Behavioral assessment of social performance: a rating system for social phobia

Capturing the biases of socially anxious people by addressing partner effects and situational parameters

To expose biases in self-perceptions of people high in social anxiety, information is needed on actual and perceived informant reports following social situations. We measured trait social anxiety (SA) in 90 college students arranged in pairs for "getting acquainted" conversations. Half participated in a small-talk task, where they took turns answering superficial questions; half participated in a closeness-generating task, where questions required gradual increases in self-disclosure. Afterward, students rated themselves and their partner on positive and negative attributes and how they think their partner viewed them. People with high SA judged themselves more negatively and less positively than their partner did (accuracy); when interacting with a partner endorsing low SA, they possessed enhanced negativity biases about how they expected to be viewed (meta-accuracy), and believed their partner's judgments were less positive than their own low self-judgments (perceived dissent). Conversely, people with low SA showed evidence of a self-enhancement bias about the impression they made on low SA strangers. Other moderators of the social cognitions of people with high SA included gender and the social situation (distortions being amplified in men and small-talk conversations). Our findings suggest that the study of SA cannot be understood using decontextualized approaches, instead requiring consideration of the synergy among the person, partner, and situation.

What determines observer-rated social performance in individuals with social anxiety disorder?

Clark and Wells (1995) proposed that cognitive variables and safety behaviors are related to social performance in social anxiety disorder (SAD). Here, we tested this relationship by concurrent assessment of cognitive, behavioral, and physiological variables and social performance in a prototypical social interaction situation. 103 participants with SAD and 23 healthy controls interacted with a confederate. Anxiety, self-focused attention, cognitions, and safety behaviors were assessed by self-report and by confederate ratings. Social performance was evaluated by independent observers using a behavioral coding system. Social performance was predicted using two regression models for self-report and confederate ratings. Between-group differences in social performance disappeared when talking time was taken into account. Talking time emerged as the most powerful predictor of social performance (54% and 58% accounted variance). Positive cognitions, self-focused attention and safety behaviors accounted for an additional, but marginal amount of variance. Reduced talking time might represent a safety behavior and may be considered an easy to measure final common behavioral outcome of cognitive processes underlying social anxiety.

Social performance is more closely associated with theory of mind and autobiographical memory than with psychopathological symptoms in clinically stable patients with schizophrenia-spectrum disorders

The purpose of this study was to examine the association of deficits in theory of mind ability (ToM), deficits in recalling autobiographical memories (AM) and social performance in patients with psychosis. Furthermore, the study aimed to investigate if deficits in ToM and AM are better predictors of social performance than psychopathological symptoms and other neurocognitive variables. In a cross-sectional design, patients with schizophrenia-spectrum disorders (n=55) and healthy controls (n=45) completed a ToM movie paradigm in which they had to infer the characters' intentions and emotions in movies displaying social situations and a first- and second-order false belief ToM paradigm. Recall of AM was investigated using a structured interview. Social performance was assessed in a standardized role-play situation, which was later rated by trained raters, blind to diagnosis. Deficits in AM were associated with deficits in the ability to infer intentions of movie characters and in social performance in patients with schizophrenia-spectrum disorders. ToM ability to infer emotions of movie characters and recalling of AM were better predictors of social performance than psychopathological symptoms and other neurocognitive deficits. The results suggest that interventions aiming to enhance ToM deficits and deficits in AM might result in improvement of social performance.

Video feedback with peer ratings in naturalistic anxiety-provoking situations for social anxiety disorder: Preliminary report

The present study aimed to examine how video feedback can affect perceived performance and anticipatory anxiety in various naturalistic social anxiety-provoking situations among clinical patients diagnosed with social anxiety disorder (SAD) and to examine predictors that might influence response to video feedback. Participants were 52 consecutive patients with DSM-IV SAD who participated in a group-based CBT program. Our results demonstrated that video feedback was associated with a decrease in the underestimation of own performance as well as the perception of feared outcomes. Moreover, anticipatory anxiety decreased after video feedback combined with peer feedback. Male sex, comorbidity with other anxiety disorders, and benzodiazepine prn, as well as patients' initial anxiety and avoidance were negative predictors of the effect of video feedback.

