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Noda S, Shirotsuki K, Nakao M. Low-intensity mindfulness and cognitive-behavioral therapy for social anxiety: a pilot randomized controlled trial. BMC Psychiatry 2024; 24:190. [PMID: 38454396 PMCID: PMC10921717 DOI: 10.1186/s12888-024-05651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive-behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. METHODS Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. RESULTS A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51-1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. CONCLUSIONS These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.
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Affiliation(s)
- Shota Noda
- Department of Psychology, Translational Clinical Psychology, Philipps University Marburg, Schulstraße 12, Marburg, 35032, Germany.
- Research Institute of Cognitive Behavior Therapy, Musashino University, 3-3-3 Ariake, Koutou-Ku, Tokyo, 135-8181, Japan.
| | - Kentaro Shirotsuki
- Faculty of Human Sciences, Musashino University, 3-3-3 Ariake, Koutou-Ku, Tokyo, 135-8181, Japan
| | - Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita-Shi, Chiba, 286-8686, Japan
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2
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Sun J, Liu T, Gao Y, Li H, Chen Y, Diao H, Zhang G, Shen H, Chang R, Yu Z, Lu J, Liang L, Zhang L. Questionnaire development on measuring parents’ anxiety about their children’s education: Empirical evidence of parental perceived anxiety data for primary and secondary school students in China. Front Psychol 2022; 13:1018313. [PMID: 36312100 PMCID: PMC9599738 DOI: 10.3389/fpsyg.2022.1018313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the implementation of the “double reduction” policy in China, parents of primary and secondary school students are experiencing a growing trend of educational anxiety that needs to be alleviated. Objective To manage the education anxiety risk of parents of primary and secondary school students, a measurement questionnaire of parents’ anxiety about their children’s education (MQPAE) was developed and its reliability and validity were evaluated. Methods A self-administered MQPAE was developed. An online crowdsourcing questionnaire platform was used to collect data on parents’ anxiety about their children’s education (PAE), and parents of primary and secondary school students in Hefei, China, were selected as the study population. The randomly extracted 5,747 questionnaires were gradually screened by discrete trend method, t-test, and Pearson’s correlation coefficient method for the initial screening of PAE items, based on which exploratory factor analysis (EFA) was conducted for the final screening of questionnaire items and the reliability of the questionnaire. The reliability of the questionnaire was assessed by internal consistency and Pearson’s correlation coefficient analysis. Confirmatory factor analysis (CFA) was conducted using 639 pre-selected data to investigate the validity of the questionnaire. Structural equation modeling was used to investigate the structural validity of the questionnaire, and average variance extracted (AVE), combined reliability (CR), and maximum of shared squared variance (MSV) were used to test for convergent and discriminant validity. Results Exploratory factor analysis extracted five factors with a cumulative variance contribution of 65.66%. The CFA showed that χ2/df = 4.306, CFI = 0.920, NFI = 0.898, RMSEA = 0.072<0.08, AGFI = 0.839>0.80, PNFI = 0.793 and PGFI = 0.708. The overall Cronbach’s α coefficient of the questionnaire was 0.956, and the factors’ Cronbach’s α coefficients were 0.926, 0.857, 0.913, 0.901, and 0.768, respectively. Repeated measurements of Pearson’s correlation coefficients were 0.908, 0.911, 0.873, 0.891, 0.907 and 0.885 (all p < 0.001). The AVE was greater than 0.5 and the CR was greater than 0.7, and the value of the MSV was less than the corresponding AVE. Conclusion The MQPAE has good reliability and validity and can be used in studies related to PAE of primary and secondary school students.
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Affiliation(s)
- Jiangjie Sun
- School of Management, Hefei University of Technology, Hefei, China
- Health Management College, Anhui Medical University, Hefei, China
- *Correspondence: Jiangjie Sun,
| | - Tong Liu
- Health Management College, Anhui Medical University, Hefei, China
| | - Yufei Gao
- Health Management College, Anhui Medical University, Hefei, China
| | - Hui Li
- Health Management College, Anhui Medical University, Hefei, China
| | - Yao Chen
- Hefei No. 42 Middle School, Hefei, China
| | | | - Genfa Zhang
- Feixi Experimental Senior Secondary School, Hefei, China
| | - Hui Shen
- Anhui Hefei No. 6 High School, Hefei, China
| | - Rong Chang
- Hefei No. 45 Middle School Furong Branch South District, Hefei, China
| | - Zhenliang Yu
- The 4th Primary School Affiliated to Hefei Normal School, Hefei, China
| | - Jingru Lu
- Health Management College, Anhui Medical University, Hefei, China
| | - Liang Liang
- School of Management, Hefei University of Technology, Hefei, China
| | - Liping Zhang
- School of Marxism, Anhui Medical University, Hefei, China
- Liping Zhang,
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Reinhold FL, Gerlicher AMV, van Someren EJW, Kindt M. Do your troubles today seem further away than yesterday? On sleep's role in mitigating the blushing response to a reactivated embarrassing episode. Sleep 2022; 45:6706913. [PMID: 36130113 PMCID: PMC9644119 DOI: 10.1093/sleep/zsac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Indexed: 01/25/2023] Open
Abstract
The "sleep to forget and sleep to remember hypothesis" proposes that sleep weakens the emotional tone of an experience while preserving or even enhancing its content. Prior experimental research however shows contradictory findings on how emotional reactivity changes after a period of sleep, likely explained by methodological variations. By addressing these inconsistencies, we investigated the mitigating effect of overnight sleep on emotional reactivity triggered by memory reactivation. Using a karaoke paradigm, we recorded participants' singing of two songs, followed by exposing them to one of the recordings (rec1) to induce an embarrassing episode. After a 12-hr period of either day-time wakefulness (N = 20) or including nighttime sleep (N = 20), we assessed emotional reactivity to the previously exposed recording (rec1) and the newly exposed recording (rec2). Emotional reactivity was assessed with a physiological measure of facial blushing as the main outcome and subjective ratings of embarrassment and valence. Sleep and wake were monitored with diaries and actigraphy. The embarrassing episode was successfully induced as indicated by objective and subjective measures. After controlling for an order effect in stimulus presentation, we found a reduction in blushing response to the reactivated recording (rec1) from pre- to post-sleep compared to wakefulness. However, emotional reactivity to the reactivated recording (rec1) and the new recording (rec2) did not differ after sleep and wakefulness. This study shows that facial blushing was reduced following overnight sleep, while subjective ratings were unaffected. Whether the beneficial effect of sleep is due to changes in memory representation or rather emotion regulation remains elusive.
