (N = 28 and N = 26), and 27 non-anxious control participants (N = 27) completed a battery of memory tasks and anxiety questionnaires in three consecutive time points. In experimental group 1, participants started systemic family therapy immediately after the first time point, while, in experimental group 2, participants begun the same type of therapy three months later at the second time point. The results showed that, compared to control participants, at the beginning of the experiment, participants in the experimental groups had significantly lower memory performance, along with higher anxiety. Psychotherapy had a beneficial effect on anxiety symptoms and cognitive performance, with significant changes occurring only after intervals of treatments. These results show that psychotherapy is effective not only in reducing anxiety symptoms but on cognitive functioning as well. This improvement might be linked to the release of cognitive resources previously absorbed by worrisome thoughts, facilitated by a heightened protection from interference.

When pictures are not beneficial in multimedia learning: the case of threat-related pictures

According to the multimedia principle, adding relevant pictures to text is beneficial for learning. This beneficial effect is particularly true for text depicted in pictures (illustrated text information) but not for a text that is not illustrated in pictures (non-illustrated text information). The multimedia principle was examined for threat-related content: spider-fearful participants (SFs) learned about spiders. Since SFs typically inadequately process spider pictures, a beneficial effect of pictures concerning illustrated text information was not assumed for SFs but only for non-anxious control participants (NACs). Participants (N = 123) were randomly assigned to either a text-only condition or a text-picture condition and classified as SFs or NACs. In line with this assumption, adding pictures to text was not beneficial for SFs but only for NACs, particularly for illustrated text information. Thus, the perceived emotional content of pictures can serve as a boundary condition for the well-established multimedia principle.

Social anxiety elicits an approach mere exposure effect for angry faces.

Zajonc (2001) called the mere exposure effect (MEE) a gateway into the subliminal - specifically, the affective unconscious discrimination of stimuli. Zajonc proposed that the MEE occurs because repeated unconscious presentation of a stimulus automatically elicits approach toward it, and thus, positive affect. We present the first test of Zajonc's hypothesis of what we term an approach mere exposure effect. We did so by using an implicit measure that identifies preferred stimuli by assessing automatic approach reactions. A total of 42 highly socially anxious and 39 nonanxious control participants were administered masked exposures to either angry or neutral faces. Then they reacted to visible pictures of angry or neutral faces that were either previously presented (old) or new in one of two ways. They either (a) pulled a joystick toward themselves, which created the visual effect of approaching these stimuli (stimulus preference), or (b) pushed a joystick away from themselves, which created the effect of avoiding the stimuli. Mere exposure to angry faces caused socially anxious participants to pull - approach - old angry faces more quickly than new angry faces, that is, an approach MEE. Nonanxious participants nearly approached old neutral faces more quickly than new neutral faces. Mere exposure to angry faces also caused socially anxious participants to approach visible angry faces generally, and counterintuitively, to approach angry faces faster than they avoided them, whether they were old or new. These results suggest that the approach MEE generalized to have fear-reducing effects in socially anxious persons.

Inflated sense of responsibility, explanatory style and the cognitive model of social anxiety disorder: a brief report of a case control study

AbstractWe sought to investigate situation-specific inflated sense of responsibility and explanatory style in social anxiety disorder (SAD) according to the cognitive model. Participants aged 17–68 years (mean = 31.9, SD = 11.1) included waiting list patients referred to a primary care mental health service for cognitive behavioural therapy for SAD (n = 18) and non-anxious control participants (n = 65). A battery of psychometric measures, including a bespoke measure of responsibility beliefs, was used. Compared with controls, participants with SAD were more likely to demonstrate an inflated sense of responsibility (p ≤ 0.001), and to adopt a negative explanatory style specific to social interaction (p ≤ 0.01). Inflated sense of responsibility was found to correlate with SAD symptomatology (r = 0.47, p ≤ 0.05), and with increased usage of safety behaviours (r = 0.47, p ≤ 0.05). Caseness (β = 1.45, p ≤ 0.01) and stability of causal attribution (β = 0.25, p ≤ 0.001) were found to predict inflated responsibility in our sample. To our knowledge this study represents the first attempt to investigate inflated responsibility within the context of SAD. Our results support the notion of inflated responsibility as a feature of SAD.Key learning aims(1)To understand the cognitive behavioural components of Clark and Wells’ model of SAD, and their bi-directional nature.(2)To understand what the term ‘inflated sense of responsibility’ refers to, and how it relates to CBT.(3)To understand what the term ‘explanatory style’ refers to, and how this concept can also relate to CBT.

