Interpersonal processes in social phobia

PERFORMANCE ANXIETY, DYSFUNCTIONAL ATTITUDES AND GENDER IN UNIVERSITY MUSIC STUDENTS

The aims of this study were twofold: 1) to investigate the relationships between anxiety and general dysfunctional attitudes, perfectionism, and the need for approval in the solo performance examination of Turkish university music students, and 2) to examine the effects of perfectionism, need for approval, and gender on anxiety. Fifty-four instrumental music students participated in this study. Research data were collected using the Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988) and the Dysfunctional Attitudes Scale (Weissman & Beck, 1978). The results revealed that there are significant positive correlations between anxiety and total score of dysfunctional attitudes, and the need for approval (p < .05). The ANOVA results also showed that while there was no main effect of perfectionism, need for approval and gender had significant effects (p < .05) on anxiety. However, interaction effects of perfectionism, need for approval, and gender on anxiety were not significant. Results are discussed in the context of related literature.

Generalized versus performance-focused social phobia: patterns of comorbidity among youth

The goal of this study was to examine patterns of comorbidity associated with generalized and performance-focused social phobia (SOP) among a community-based sample of youth while also examining whether gender and age influenced the associations found. Participants from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, aged 9-17 (N=1295), were used. Diagnoses were based on structured clinical interviews with youth and their caregivers. Results indicated that both subtypes of SOP were associated with a range of other anxiety disorders. Contrary to the expectations, performance-focused SOP was somewhat more strongly associated with depressive disorders than was generalized SOP; this difference was driven primarily by higher rates of dysthymia (DYS) among those with performance-focused SOP than generalized SOP. Although attention-deficit hyperactivity disorder (ADHD) was associated with generalized SOP, more severe externalizing behavior (oppositional defiant disorder (ODD) and conduct disorder (CD)) was only associated with performance-focused SOP. Limited gender and age differences in these relationships were found.

Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia

BACKGROUND

Previous functional brain imaging studies of social anxiety have implicated amygdala hyperactivity in response to social threat, though its relationship to quantitative measures of clinical symptomatology remains unknown. The primary aim of this study was to examine the association between response to emotionally harsh faces in the amygdala, a region implicated in social and threat-related processing, and severity of social anxiety symptoms in patients with generalized social phobia (GSP).

METHODS

Ten subjects with GSP naive to psychotropic medications and without psychiatric comorbidity and ten healthy comparison subjects matched on age, gender, ethnicity, and education completed the Liebowitz Social Anxiety Scale and underwent high-field (4Tesla) functional magnetic resonance imaging while viewing blocks of emotionally salient faces.

RESULTS

Relative to happy faces, activation of the amygdala in response to harsh (angry, disgusted, fearful) faces was greater in GSP patients than in controls, and the extent of amygdala activation was positively correlated with severity of social anxiety symptoms, but not general state or trait anxiety levels.

CONCLUSIONS

Our findings suggest that amygdala activation to interpersonal threat can be specifically linked to the severity of social anxiety symptoms of individual GSP patients, and thus, may serve as a useful functional marker of disease severity.

Impact of Social Developmental Experiences on Cognitive-Behavioral Therapy for Generalized Social Phobia

The current study examined how the social developmental experiences of people with generalized social phobia (GSP) affect their therapeutic relationships and treatment response. GSP patients (N = 27) completed measures of social learning experiences, and then participated in a 12-session group cognitive-behavioral treatment program. Both patients and therapists completed the Working Alliance Inventory (WAI) and rated their perceptions of each other at sessions 3 and 8. Self-reported childhood parental abuse was associated with a weaker working alliance and a more negative patient-therapist relationship. Childhood abuse also increased the risk of a poor treatment outcome, as reflected in less change in symptoms of social phobia and depression.

Parental overprotection and interpersonal behavior in generalized social phobia

Forty-one people with generalized social phobia (GSP) and 42 community controls completed a measure of social developmental experiences and then participated in a social interaction with an experimental assistant whose behavior was either friendly or ambiguous. Following the interaction, confederates rated participants' behavior and their desire to interact with their partner again. In people with social phobia, but not controls, perceptions of parental overprotection were associated with less responsiveness to partner behavior. Moreover, failure to reciprocate the friendly partner's behavior led to social rejection. The results support the value of incorporating social developmental concepts into cognitive-behavioral models of social phobia and highlight the contribution of social learning experiences to the development of maladaptive interpersonal behavior in these individuals.

Hiding anxiety versus acknowledgment of anxiety in social interaction: relationship with social anxiety

According to cognitive and interpersonal models, safety behaviors in social phobia (e.g., avoiding eye contact, hiding blushing) erroneously induce negative evaluation by interaction partners. Presumably, a bias about the social outcome of safety behaviors causes this negative interaction cycle. Such a bias might be subject to double standard in social phobia (i.e., having more stringent rules for oneself than for others). Female students (n=81) predicted more negative social outcomes for a prominent type of safety behavior, hiding anxiety, than for the opposite behavior, acknowledgment of anxiety and ongoing behavior (control condition) in scripts of self- and other-target persons. The relation between social anxiety and double standard was robust. Social anxiety did not relate to a cognitive bias regarding hiding ones anxiety, as we expected, but was associated with the belief that acknowledgment of anxiety has negative social outcomes specifically for them. These results are evaluated in light of the interpersonal consequences anxiety-related behaviors have in social interactions.

Social interpretation bias and generalized social phobia: the influence of developmental experiences

Patients with generalized social phobia (N = 42) and non-phobic community controls (N = 42) engaged in a social interaction with an experimental assistant whose behavior was used to create either a positive or an ambiguous social environment. Participants then rated their own performance and their partner's behavior. As a group, social phobic patients displayed negatively biased self-judgments, but failed to display biased social interpretations. Among the social phobia group, a social developmental history marked by parental hostility was associated with negative interpretations of partner behavior and a history of parental overprotection was associated with less sensitivity to partner behavior. The results supported cognitive models of social phobia, which implicate negative learning experiences in the development of information processing biases.

Unexplored issues and future directions in social phobia research

There have been significant advances in recent years in the understanding and treatment of social phobia, which are summarised in this Special Issue. This paper outlines and describes some further priority areas for future research. It is suggested that social phobia should be investigated as a developmental condition, with special attention to the first two years of life; and subtypes of social phobia be further explored and their implication for treatment. Social phobia is often comorbid with other disorders and its relationship with these disorders warrants further investigation with respect to causality and treatment implications. Lastly, the investigation of social phobia within a health services research context is highlighted with the necessity of refining the design of clinical trials to establish the efficacy and effectiveness of current treatments.