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Affiliation(s)
- Faya L Reinhold
- Department for Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands
| | - Anna M V Gerlicher
- Department for Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands,Department for Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, The Netherlands
| | - Eus J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands,Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Merel Kindt
- Corresponding author. Merel Kindt and Faya Louisa Reinhold, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands.
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Self-Consciousness, Self-Objectification, and Social Anxiety as Predictors of Photo Editing Behavior among Emerging Adults. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2022. [DOI: 10.1155/2022/6609752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aims to assess the impact of self-consciousness, self-objectification, and social anxiety on photo editing behavior among emerging adults. Correlational research strategy was used for the present quantitative research, and convenient sampling strategy was used to collect data of 444 university students (135 males and 309 females) with the age range of 18-25 years. The self-consciousness scale, objectified body consciousness scale, photo manipulation scale, and social anxiety scale were used as assessment tools for this study. For data analysis,
-test for independent samples, correlation, and regression analysis were implied. The results revealed that women had higher self-consciousness and social anxiety in contrast to men. Moreover, self-objectification and evaluation anxiety were positively correlated with photo editing behavior. Lastly, overall self-objectification and body shame, one of the three aspects of self-objectification resulted as significant predictors of photo manipulation behavior among emerging adults. This study contributes to the indigenous literature of clinical and social psychology.
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Noda S, Shirotsuki K, Sasagawa S. Self-focused attention, cost/probability bias, and avoidance behavior mediate the relationship between trait mindfulness and social anxiety: A cross-sectional study. Front Psychol 2022; 13:942801. [PMID: 36033088 PMCID: PMC9399945 DOI: 10.3389/fpsyg.2022.942801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors for social anxiety. In particular, cost bias and avoidance behavior predict social anxiety. It has been shown that the enhancement of trait mindfulness improves these maintaining factors. This study examines the relationships among trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety, and clarifies whether they mediate the relationship between trait mindfulness and social anxiety. A cross-sectional design was used to examine the relationships among these variables. Participants were recruited from three universities in Japan (January 2019–December 2019). Undergraduate students (N = 367) completed a set of self-report measures assessing trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Results of path analyses revealed that the hypothesized model’s goodness-of-fit indices had high values. Trait mindfulness showed a direct negative association with self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Moreover, trait mindfulness was negatively associated with social anxiety via self-focused attention, cost/probability bias, and avoidance behavior. These findings indicate that mindfulness plays an important role in social anxiety and provide impetus for future research involving clinical studies of mindfulness-based interventions for social anxiety.
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Affiliation(s)
- Shota Noda
- Graduate School of Human and Social Sciences, Musashino University, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- *Correspondence: Shota Noda,
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Ganho-Ávila A, Vieira Figueiredo D, Vagos P. Online Cognitive Therapy for Social Anxiety Disorder in Adolescence: A Clinical Case Study Using the CT@TeenSAD. Clin Case Stud 2022. [DOI: 10.1177/15346501221091519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SAD is an intense fear or anxiety associated with past, current, or future social situations. The Clark and Wells (1995) cognitive model for SAD has been proved to be clinically effective in adults, and its developmentally sensitive adaptations for adolescents have recently shown promising results. Given this evidence and considering that adolescence is typically the age of onset for the first SAD symptoms and a critical developmental period for the delivery of evidence-based interventions, we adapted CT for adolescents for online intervention (CT@TeenSAD) encompassing 10 weekly, 90 min sessions, extended by two booster sessions. This work presents the first case study of that intervention as applied to Merida (M.; pseudonym; 17-year-old, girl). The estimated Reliable Change Index shows M.’s progress for most of her symptoms, from pre-to post-treatment (RCI-1 range: −.53 to −8.03), and the maintenance of benefits at 3 months follow-up (RCI-2 range: .00 to −2.25). A relapse in the adoption of safety behaviors was seen between post-treatment and follow-up, which might be explained by the life-changing challenges experienced by M. between session 10 and follow-up, concerning her transition from high school to college. M.’s case study offers a first glance on the promising results of CT@TeenSAD related to its efficacy and feasibility. Likewise, it offers the opportunity to critically appraise the limitations of the intervention as well as practical challenges and suggestions thought to be useful for therapists willing to implement CT@TeenSAD in the future.
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Affiliation(s)
- Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Vagos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Human Development, Portucalense Infante D. Henrique University, Porto, Portugal
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7
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Meral Y, Vriends N. Self-image and self-focused attention in a social interaction situation: what is relevant for social anxiety? Behav Cogn Psychother 2021; 50:1-11. [PMID: 34651570 DOI: 10.1017/s1352465821000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND According to Clark and Wells' cognitive model (Clark and Wells, 1995), social anxiety is maintained by both a negative self-image and self-focused attention (SFA). Although these maintaining factors were investigated extensively in previous studies, the direction of this relationship remains unclear, and so far, few studies have investigated self-image and SFA together within a current social interaction situation. AIMS The aim of this experiment is to investigate the influence of a negative versus positive self-image on social anxiety and on SFA during a social interaction. METHOD High (n = 27) and low (n = 36) socially anxious participants, holding a manipulated negative versus positive self-image in mind, had a real-time video conversation with a confederate. Social anxiety, SFA and state anxiety before and during the conversation were measured with questionnaires. RESULTS An interaction between negative self-image and social anxiety showed that high socially anxious individuals with a negative self-image in mind were more anxious than those with a positive self-image in mind during the conversation. They were also more anxious compared with low socially anxious individuals. Furthermore, high socially anxious individuals reported higher SFA; however, SFA was not affected by negative or positive self-image. CONCLUSION The present results confirm once again the strong influence of self-image and SFA on social anxiety, highlighting that a negative self-image has more impact on socially anxious individuals. Moreover, the present results suggest that SFA is not necessarily affected by a negative self-image, indicating that therapies should focus on both.