Feeling safe but appearing anxious: Differential effects of alcohol on anxiety and social performance in individuals with social anxiety disorder

Social anxiety disorder (SAD) and alcohol use disorders (AUD) co-occur frequently and there is preliminary evidence that alcohol might reduce social anxiety. It is, however, unclear which mechanisms contribute to the anxiety reducing effect, particularly regarding key aspects of social anxiety such as deficits in social performance. We compared self-rated and physiological measures of anxiety as well as self- and observer-rated social performance in a sample of 62 individuals with SAD and 60 nonanxious control participants during a speech task after receiving either alcohol, an alcohol-free placebo drink or orange juice. SAD patients reported more anxiety during the speech task than did control participants. Furthermore, SAD patients underestimated their performance in comparison to observer ratings. Alcohol reduced self-report anxiety only in SAD patients, while observers rated all participants as less competent when intoxicated. Although individuals with SAD experience a reduction in anxiety when drinking alcohol, simultaneous decreases in social performance might contribute to negative reactions from others and consequently increase the risk of further alcohol use to cope with these negative reactions.

Exposure reduces negative bias in self-rated performance in public speaking fearful participants

Background and objectivesIndividuals with public speaking anxiety (PSA) under-rate their performance compared to objective observers. The present study examined whether exposure reduces the discrepancy between self and observer performance ratings and improved observer-rated performance in individuals with PSA. MethodsPSA participants gave a speech in front of a small audience and rated their performance using a questionnaire before and after completing repeated exposures to public speaking. Non-anxious control participants gave a speech and completed the questionnaire one time only. Objective observers watched videos of the speeches and rated performance using the same questionnaire. ResultsPSA participants underrated their performance to a greater degree than did controls prior to exposure, but also performed significantly more poorly than did controls when rated objectively. Bias significantly decreased and objective-rated performance significantly increased following completion of exposure in PSA participants, and on one performance measure, anxious participants no longer showed a greater discrepancy between self and observer performance ratings compared to controls. LimitationsThe study employed non-clinical student sample, but the results should be replicated in clinical anxiety samples. ConclusionsThese findings indicate that exposure alone significantly reduces negative performance bias among PSA individuals, but additional exposure or additional interventions may be necessary to fully correct bias and performance deficits.

Angry-happy interpretations of ambiguous faces in social anxiety disorder

Social Anxiety Disorder (SAD) is characterized by a tendency to interpret ambiguous social cues as negative. Here we tested whether interpretation of ambiguous faces differs between participants with SAD and non-anxious controls. Twenty-seven individuals with SAD and 21 non-anxious control participants completed an emotion recognition task in which they judged ambiguous morphed faces as happy or angry. Participants with SAD judged a higher proportion of the faces as angry compared to non-anxious participants, and were slower to judge faces as angry compared to happy, while no such reaction time bias manifested in the control group. Finally, happy judgments were slower in the SAD group compared to the control group, while angry judgments were faster in the SAD group compared to the control group. These findings provide evidence for a negative bias in resolving emotional ambiguity in facial expressions among individuals with SAD.

The effects of cognitive load on attention control in subclinical anxiety and generalised anxiety disorder

Poor regulation of emotions may involve impaired attention control. In the current paper, we report the results of two studies examining the interaction of anxiety, attention control and cognitive load. In Study I, using a performance-based task to assess attention control, we examined whether anxiety is associated with impaired attention control, and whether these effects are influenced by working memory load. In Study II, we examined these effects in patients with a diagnosis of generalised anxiety disorder (GAD) compared to non-anxious control (NAC) participants. Results of Study I showed that high anxiety was associated with increased attention control, that is decreased interference from distractors, but only under high cognitive load. These results were replicated in Study II such that individuals with GAD showed increased attention control relative to NACs, but only under high cognitive load. These results help clarify previous predictions regarding the effect of anxiety on attention control.