Compensatory deficits following rejection: the role of social anxiety in disrupting affiliative behavior

BACKGROUND

Managing perceived or actual social rejection is an important facet of meeting basic needs for affiliation. Social anxiety disorder (SAD) is characterized by significant distress and debilitation relating to affiliation and recent work suggests higher levels of social anxiety symptoms may adversely affect responses to social rejection. This study examined emotional and behavioral responding to a social rejection stressor to explore whether social anxiety moderates the effects of social rejection on prosocial compensatory behaviors.

METHODS

Individuals (N=37) evaluated on social anxiety symptoms were assigned to either a social rejection condition or control condition.

RESULTS

Consistent with expectation, rejection promoted renewed interest in connecting with sources of positive social interaction among participants low in social anxiety. Participants with higher levels of social anxiety, however, failed to react to rejection in a positive or prosocial manner and exhibited some evidence of negative social responses.

CONCLUSIONS

Such differential compensatory responding could have important implications for the genesis, maintenance, and treatment of SAD.

Differentiating social phobia from shyness

To clarify the relationship between social phobia and shyness, this study examined the characteristics of highly shy persons with social phobia, highly shy persons without social phobia, and non-shy persons. Those with social phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without social phobia. About one-third of the highly shy without social phobia reported no social fears, highlighting heterogeneity of the shy. The social phobia group reported similar levels of anxiety as the shy without social phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The social phobia group performed less effectively across tasks than those without social phobia. All groups' perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of social phobia.

Interoceptive Sensitivity Modulates Anxiety During Public Speaking

This study explored the relationship between interoceptive sensitivity and the experience of public-speaking anxiety. We compared participants with high and low interoceptive sensitivity concerning self-report and behavioral measures of anxiety and concerning physiological variables before, during, and after a public-speaking task. Participants with high interoceptive sensitivity reported significantly less state anxiety before and after performing a public speech as well as less habitual public-speaking anxiety. No significant differences in behavioral or physiological measures were observed. We assume that individuals with high interoceptive sensitivity, to whom physiological signals are more easily accessible, experience less uncertainty during public speaking and can thus adjust their emotional processes more adequately. This finding appears in line with Damasio’s somatic marker hypothesis, which suggests that reasoning, decision-making, and social behavior are optimized by body-related signals in complex situations.

Social performance deficits in social anxiety disorder: reality during conversation and biased perception during speech

Cognitive models emphasize that patients with social anxiety disorder (SAD) are mainly characterized by biased perception of their social performance. In addition, there is a growing body of evidence showing that SAD patients suffer from actual deficits in social interaction. To unravel what characterizes SAD patients the most, underestimation of social performance (defined as the discrepancy between self-perceived and observer-perceived social performance), or actual (observer-perceived) social performance, 48 patients with SAD and 27 normal control participants were observed during a speech and conversation. Consistent with the cognitive model of SAD, patients with SAD underestimated their social performance relative to control participants during the two interactions, but primarily during the speech. Actual social performance deficits were clearly apparent in the conversation but not in the speech. In conclusion, interactions that pull for more interpersonal skills, like a conversation, elicit more actual social performance deficits whereas, situations with a performance character, like a speech, bring about more cognitive distortions in patients with SAD.

Do controlling maternal behaviours increase state anxiety in children's responses to a social threat? A pilot study

Past research has demonstrated a link between controlling parenting and child anxiety. However, the causal nature of this association has not yet been established since most previous studies have utilised cross-sectional designs. The aim of the current study was to implement an experimental design to examine the impact of maternal control on children's state anxiety when faced with a social threat. Mothers of 26 children aged 7-13 years were randomly allocated to conditions in which they were either required to be overly controlling or minimally controlling during preparation of a practice speech by their child. In a subsequent speech that children were required to prepare alone, children whose mothers had previously been overly controlling during the practice showed greater anxiety than did children whose mothers had previously been minimally controlling. This pilot study describes a novel paradigm that has the potential to address issues related to the causal role of specific parenting behaviours in the experience of negative emotions.

Differentiating interpersonal correlates of depressive symptoms and social anxiety in adolescence: implications for models of comorbidity

Research on psychosocial correlates of depression and social anxiety often has not accounted for their comorbidity. Differentiating correlates of depression and social anxiety may inform the development of comorbidity models. Building on research linking both disorders to interpersonal dysfunction, this study examined interpersonal correlates of depressive symptoms and social anxiety in nonreferred early adolescent (M age = 13.46) girls (n = 83), controlling for comorbid symptoms. Although both showed significant bivariate correlations with peer and family variables, partial correlations revealed that social anxiety (controlling for depressive symptoms) was more strongly related to peer variables (e.g., social competence and trust and communication in friendships), whereas depressive symptoms (controlling for social anxiety) were more strongly related to family variables (e.g., lower trust and greater alienation and conflict). Comorbid girls showed heightened peer and family alienation compared to purely dysphoric or anxious girls. Implications for casual models of comorbidity and for understanding poorer outcomes associated with comorbidity and discussed.

Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication?

Participants with generalized social phobia (GSP) with (n=36) and without (n=19) avoidant personality disorder (AVPD) were compared via contrasts of group means and classification analysis on purported core features of AVPD. GSP-AVPD participants proved to be more severely impaired or distressed on some group contrasts. Cluster analysis identified two groups in the sample, with group membership significantly correlated to AVPD diagnosis. However, almost all significant findings were nullified when severity of social phobia was statistically controlled. Thus, at least where participants with social phobia are concerned, it seems most parsimonious to consider AVPD a severe form of GSP rather than a separate diagnostic category.

Post-event processing in social anxiety

Clark and Wells' [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.

The reverse of social anxiety is not always the opposite: the reverse-scored items of the social interaction anxiety scale do not belong

Although well-used and empirically supported, the Social Interaction Anxiety Scale (SIAS) has a questionable factor structure and includes reverse-scored items with questionable utility. Here, using samples of undergraduates and a sample of clients with social anxiety disorder, we extend previous work that opened the question of whether the reverse-scored items belong on the scale. First, we successfully confirmed the factor structure obtained in previous samples. Second, we found the reverse-scored items to show consistently weaker relationships with a variety of comparison measures. Third, we demonstrated that removing the reverse-scored questions generally helps rather than hinders the psychometric performance of the SIAS total score. Fourth, we found that the reverse-scored items show a strong relationship with the normal personality characteristic of extraversion, suggesting that the reverse-scored items may primarily assess extraversion. Given the above results, we suggest investigators consider performing data analyses using only the straightforwardly worded items of the SIAS.

Spontaneous emotion regulation during evaluated speaking tasks: associations with negative affect, anxiety expression, memory, and physiological responding

In these studies, the correlates of spontaneously using expressive suppression and cognitive reappraisal during stressful speeches were examined. Spontaneous emotion regulation means that there were no instructions of how to regulate emotions during the speech. Instead, participants indicated after the speech to what extent they used self-motivated expressive suppression or reappraisal during the task. The results show that suppression is associated with less anxiety expression, greater physiological responding, and less memory for the speech while having no impact on negative affect. In contrast, reappraisal has no impact on physiology and memory while leading to less expression and affect. Taken together, spontaneous emotion regulation in active coping tasks has similar consequences as experimentally induced emotion regulation in passive tasks.

Language use in females with fragile X or Turner syndrome during brief initial social interactions

Fragile X and Turner syndromes are associated with risk of atypical social function. We examined language use, including normal and atypical speech, during initial social interactions among participants engaged in a brief social role play with an unfamiliar adult. There were 27 participants with Turner syndrome, 20 with fragile X syndrome and 28 in an age-matched comparison group. Females with fragile X did not exhibit more abnormal language, but exhibited less of what is typical during initial interactions. Overall rates of dysfluencies did not differ, although females with fragile X made more phrase repetitions. Females with Turner syndrome had no language use abnormalities. Our findings suggest that language use may influence social function in females with fragile X syndrome and that such language characteristics may be observed in the context of brief encounters with an unfamiliar adult.

Social behavior and cortisol reactivity in children with fragile X syndrome

OBJECTIVE

To examine the association between limbic-hypothalamic-pituitary-adrenal (L-HPA) axis reactivity and social behavior in children with fragile X syndrome (FXS).

METHOD

Salivary cortisol changes and concurrent anxiety-related behaviors consistent with the behavioral phenotype of FXS were measured in 90 children with the fragile X full mutation and their 90 unaffected siblings during a social challenge task in the home.

RESULTS

Boys and girls with FXS demonstrated more gaze aversion, task avoidance, behavioral signs of distress, and poorer vocal quality than the unaffected siblings. Multiple regression analyses showed that after accounting for effects of IQ, gender, age, quality of the home environment, and basal cortisol level, cortisol reactivity to the task was significantly associated with social gaze in children with FXS. The most gaze-aversive children with FXS had cortisol reductions, whereas those with more eye contact demonstrated the most cortisol reactivity. Unaffected siblings demonstrated an opposite pattern in which less eye contact was associated with increased cortisol reactivity.