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Affiliation(s)
- Yasemin Meral
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055Basel, Switzerland
- Department of Psychology, Izmir University of Economics, Sakarya caddesi 156, 35330, Izmir, Turkey
| | - Noortje Vriends
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055Basel, Switzerland
- Child and Adolescent Psychiatric Clinic, University Psychiatric Clinics, Schanzenstrasse 13, 4056Basel, Switzerland
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Noda S, Okawa S, Shirotsuki K, Sasagawa S, Bögels SM. The Japanese self-focused attention scale: Factor structure, internal consistency, convergent, and discriminant validity. J Clin Psychol 2021; 77:2011-2026. [PMID: 33822367 DOI: 10.1002/jclp.23133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 01/20/2021] [Accepted: 03/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Self-focused attention is a maintaining factor for social anxiety disorder. It was shown that self-focused attention correlates with trait mindfulness, but not with attention control. This study examined the reliability and validity of the Japanese version of the self-focused attention (J-SFA) scale. METHOD Students (N = 502) completed a set of questionnaires, measuring self-focused attention, social anxiety symptoms, trait mindfulness, and attention control. RESULTS A confirmatory factor analysis indicated that the J-SFA scale has a bi-factor structure. The Cronbach's α coefficient was high. Correlation analysis showed that each factor of the J-SFA scale was significantly weakly to moderately correlated with social anxiety symptoms and trait mindfulness, and the J-SFA scale's factors were significantly or non-significantly very weakly correlated with attentional control functions. CONCLUSION The findings indicate that the J-SFA demonstrated satisfactory reliability and validity for our sample and provide impetus for future research into the measure for clinical and nonclinical samples in Japan.
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Affiliation(s)
- Shota Noda
- Graduate School of Human and Social Sciences, Musashino University, Koutouku, Tokyo, Japan.,Tokyo Mindfulness Center, Minatoku, Tokyo, Japan
| | - Sho Okawa
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Research Center of Child Mental Development, Chiba University, Chiba-shi, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Chiba University, Chiba-shi, Chiba, Japan
| | | | - Satoko Sasagawa
- Faculty of Human Sciences, Mejiro University, Shinjukuku, Tokyo, Japan
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, NG Amsterdam, The Netherlands
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Social Anxiety, Fear of Negative Evaluation, and Distress in a Virtual Reality Environment. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAccording to cognitive theories of social anxiety, fear of negative evaluation (FNE) may be the mechanism whereby social anxiety induces distress. However, studying this can be challenging, as individuals with social anxiety may be reluctant to enter anxiety-provoking social situations, such as speaking in front of others. The present study used virtual reality (VR) to examine if giving a presentation in front of a virtual audience induced distress among undergraduate students and to test the hypothesis that FNE would mediate the relationship between social anxiety and distress. University students (N = 58, 70% female) entered a VR environment where they stood in front of a virtual audience and gave a short, impromptu presentation about their university. Participants also completed self-report measures of social anxiety, FNE, and distress (estimated before, during, and after VR). Distress and FNE had positive relationships with social anxiety and FNE fully mediated the relationship between social anxiety and distress. As far as we are aware, this is the first VR study to show this effect. The findings indicate that FNE could be a useful treatment target to reduce distress when presenting in front of an audience, either in VR or in person.
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Azriel O, Lazarov A, Segal A, Bar-Haim Y. Visual attention patterns during online video-mediated interaction in socially anxious individuals. J Behav Ther Exp Psychiatry 2020; 69:101595. [PMID: 32819540 DOI: 10.1016/j.jbtep.2020.101595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/20/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES These days, a growing number of social interactions occur through video-mediated communication (VMC). However, little is known about how socially anxious individuals use this technology. Here, we examined the visual attention patterns of high and low socially anxious individuals during a live interaction with a study confederate using a typical online VMC setup. METHODS High (n = 30) and low (n = 30) socially anxious participants completed a VMC-based social interaction task comprised of two parts: A one-on-one acquaintance interview followed by a one-on-one short presentation assignment. State anxiety was measured before and after the task, and gaze data was collected throughout. RESULTS High socially anxious participants experienced elevated anxiety following the interaction task, whereas no elevation was observed for low socially anxious participants. Gaze data revealed that high socially anxious participants dwelled longer on the confederate's image during the acquaintance interview compared with the presentation task, and dwelled longer on non-face areas during the presentation relative to during the acquaintance interview. This task-related gaze pattern was not observed among low socially anxious participants. LIMITATIONS An analog sample was used in this study and future research should replicate its findings in a clinical sample. Future studies may also wish to counterbalance confederate's gender and task order across participants. CONCLUSIONS The results suggest that during VMC, socially anxious individuals observe their environment differently than non-socially anxious individuals, depending on the context of the interaction. This context-dependency might help explain mixed findings in previous studies. Further theoretical implications of these findings are discussed.
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Affiliation(s)
- Omer Azriel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Adva Segal
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Self-Focused Attention as a Predictor of Post-event and Anticipatory Processing: Examination of a Moderation Model. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vogel F, Gensthaler A, Stahl J, Schwenck C. Fears and fear-related cognitions in children with selective mutism. Eur Child Adolesc Psychiatry 2019; 28:1169-1181. [PMID: 30684088 DOI: 10.1007/s00787-019-01281-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Selective mutism (SM) is classified under the category of anxiety disorders in DSM-5 [1], although concrete fears that underlie the condition are not specified contrary to all other anxiety disorders. Given the lack of studies systematically investigating fears in SM, content and frequency of concrete fears as well as related cognitions have remained unclear so far. One hundred and twenty-four participants [M = 13.25 years (SD = 3.24), range 8-18 years] with SM (n = 65), social phobia (SP n = 18) or with typical development (TD n = 51) took part in an online survey. Participants with SM (n = 65) answered an open-ended question concerning fears that might cause the consistent failure to speak in select situations. Additionally, participants with SM, SP and TD completed a survey containing 34 fear-related cognitions that might occur in speech-demanding situations. Open text answers were systematically evaluated by extracting higher-order categories using a Qualitative Content Analysis. Single item scores of the survey were compared between the three groups. 59% of all spontaneously reported fears were assigned to the cluster of social fears. Other reported fears represented the categories fear of mistakes (28%), language-related fears (8%) and voice-related fears (5%). The SM- and SP group only differed regarding the cognition that one's own voice might sound funny (SM > SP). Social fears and the fear of mistakes account for the majority of fears in SM. Therefore, future interventions should consider specifically targeting these types of fears.