Social Anxiety Disorder and Global/Local Performance on a Visuospatial Processing Task

Few research studies have examined differences in processing “big-picture,” global stimuli versus detailed, local stimuli in individuals with social anxiety disorder (SAD). Similarly, little is known about the impact of a social stressor on cognitive functioning in SAD. This study explores differences in memory for global and local visuospatial information between participants with SAD (n = 37) and non-anxious control participants (n = 40) using the Rey-Osterrieth Complex Figure Test. Half of the participants were exposed to a social stressor (anticipating giving a speech) while they completed the task. Two scoring subscales were used to distinguish between reproduction of global elements and local features on Copy, Immediate Recall, and Delayed Recall trials. Results indicated that participants with SAD who were not exposed to the social stressor performed more poorly at reproducing local elements on the Copy trial, compared to participants in the SAD-stressor present group and both control groups. Additionally, control participants, but not those with SAD, demonstrated improvement in memory for global elements from Immediate to Delayed Recall trials. These results suggest that trait social anxiety impairs consolidation of global visuospatial information over time, and interacts with the presence of a state stressor to affect reproduction of details.

Enhanced visuomotor processing of phobic images in blood-injury-injection fear

Numerous studies have identified attentional biases and processing enhancements for fear-relevant stimuli in individuals with specific phobias. However, this has not been conclusively shown in blood-injury-injection (BII) phobia, which has rarely been investigated even though it has features distinct from all other specific phobias. The present study aims to fill that gap and compares the time-course of visuomotor processing of phobic stimuli (i.e., pictures of small injuries) in BII-fearful (n=19) and non-anxious control participants (n=23) by using a response priming paradigm. In BII-fearful participants, phobic stimuli produced larger priming effects and lower response times compared to neutral stimuli, whereas non-anxious control participants showed no such differences. Because these effects are fully present in the fastest responses, they indicate an enhancement in early visuomotor processing of injury pictures in BII-fearful participants. These results are comparable to the enhanced processing of phobic stimuli in other specific phobias (i.e., spider phobia).

You See What you Fear: Spiders Gain Preferential Access to Conscious Perception in Spider-Phobic Patients

In phobic individuals, behavioral responses to phobia-related cues are facilitated and brain responses are augmented. It has rarely been investigated whether this preferential processing is accompanied by an altered conscious perception of phobia-related cues. We used binocular rivalry to investigate conscious perception of phobia-related cues in phobic individuals. 21 spider-phobic patients and 20 non-anxious control participants viewed pictures of spiders or flowers, each paired with a neutral pattern under conditions of binocular rivalry. Spider-phobic patients more often reported that they saw spider pictures as the first percept, and the total duration of seeing spider percepts was significantly longer in patients than in non-anxious participants. A second experiment was conducted to rule out that these differences were caused by different response criteria. Results support the validity of self-report in Experiment 1. In sum, predominance of phobia-related cues in binocular rivalry provides evidence that phobia-related cues gain preferential access to visual awareness in phobic individuals.

Semantic Priming and Interpretation Bias in Social Anxiety Disorder

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

Lack of a Benign Interpretation Bias in Social Anxiety Disorder

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

Psychometric evaluation of the Fear of Positive Evaluation Scale in patients with social anxiety disorder.

The Fear of Positive Evaluation Scale (FPES; J. W. Weeks, R. G. Heimberg, & T. L. Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only 1 previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (T. A. Fergus et al., 2009). The primary purpose of the present study was to conduct a large multisite examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype = 97.8%). Responses of nonanxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples.

Gender role traits among individuals with social anxiety disorder

The present study investigated differences between individuals with and without social anxiety disorder (SAD) in instrumentality and expressiveness, personality traits traditionally linked to the male and female gender roles, respectively. Based on evolutionary and self-discrepancy theories, it was hypothesized that individuals with SAD would score lower on instrumentality and report a discrepancy between their perceived and ideal level of instrumentality compared to control participants. Sixty-four patients with SAD and 31 non-anxious control participants completed a battery of questionnaires, including ratings of their perceived and ideal gender role attributes and current psychosocial distress. Results supported the hypotheses, and provided initial evidence that a discrepancy between perceived and ideal instrumentality may be linked to social anxiety severity, depression and lower quality of life. No differences were detected between groups in expressiveness. The present findings suggest that individuals with SAD perceive themselves to be deficient in instrumentality. They also suggest that increasing instrumentality among individuals with SAD may be beneficial for treatment.

Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants.