CONCLUSIONS

Results of the study suggest a unique relation between abnormal gaze behavior and L-HPA mediated stress reactivity in FXS.

Evidence-based assessment of anxiety disorders in adults

This article discusses issues related to the development and dissemination of evidence-based assessment strategies for anxiety disorders and associated problems. It begins with a review of the criteria that should be considered when determining whether particular assessment procedures are evidence-based. These include such factors as reliability, validity, cost-effectiveness, consumer acceptability, utility across different populations, and ease of dissemination. The importance of considering the purpose of the assessment process when deciding whether a procedure is evidence-based is emphasized. Next, the major assessment domains that are particularly important in the area of anxiety disorders (e.g., triggers for anxiety symptoms, avoidance behaviors) are reviewed. Finally, some potential obstacles to the dissemination of evidence-based assessment procedures are discussed along with suggestions for managing these obstacles.

Interpersonal processes in social phobia

Social phobia is a condition in which anxiety impairs the person's ability to relate to others. Here, we draw on concepts from interpersonal theory to examine the literature on the role of interpersonal processes in creating and maintaining this disorder. Studies that examine interpersonal interactions with significant others and strangers are reviewed. We next consider topics of particular relevance to relationship impairment, such as the effect of anxiety on cognitive processing of social information, and the social developmental pathways to social phobia. The impact of interpersonal factors on the process and outcome of cognitive-behavioral treatment is also discussed. Finally, we identify emerging themes in the research literature and consider directions for future work. Throughout the paper we highlight topics central to the interpersonal perspective, such as the self-perpetuating interpersonal cycle, interpersonal variability in social phobia, and the relational nature of self-related information.

Social anxiety in older adults: phenomenology, prevalence, and measurement

Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.

Behavioral assessment of public-speaking anxiety using a modified version of the Social Performance Rating Scale

The current study aimed to extend the evaluation of the utility of the Social Performance Rating Scale (SPRS) [Behav. Res. Ther. 36 (1998) 995]. We examined the utility of a modified SPRS for the behavioral assessment of public-speaking anxiety among patients with social phobia (n = 49). The videotaped performance of public-speaking fearful patients in a public-speaking task was rated using four of the five SPRS ratings and was compared to global ratings by patients and observers, as well as to self-report and clinician-administered measures of social anxiety. The pattern of correlations with criterion measures of social anxiety provided evidence for the convergent and divergent validity of this modified SPRS for the behavioral assessment of public-speaking anxiety.

Behavioral assessment of social anxiety in females with Turner or fragile X syndrome

Social skills impairment in children with Turner or fragile X syndrome has been documented using parental reports. Anxiety, shyness, and difficulty understanding social cues have been reported for females with Turner syndrome; whereas social withdrawal, avoidance of social interactions, and anxiety are often reported for females with fragile X syndrome. Social interaction anxiety in these two populations may be a framework for understanding the difficulty these children experience in social situations. In the present study, 29 females with Turner syndrome and 21 females with fragile X syndrome ages 6-22 years were compared to females in a comparison group, on a videotaped role-play interaction. Behavioral indices examined included eye-contact maintenance, duration of speech, and body discomfort as observed during the brief interaction. Three of eight such behavioral measures of social skills differentiated the participant groups from each other. Specifically, participants with fragile X required more time to initiate interactions than did participants in either of the remaining groups; and females with Turner syndrome made fewer facial movements than did females in the fragile X or comparison group. Self-report and parental ratings did not suggest higher levels of anxiety in females with Turner or fragile X syndrome, but did reflect higher levels of social difficulty. The authors discuss these findings in terms of understanding the nature of social dysfunction in females with Turner or fragile X syndrome.

Asian American-white American differences in expressions of social anxiety: a replication and extension

This study examined whether Asian American-White American differences on a trait measure of social anxiety extend to nonverbal behavior and to reports of anxiety-related emotions during a 3-min social performance task. Forty Asian Americans and 40 White Americans completed a trait measure of social anxiety and rated their emotions before, and immediately after, a social performance task. Their videotaped behavior was coded using microlevel behavioral codes (e.g., gaze avoidance, fidgeting). Results indicated that Asian Americans reported more anxiety than White Americans on the trait measure and on the emotion rating scales but that they did not differ substantially on microlevel behavioral indexes of social anxiety. Implications of ethnic variations in the patterns of anxious responding are discussed.