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Affiliation(s)
- Felix Vogel
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394, Giessen, Germany.
| | - Angelika Gensthaler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Julia Stahl
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394, Giessen, Germany
| | - Christina Schwenck
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394, Giessen, Germany
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Nikolić M, van der Storm L, Colonnesi C, Brummelman E, Kan KJ, Bögels S. Are Socially Anxious Children Poor or Advanced Mindreaders? Child Dev 2019; 90:1424-1441. [PMID: 31099053 PMCID: PMC6852401 DOI: 10.1111/cdev.13248] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Why are some children more socially anxious than others? One theory holds that socially anxious children are poor mindreaders, which hampers their social interactions; another that socially anxious children are advanced mindreaders leading to heightened self-consciousness in social situations. To test these theories simultaneously, this study (N = 105, ages 8-12) assessed children's mindreading (accuracy in detecting mental states from the eye region), self-consciousness (indexed as physiological blushing during public performance), and social anxiety levels. Results support both theories, showing a quadratic relation between mindreading and social anxiety. Low mindreading was related to clinical levels of social anxiety. High mindreading was related to subclinical levels of social anxiety through blushing. Our findings suggest two social-cognitive pathways to heightened social anxiety.
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Inflated sense of responsibility, explanatory style and the cognitive model of social anxiety disorder: a brief report of a case control study. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Budnick CJ, Anderson EM, Santuzzi AM, Grippo AJ, Matuszewich L. Social anxiety and employment interviews: does nonverbal feedback differentially predict cortisol and performance? ANXIETY STRESS AND COPING 2018; 32:67-81. [PMID: 30298757 DOI: 10.1080/10615806.2018.1530349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND & OBJECTIVES Interviewers often provide positive nonverbal feedback to reduce interviewees' anxiety. Socially anxious individuals typically harbor negative self-views discrepant with positive feedback. We examined whether nonverbal feedback and social anxiety jointly influence cortisol responses to, and performance during, interviews. DESIGN An experimental between-subjects design randomly assigned participants to feedback condition. METHODS Undergraduate students (N = 130) provided saliva and completed social anxiety, interview anxiety, and affective measures before a simulated interview. Following a standardized script, a confederate interviewer provided positive, ambiguous, or negative nonverbal feedback. Participants then provided saliva and completed self-focused attention and self-awareness measures. Confederate interviewers and an external rater evaluated participants' anxiety displays, assertive behavior, and performance. RESULTS Positive feedback decreased cortisol and improved performance for low social anxiety participants. Socially anxious participants exhibited higher cortisol but did not exhibit significant differences in performance after positive compared to negative feedback. CONCLUSIONS Consistent with previous findings, positive feedback did not benefit socially anxious interviewees. Positive feedback increased physiological arousal relative to negative feedback but did not hinder performance among people high in social anxiety. These results provide novel information about the interactive influence of social anxiety and nonverbal interviewer feedback on arousal, self-focus, and interview performance.
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Affiliation(s)
| | - Eden M Anderson
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Alecia M Santuzzi
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Angela J Grippo
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Leslie Matuszewich
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
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Brummelman E, Nikolić M, Bögels SM. What's in a blush? Physiological blushing reveals narcissistic children's social-evaluative concerns. Psychophysiology 2018; 55:e13201. [DOI: 10.1111/psyp.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Eddie Brummelman
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
- Department of Psychology; Stanford University; Stanford California USA
| | - Milica Nikolić
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
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17
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Ahn JK, Kwon JH. Modifying Negative Self-Imagery Increases the Effectiveness of Cognitive Behavior Therapy for Social Anxiety Disorder: A Benchmarking Study. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9918-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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18
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Vriends N, Meral Y, Bargas-Avila JA, Stadler C, Bögels SM. How do I look? Self-focused attention during a video chat of women with social anxiety (disorder). Behav Res Ther 2017; 92:77-86. [PMID: 28284146 DOI: 10.1016/j.brat.2017.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 02/19/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
We investigated the role of self-focused attention (SFA) in social anxiety (disorder) in an ecologically valid way. In Experiment 1 high (n = 26) versus low (n = 25) socially anxious single women between 18 and 30 years had a video ("Skype") conversation with an attractive male confederate, while seeing themselves and the confederate on-screen. The conversation was divided in four phases: (I) warm-up, (II) positive (confederate was friendly to the participant), (III) critical (confederate was critical to the participant), and (IV) active (participant was instructed to ask questions to the confederate). Participant's SFA was measured by eye-tracked gaze duration at their own image relative to the confederates' video image and other places at the computer screen. Results show that high socially anxious participants were more self-focused in the critical phase, but less self-focused in the active phase than low socially anxious participants. In Experiment 2 women diagnosed with SAD (n = 32) and controls (n = 30) between 18 and 30 years conducted the same experiment. Compared to controls participants with SAD showed increased SFA across all four phases of the conversation, and SFA predicted increased self-rated anxiety during the conversation. In conclusion, in subclinical social anxiety SFA is high only when the interaction partner is critical, whereas instructions to ask questions to the confederate reduces subclinical socially anxious' SFA, while clinical SAD is characterized by heightened self-focused attention throughout the interaction. Results support theories that social anxiety disorder is maintained by SFA, and imply that interventions that lower SFA may help prevent and treat social anxiety disorder, but that SFA can also be adaptive in certain types of interaction, such as when receiving compliments.