The present study examined the effect of worry versus relaxation and neutral thought activity on both physiological and subjective responding to positive and negative emotional stimuli. Thirty-eight participants with generalized anxiety disorder (GAD) and 35 nonanxious control participants were randomly assigned to engage in worry, relaxation, or neutral inductions prior to sequential exposure to each of four emotion-inducing film clips. The clips were designed to elicit fear, sadness, happiness, and calm emotions. Self reported negative and positive affect was assessed following each induction and exposure, and vagal activity was measured throughout. Results indicate that worry (vs. relaxation) led to reduced vagal tone for the GAD group, as well as higher negative affect levels for both groups. Additionally, prior worry resulted in less physiological and subjective responding to the fearful film clip, and reduced negative affect in response to the sad clip. This suggests that worry may facilitate avoidance of processing negative emotions by way of preventing a negative emotional contrast. Implications for the role of worry in emotion avoidance are discussed.

Memory for Physiological Feedback in Social Anxiety Disorder: The Role of Fear of Bodily Sensations

This study examined whether individuals with social anxiety disorder have a memory bias for bodily sensations associated with anxiety. Using a false feedback paradigm, 33 individuals with social anxiety disorder (SAD) and 34 non-anxious control (NAC) participants completed a performance task while monitoring stimuli they were told provided feedback on whether their physiological response was changing or stable. On measures of free recall and recognition for their feedback no differences were found between SAD and NAC individuals. However, among SAD participants only, fear of bodily sensations was significantly associated with enhanced memory for stimuli associated with physiological responses. Results suggest that research and treatment may benefit from considering not only fear of social situations, but also the focus of those fears, such as bodily sensations, when examining memory biases in social anxiety.

Threat processing in obsessive-compulsive disorder: Evidence from a modified negative priming task

Individuals with obsessive-compulsive disorder (OCD) often experience intrusive thoughts. These intrusions may be due to biases in information processing mechanisms, including attention, memory, and learning. To examine this hypothesis, we presented a modified negative priming (NP) paradigm with idiographically selected words to 19 individuals with OCD (OCs) and 19 matched non-anxious control participants (NACs). The words included OCD-relevant threat, OCD-relevant positive, and neutral words. This paradigm typically elicits positive priming because participants may learn the contingency between the prime and probe that facilitates responding [Frings and Wentura (2006). Strategy effects counteract distractor inhibition: NP with constantly absent probe distractors. Journal of Experimental Psychology: Human Perception and Performance, 32, 854–864]. As predicted, NACs showed facilitation (i.e., positive priming) rather than NP for all word types, whereas OCs exhibited facilitation for only neutral words. For positive words, OCs exhibited no priming and for threat words they exhibited NP. These results suggest that for idiographic, OCD-relevant threat information, individuals with OCD show difficulty learning the contingency between the information in the prime and probe displays relative to the NACs.

Phenomenal characteristics of autobiographical memories for social and non-social events in social phobia

Previous studies failed to show clear differences between people with social phobia and non-anxious individuals regarding the specificity and affective intensity of their autobiographical memories for social events. However, these studies did not assess the subjective experience associated with remembering. In this study, people with social phobia and non-anxious control participants recalled social and non-social events, and rated the phenomenal characteristics of their memories. The memories of people with social phobia for social events contained fewer sensorial details but more self-referential information than controls’ memories. In addition, people with social phobia remembered social situations from an observer perspective, viewing themselves as if from outside, to a greater extent than controls. By contrast, the two groups did not differ concerning their memories for non-social events. These findings are discussed in relation to cognitive models of social phobia.

Spider fearful individuals attend to threat, then quickly avoid it: Evidence from eye movements.

According to cognitive models of anxiety, anxiety patients exhibit an early reflexive attentional bias toward threat stimuli, which may be followed by intentional avoidance of these stimuli. To determine the time course of attentional vigilance and avoidance, the authors conducted an eye-tracking study in which 22 highly spider fearful participants (SFs) and 23 nonanxious control participants (NACs) studied groups of 4 pictures (spider, butterfly, dog, and cat). The authors found that the very first fixation was on a spider picture more often in SFs than in NACs. However, SFs quickly moved their eyes away from the spider they had fixated first, yielding shorter gaze durations than NACs. Afterward, SFs exhibited shorter gaze durations on spiders than NACs for the rest of the 1-min presentation time. This early reflexive attentional bias toward threat followed by avoidance of threat may explain earlier failures to find attentional biases in anxiety.