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Affiliation(s)
- Noortje Vriends
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland; Present address: Child and Adolescent Psychiatric Clinic, University Psychiatric Clinic, University of Basel, Schanzenstrasse 13, 4056 Basel, Switzerland.
| | - Yasemin Meral
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland; Department of Psychology, Izmir University of Economics, Sakarya Street, No:156, 35330 Balcova, Izmir, Turkey
| | - Javier A Bargas-Avila
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland; Present address: Google User Experience Research, Brandschenkestrasse 110, 8002 Zurich, Switzerland
| | - Christina Stadler
- Present address: Child and Adolescent Psychiatric Clinic, University Psychiatric Clinic, University of Basel, Schanzenstrasse 13, 4056 Basel, Switzerland
| | - Susan M Bögels
- Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, The Netherlands
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Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review. Clin Psychol Rev 2016; 52:1-18. [PMID: 27912159 DOI: 10.1016/j.cpr.2016.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 11/14/2016] [Accepted: 11/18/2016] [Indexed: 12/19/2022]
Abstract
A consistent feature across cognitive-behavioural models of social anxiety disorder (SAD) is the central role of the self in the emergence and maintenance of the disorder. The strong emphasis placed on the self in these models and related empirical research has also been reflected in evidence-based treatments for the disorder. This systematic review provides an overview of the empirical literature investigating the role of self-related constructs (e.g., self-beliefs, self-images, self-focused attention) proposed in cognitive models of SAD, before examining how these constructs are modified during and following CBT for SAD. Forty-one studies met the inclusion criteria. Guided by Stopa's (2009a, b) model of self, most studies examined change in self-related content, followed by change in self-related processing. No study examined change in self-structure. Pre- to post-treatment reductions were observed in self-related thoughts and beliefs, self-esteem, self-schema, self-focused attention, and self-evaluation. Change in self-related constructs predicted and/or mediated social anxiety reduction, however relatively few studies examined this. Papers were limited by small sample sizes, failure to control for depression symptoms, lack of waitlist, and some measurement concerns. Future research directions are discussed.
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20
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Fergus TA, Bardeen JR. The Attention Training Technique: A Review of a Neurobehavioral Therapy for Emotional Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Self-focused attention and safety behaviors across group therapies for social anxiety disorder. ANXIETY STRESS AND COPING 2016; 30:441-455. [DOI: 10.1080/10615806.2016.1239083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Ng AS, Abbott MJ. The Effect of Negative, Positive, and Neutral Self-imagery on Symptoms and Processes in Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-015-9751-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Dijk C, de Jong PJ, Peters ML. Judgmental Biases of Individuals with a Fear of Blushing: The Role of Relatively Strict Social Norms. Clin Psychol Psychother 2016; 23:176-82. [DOI: 10.1002/cpp.1958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Corine Dijk
- Programme Group Clinical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Peter J. de Jong
- Department Clinical Psychology and Experimental Psychopathology; University of Groningen; Groningen The Netherlands
| | - Madelon L. Peters
- Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine; Maastricht University; Maastricht The Netherlands
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24
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Kitchens MB. Thinking About God Causes Internal Reflection in Believers and Unbelievers of God. SELF AND IDENTITY 2015. [DOI: 10.1080/15298868.2015.1072108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Nikolić M, Colonnesi C, de Vente W, Drummond P, Bögels SM. Blushing and Social Anxiety: A Meta-Analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Milica Nikolić
- Research Institute of Child Development and Education; University of Amsterdam
| | - Cristina Colonnesi
- Research Institute of Child Development and Education; University of Amsterdam
| | - Wieke de Vente
- Research Institute of Child Development and Education; University of Amsterdam
| | - Peter Drummond
- School of Psychology and Exercise Science; Murdoch University
| | - Susan M. Bögels
- Research Institute of Child Development and Education; University of Amsterdam
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26
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Boehme S, Miltner WHR, Straube T. Neural correlates of self-focused attention in social anxiety. Soc Cogn Affect Neurosci 2015; 10:856-62. [PMID: 25326038 PMCID: PMC4448029 DOI: 10.1093/scan/nsu128] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/24/2014] [Accepted: 10/14/2014] [Indexed: 11/13/2022] Open
Abstract
Socially anxious individuals tend to shift their attention away from external socially threatening cues and instead become highly self-focused. Such heightened self-focused attention has been suggested to be involved in the development and maintenance of social anxiety disorder. This study used functional magnetic resonance imaging to investigate the neural correlates of self-focused attention in 16 high socially anxious (HSA) and 16 low socially anxious (LSA) individuals. Participants were instructed to focus their attention either inwardly or outwardly during a simulated social situation. Results indicate hyperactivation of medial prefrontal cortex (mPFC), temporo-parietal junction (TPJ) and temporal pole during inward vs outward attention in HSA compared with LSA participants. Furthermore, activation of mPFC, right anterior insula, TPJ and posterior cingulate cortex was positively correlated with the trait of self-focused attention in HSA subjects. Results highlight the prominent role of the mPFC and other cortical structures in abnormal self-focused attention in social anxiety. Finally, findings for the insula suggest increased processing of bodily states that is related to the amount of habitual self-focused attention in social anxiety.
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Affiliation(s)
- Stephanie Boehme
- Laboratory of Psychophysiology and functional Imaging, Department of Psychiatry, Psychosomatics & Psychotherapy, University of Wüerzburg; Fuechsleinstr. 15, D-97080 Würzburg, Germany, Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3//1, D-07743 Jena, Germany, and Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany Laboratory of Psychophysiology and functional Imaging, Department of Psychiatry, Psychosomatics & Psychotherapy, University of Wüerzburg; Fuechsleinstr. 15, D-97080 Würzburg, Germany, Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3//1, D-07743 Jena, Germany, and Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
| | - Wolfgang H R Miltner
- Laboratory of Psychophysiology and functional Imaging, Department of Psychiatry, Psychosomatics & Psychotherapy, University of Wüerzburg; Fuechsleinstr. 15, D-97080 Würzburg, Germany, Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3//1, D-07743 Jena, Germany, and Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
| | - Thomas Straube
- Laboratory of Psychophysiology and functional Imaging, Department of Psychiatry, Psychosomatics & Psychotherapy, University of Wüerzburg; Fuechsleinstr. 15, D-97080 Würzburg, Germany, Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3//1, D-07743 Jena, Germany, and Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
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Intrapersonal and interpersonal concomitants of facial blushing during everyday social encounters. PLoS One 2015; 10:e0118243. [PMID: 25679216 PMCID: PMC4334548 DOI: 10.1371/journal.pone.0118243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Facial blushing may usually be undesirable but may have an ameliorative function for some individuals under some circumstances. Researchers have studied the blush in laboratory settings, but not in daily life. In the present research, conducted with young adults, we employed for the first time an event-contingent recording method for assessing facial blushing during every-day social encounters. Blushing was associated with feeling embarrassed, ashamed, and exposed. These findings, though based on correlational analyses, are consistent with the idea that blushing is often unpleasant and can be maladaptive, and may contribute to the common belief that blushing is an undesirable response. Frequent blushers generally reported lower levels of dominant behavior, higher levels of submissive behavior, and perceived their social interaction partners as more powerful and less affiliative. This was independent of whether they blushed or not, suggesting that altered social behaviors and perceptions are associated with blushing-associated traits rather than with the blushing state. The experience of the blush varied as a function of the frequency with which a person blushed. Blushing was associated with higher levels of shame in frequent blushers than in infrequent blushers. In infrequent blushers, blushing was associated with higher levels of pleasant affect, suggesting that for infrequent blushers the blush may occur in positive social encounters.
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28
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Bögels SM, Wijts P, Oort FJ, Sallaerts SJM. Psychodynamic psychotherapy versus cognitive behavior therapy for social anxiety disorder: an efficacy and partial effectiveness trial. Depress Anxiety 2014; 31:363-73. [PMID: 24577880 DOI: 10.1002/da.22246] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 01/06/2014] [Accepted: 01/18/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Comparing the overall and differential effects of psychodynamic psychotherapy (PDT) versus cognitive behavior therapy (CBT) for social anxiety disorder (SAD). DESIGN Patients with a primary SAD (N = 47) were randomly assigned to PDT (N = 22) or CBT (N = 27). Both PDT and CBT consisted of up to 36 sessions (average PDT 31.4 and CBT 19.8 sessions). Assessments took place at waitlist: pretest, after 12 and 24 weeks for those who received longer treatment: posttest, 3-month and 1-year follow-up. METHODS Changes in the main outcome measure self-reported social anxiety composite, as well as in other psychopathology, social skills, negative social beliefs, public self-consciousness, defense mechanisms, personal goals, independent rater's judgments of SAD and general improvement, and approach behavior during an objective test, were analyzed using multilevel analysis. RESULTS No improvement occurred during waitlist. Treatments were highly efficacious, with large within-subject effect sizes for social anxiety, but no differences between PDT and CBT on general and treatment-specific measures occurred. Remission rates were over 50% and similar for PDT and CBT. Personality disorders did not influence the effects of PDT or CBT. CONCLUSIONS PDT and CBT are both effective approaches for SAD. Further research is needed on the cost-effectiveness of PDT versus CBT, on different lengths PDT, and on patient preferences and their relationship to outcome of PDT versus CBT.
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Affiliation(s)
- Susan M Bögels
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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29
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Holzman JB, Valentiner DP, McCraw KS. Self-Focused Attention and Post-Event Processing: Relevance to Social Performance Anxiety and Social Interaction Anxiety. J Cogn Psychother 2014; 28:72-82. [DOI: 10.1891/0889-8391.28.1.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and unconditional beliefs about self. These results and their theoretical implications are discussed.
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30
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Mohiyeddini C, Bauer S, Semple S. Public self-consciousness moderates the link between displacement behaviour and experience of stress in women. Stress 2013. [PMID: 23205741 DOI: 10.3109/10253890.2012.755171] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
When stressed, people typically show elevated rates of displacement behaviour--activities such as scratching and face touching that seem irrelevant to the ongoing situation. Growing evidence indicates that displacement behaviour may play a role in regulating stress levels, and thus may represent an important component of the coping response. Recently, we found evidence that this stress-regulating effect of displacement behaviour is found in men but not in women. This sex difference may result from women's higher levels of public self-consciousness, which could inhibit expression of displacement behaviour due to the fear of projecting an inappropriate image. Here, we explored the link between public self-consciousness, displacement behaviour and stress among 62 healthy women (mean age = 26.59 years; SD = 3.61). We first assessed participants' public self-consciousness, and then quantified displacement behaviour, heart rate and cognitive performance during a Trier Social Stress Test (TSST) and used self-report questionnaires to assess the experience of stress afterwards. Public self-consciousness was negatively correlated with rate of displacement behaviour, and positively correlated with both the subjective experience of stress post-TSST and the number of mistakes in the cognitive task. Moderation analyses revealed that for women high in public self-consciousness, high levels of displacement behaviour were associated with higher reported levels of stress and poorer cognitive performance. For women low in public self-consciousness, stress levels and cognitive performance were unrelated to displacement behaviour. Our findings indicate that public self-consciousness is associated with both the expression of displacement behaviour and how such behaviour mediates responses to social stress.
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Affiliation(s)
- Changiz Mohiyeddini
- Department of Psychology, University of Roehampton, Holybourne Avenue, London, UK.
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31
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Hook JN, Valentiner DP, Connelly J. Performance and interaction anxiety: specific relationships with other- and self-evaluation concerns. ANXIETY STRESS AND COPING 2013; 26:203-16. [DOI: 10.1080/10615806.2012.654777] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Comparison of Attention Training and Cognitive Therapy in the Treatment of Social Phobia: A Preliminary Investigation. Behav Cogn Psychother 2012; 42:74-91. [DOI: 10.1017/s1352465812001051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Prominent models of social phobia highlight the role played by attentional factors, such as self-focused attention, in the development and maintenance of social phobia. Elevated self-focused attention is associated with increases in self-rated anxiety. Treatments that aim to modify and change attentional processes, specifically self-focused attention, will have a direct effect on social phobia symptoms. Thus, Attention Training targets attentional focus. Aim: The present study aimed to investigate the efficacy of Attention Training in comparison to an established treatment for social phobia, Cognitive Therapy. Method: Participants (Intention-to-treat = 45; completers = 30) were allocated to either 6 weeks of Attention Training or Cognitive Therapy. It was hypothesized that both treatments would be effective in reducing social phobia symptoms, but that Attention Training would work primarily by reducing levels of self-focused attention. Results: The results found an overall effectiveness of both treatment conditions in reducing social phobia symptoms. However, Attention Training significantly improved scores on the Self-Focused Attention questionnaire and the Brief Fear of Negative Evaluation questionnaire compared to Cognitive Therapy. Conclusion: Attention Training seems to be a promising treatment for social phobia.
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33
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김환, Hoon-Jin Lee. Development and validation of dysfunctional self-focus attributes scale. ACTA ACUST UNITED AC 2012. [DOI: 10.15842/kjcp.2012.31.2.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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34
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Drummond PD, Su D. The relationship between blushing propensity, social anxiety and facial blood flow during embarrassment. Cogn Emot 2012; 26:561-7. [DOI: 10.1080/02699931.2011.595775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Carter EC, McCullough ME, Carver CS. The Mediating Role of Monitoring in the Association of Religion With Self-Control. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2012. [DOI: 10.1177/1948550612438925] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religiosity is related to a variety of positive outcomes and the nature of this relationship has long been a topic of inquiry. Recently, it was proposed that an important piece of this puzzle may be the propensity for religious beliefs to promote self-control, a trait that is linked to a range of benefits. How religion translates into self-control, however, remains unclear. We examined the extent to which religiosity’s relationship with self-control is mediated by self-monitoring, perceived monitoring by God, and perceived monitoring by other people. Results revealed that more religious people tended to monitor their standing regarding their goals (self-monitoring) to a greater degree, which in turn related to more self-control. Also, religious people tended to believe that a higher power was watching them, which related to greater self-monitoring, which in turn was related to more self-control.
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Affiliation(s)
- Evan C. Carter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Charles S. Carver
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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36
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Drummond PD, Lazaroo D. The effect of facial blood flow on ratings of blushing and negative affect during an embarrassing task: preliminary findings. J Anxiety Disord 2012; 26:305-10. [PMID: 22257642 DOI: 10.1016/j.janxdis.2011.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 12/20/2011] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
Abstract
Expecting to blush is a common source of social anxiety, and is associated with heightened perceptions of blushing and embarrassment. To assess whether sensory cues associated with heightened facial blood flow are an additional source of anxiety, the vasodilator niacin (100mg) or placebo was administered double-blind to 33 participants, and facial blood flow was investigated when they sang a children's song. Vasodilatation during singing was greater in the niacin than placebo condition, and niacin-evoked flushing and increases in pulse rate were greater in participants with high than low fear of negative evaluation. Nevertheless, ratings of embarrassment, anxiety, blushing and facial heat were similar in both drug conditions. This dissociation implies that cognitive appraisals or negative affect overrode more subtle physiological cues of blushing during embarrassment. Clarifying how judgments about blushing are made could be crucial for correcting faulty assumptions about blushing in people who are frightened of this response.
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Affiliation(s)
- Peter D Drummond
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
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Drummond PD, Lazaroo D. The effect of niacin on facial blood flow in people with an elevated fear of negative evaluation. Eur Neuropsychopharmacol 2012; 22:200-4. [PMID: 21856131 DOI: 10.1016/j.euroneuro.2011.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/16/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
The vasodilator niacin may provoke greater facial flushing and other symptoms of anxiety in patients with social anxiety disorder than in non-anxious controls. To determine whether this also applies in non-clinical samples, niacin (100mg) or placebo was administered double-blind to 33 young adults and flushing was investigated in relation to fear of negative evaluation (a cardinal feature of social anxiety). Increases in facial blood flow were greater in people with high than low fear of negative evaluation in the niacin condition, but were similar in both groups in the placebo condition. However, changes in pulse rate and ratings of embarrassment, anxiety, blushing and facial heat were similar in both groups in both drug conditions. These findings suggest that the facial vessels of people with a heightened fear of negative evaluation are particularly responsive to niacin under conditions of low anxiety and embarrassment.
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Affiliation(s)
- Peter D Drummond
- School of Psychology, Murdoch University, Perth, Western Australia.
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Drummond PD, Su D. Blushing in rosacea sufferers. J Psychosom Res 2012; 72:153-8. [PMID: 22281458 DOI: 10.1016/j.jpsychores.2011.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Rosacea is characterized by extremely sensitive skin and persistent facial flushing, perhaps initiated or exacerbated by frequent or intense blushing. To investigate this, blushing was assessed in rosacea sufferers and controls during embarrassing laboratory tasks. METHODS Changes in forehead blood flow were monitored with laser Doppler fluxmetry in 31 rosacea sufferers (12 with severe symptoms and 19 with mild symptoms) and 86 controls while singing, giving an impromptu speech, and listening to recordings of these activities. RESULTS Changes in forehead blood flow were similar in rosacea sufferers and controls, and were similar in subgroups with mild and severe rosacea. Even so, rosacea sufferers thought that that they blushed more intensely and were more embarrassed than controls during most of the tasks. Likewise, changes in forehead blood flow were similar in participants with mild and severe rosacea. Nevertheless, ratings of embarrassment and blushing were greater in those with severe than mild symptoms. Within the rosacea group, increases in blood flow while singing were greatest in participants with the highest blushing ratings, whereas increases in blood flow while listening to the speech were greatest in the most embarrassed participants. CONCLUSIONS These findings do not support the hypothesis that blushing is abnormal in rosacea but, nevertheless, suggest that rosacea sufferers are more aware of and embarrassed by blushing than controls. This might contribute to social anxiety in rosacea sufferers.
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Affiliation(s)
- Peter D Drummond
- School of Psychology, Murdoch University, Perth, Western Australia, 6150, Australia.
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Gaydukevych D, Kocovski NL. Effect of self-focused attention on post-event processing in social anxiety. Behav Res Ther 2012; 50:47-55. [DOI: 10.1016/j.brat.2011.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 02/05/2023]
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Su D, Drummond PD. Blushing Propensity and Psychological Distress in People with Rosacea. Clin Psychol Psychother 2011; 19:488-95. [DOI: 10.1002/cpp.763] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daphne Su
- School of Psychology; Murdoch University; Perth; Western Australia; Australia
| | - Peter D. Drummond
- School of Psychology; Murdoch University; Perth; Western Australia; Australia
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Not self-focused attention but negative beliefs affect poor social performance in social anxiety: An investigation of pathways in the social anxiety–social rejection relationship. Behav Res Ther 2010; 48:984-91. [DOI: 10.1016/j.brat.2010.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/28/2010] [Accepted: 06/10/2010] [Indexed: 11/21/2022]
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Colonnesi C, Engelhard IM, Bögels SM. Development in children's attribution of embarrassment and the relationship with theory of mind and shyness. Cogn Emot 2010. [DOI: 10.1080/02699930902847151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010; 27:168-89. [PMID: 20143427 DOI: 10.1002/da.20670] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. METHOD A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. RESULTS/CONCLUSIONS Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
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Affiliation(s)
- Susan M Bögels
- Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.
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44
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Dijk C, Voncken MJ, de Jong PJ. I blush, therefore I will be judged negatively: influence of false blush feedback on anticipated others’ judgments and facial coloration in high and low blushing-fearfuls. Behav Res Ther 2009; 47:541-7. [DOI: 10.1016/j.brat.2009.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/05/2009] [Accepted: 03/13/2009] [Indexed: 11/26/2022]
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George L, Stopa L. Private and public self-awareness in social anxiety. J Behav Ther Exp Psychiatry 2008; 39:57-72. [PMID: 17214960 DOI: 10.1016/j.jbtep.2006.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 06/27/2006] [Accepted: 09/18/2006] [Indexed: 11/30/2022]
Abstract
Clark and Wells' [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.
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Affiliation(s)
- Lindsay George
- Department of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Consedine NS, Krivoshekova YS, Harris CR. Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: psychometric development and links to treatment-seeking outcomes. Br J Health Psychol 2007; 12:439-62. [PMID: 17640455 DOI: 10.1348/135910706x118747] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Understanding why people do not always engage in medical examinations that might benefit them is a public health issue which is receiving increased attention. One area of promise involves the study of medical embarrassment, although current studies are weakened in that they measure medical embarrassment in a theoretically naïve and unidimensional manner and have assumed that embarrassment is exclusively a barrier to the timely seeking of treatment. DESIGN Convenience sampling was used to recruit 116 male and 134 female students (mean age = 19.94 years, 47.2% Caucasian, 20.4% African-American, 32.4% Asian) from two large universities in different parts of the United States. METHODS Participants completed a comprehensive measure of medical embarrassment, reported on previous treatment avoidance because of embarrassment, and recorded the frequency of psychological, general and sex-related visits across the previous 5 years. RESULTS As expected, medical embarrassment was not unidimensional and appeared to have two distinct factors--bodily embarrassment and judgment concern. Bodily embarrassment generally predicted less frequent medical contact although not equally so across domains and it interacted with judgment concern in several cases, providing preliminary evidence that there are situations in which aspects of medical embarrassment may actually facilitate greater medical contact. CONCLUSIONS The data highlight the importance of considering the role of emotions other than fear in health behaviour and the means by which they may facilitate or deter the timely seeking of diagnosis and treatment.
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Zou JB, Hudson JL, Rapee RM. The effect of attentional focus on social anxiety. Behav Res Ther 2007; 45:2326-33. [PMID: 17521604 DOI: 10.1016/j.brat.2007.03.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 03/18/2007] [Accepted: 03/21/2007] [Indexed: 11/15/2022]
Abstract
The aim of the present study was to examine the effect of attentional focus on social anxiety in a group of high and low blushing-anxious subjects. One hundred and fourteen psychology undergraduate students were screened using the Fear of Blushing subscale of the Blushing Questionnaire [Bögels, S. M., & Reith, W. (1999). Validity of two questionnaires to assess social fears: The Dutch social phobia and anxiety questionnaire and the blushing, trembling and sweating questionnaire. Journal of Psychopathology and Behavioral Assessment, 21, 51-66]. Those with the most extreme scores in the top and bottom 20% of the distribution were selected to form a high (n=22) and a low (n=22) blushing-anxious group. Subjects were randomly allocated to either a self-focused attention (SFA) condition or a task-focused attention (TFA) condition. They were asked to engage in a 5 min conversation with the first author, and were instructed to either self-focus (SFA condition) or task-focus (TFA condition). Levels of social anxiety and self-awareness were measured using visual analogue scales. Results suggest that the there was a significant condition by group interaction, with high blushing individuals showing considerably higher levels of social anxiety in the SFA condition compared to the TFA condition while low blushing individuals showed no significant difference across the two conditions.
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Affiliation(s)
- Judy B Zou
- Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
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Chaker S, Hoyer J. Erythrophobie: Störungswissen und Verhaltenstherapie. VERHALTENSTHERAPIE 2007. [DOI: 10.1159/000105103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Drummond PD, Back K, Harrison J, Helgadottir FD, Lange B, Lee C, Leavy K, Novatscou C, Orner A, Pham H, Prance J, Radford D, Wheatley L. Blushing during social interactions in people with a fear of blushing. Behav Res Ther 2007; 45:1601-8. [PMID: 16890188 DOI: 10.1016/j.brat.2006.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 05/23/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
Changes in facial blood flow were investigated during an introductory conversation, delivering a speech, and listening to the speech afterwards in 16 people with a fear of blushing and 16 controls. It was hypothesized that fear of blushing would be associated with high ratings of self-reported blushing intensity and embarrassment during the tasks, and with persistence of the blushing reaction between tasks. Embarrassment and self-reported blushing intensity were greater in the fear-of-blushing group than in controls throughout the experiment. Increases in facial blood flow were similar in the two groups during each of the tasks. However, blushing dissipated more slowly after each task in the fear-of-blushing group than in controls, resulting in an incremental increase in facial blood flow over the course of the experiment. The slow recovery after an episode of blushing might result in physiological or social cues that help to maintain a fear of blushing.
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Affiliation(s)
- Peter D Drummond
- School of Psychology, Murdoch University, 6150, Western Australia, Australia.
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Fear of Blushing: No Overestimation of Negative Anticipated Interpersonal Effects, But a High-Subjective Probability of Blushing. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-007-9145-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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