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Karimi H, Rasoli Jokar AH, Salehi S, Aghadoost S. Behind the mask: Stuttering, anxiety, and communication dynamics in the era of COVID-19. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 39078384 DOI: 10.1111/1460-6984.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/07/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND While wearing masks during the pandemic poses communication and social challenges for people in everyday life, those with social anxiety might find them plausible, aligning with contemporary cognitive theories. Social anxiety involves fearing negative assessments and holding a negative self-image. Concealing anxiety symptoms during mask use may contribute to a more positive self-perception. AIMS Given that up to 60% of adults seeking stuttering treatment also meet criteria for social anxiety disorder, this study aims to investigate the complex relationship between communication freedom, self-perceived stuttering and anxiety in adults who stutter (AWS). The unique context of mandatory mask-wearing during the pandemic provides an opportunity to explore these dynamics and understand the conflicting relationships between stuttering, anxiety-related safety behaviours and the need for open communication in AWS. METHODS AND PROCEDURES Twenty AWS participated in interviews, responding to open-ended questions to elucidate their affective, cognitive and behavioural experiences while wearing masks during the COVID-19 pandemic. Thematic analysis was used to identify the emerging themes and subthemes based on information-rich quotes, employing a six-phase recursive process. Various speech and anxiety-related measures were used to describe the characteristics of the study participants. OUTCOMES AND RESULTS Three main themes and sub-themes emerged. The first theme highlights communication challenges for AWS wearing masks, impacting verbal and nonverbal interactions. The second theme reveals AWS wearing masks to conceal stuttering cues, experiencing reduced stress. The third theme indicates that, despite the comfort in concealment, most AWS prefer speaking freely without a face mask. CONCLUSIONS AND IMPLICATIONS The conflict between the desire for authentic, fluent communication and the ease of hiding stuttering symptoms poses a major dilemma for AWS. According to the results of this study, most adults who stutter prioritize open communication. However, there were some individual differences. A major factor influencing their decision was their fear of negative evaluation. WHAT THIS PAPER ADDS What is already known on the subject The prevalence of social anxiety is higher among adults who stutter (AWS), possibly stemming from their prior negative experiences with stuttering. In response, AWS may adopt adaptive or maladaptive coping behaviours to manage stuttering and mitigate fears of negative evaluation. Maladaptive strategies, like avoiding certain communication situations, can diminish their satisfaction with everyday speaking situations. What this study adds This study leveraged the mask-wearing mandate during the pandemic to explore the intricate relationship between anxiety-related symptoms and communication. While some participants saw masks as a plausible means to conceal stuttering and anxiety, most preferred open communication without the challenges posed by masks. Our findings offer additional support for the varied emotional, cognitive and behavioural responses that AWS may display in response to changes in daily life, emphasizing the individual differences within this population and highlighting that stuttering goes beyond observable speech dysfluencies. What are the clinical implications of this work? Our study underscores the need for comprehensive therapeutic interventions addressing both the physical and cognitive-emotional aspects of stuttering in AWS. Recognizing the role of safety behaviours and self-focused attention emphasizes the importance of an integrated approach, enhancing communication efficacy and social well-being for AWS. Addressing speech fluency alone, without considering pertinent cognitive-emotional factors, falls short in providing adequate stuttering treatment.
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Affiliation(s)
- Hamid Karimi
- Faculty of Health, Charles Darwin University, Darwin, Australia
| | | | - Sadaf Salehi
- Department of Communication Sciences and Disorders, Wayne State University, Detroit, USA
| | - Samira Aghadoost
- Speech Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Moscovitch DA, Moscovitch M, Sheldon S. Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1412-1435. [PMID: 36795637 PMCID: PMC10623626 DOI: 10.1177/17456916221141351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.
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Affiliation(s)
- David A. Moscovitch
- Department of Psychology and Centre for Mental Health Research & Treatment, University of Waterloo
| | - Morris Moscovitch
- Rotman Research Institute and Department of Psychology, Baycrest Centre for Geriatric Care
- Department of Psychology, University of Toronto
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Ferguson RJ, Ouimet AJ, Gardam O. Judging others makes me forget: Assessing the cognitive, behavioural, and emotional consequences of other-evaluations on self-evaluations for social anxiety. J Behav Ther Exp Psychiatry 2023; 80:101763. [PMID: 37247977 DOI: 10.1016/j.jbtep.2022.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES People with Social Anxiety Disorder (SAD) evaluate themselves negatively before, during, and after anxiety-provoking social situations, which leads to negative consequences (e.g., performance deficits, memory impairments, and post-event processing). Despite decades of research, little is known regarding whether these evaluations generalize to how they view others. Social projection theory-the belief that others are similar to oneself-might further extend the basic Cognitive Behavioural Therapy (CBT) model. Our aim was to understand whether the degree to which people negatively evaluate a visibly anxious person causes them to negatively evaluate themselves. METHODS 172 unselected participants completed several baseline questionnaires. We then randomly assigned participants to provide high-, medium-, or no-evaluation of a videotaped anxious person (i.e., other-evaluations) while we assessed their state anxiety. After, they evaluated the anxious person on multiple criteria. Participants then participated in an impromptu conversation task and subsequently evaluated their own performance. RESULTS Although our manipulation was effective, we found no emotional or behavioural differences between conditions. However, people in the high-evaluation condition recalled significantly fewer facts about their conversation partner than did people in the medium- and no-evaluation conditions. LIMITATIONS After data cleaning, the sample size was slightly smaller than planned; most analyses were nonetheless appropriately powered. Our findings may not generalize beyond unselected undergraduate students; replication in a clinical sample is warranted. CONCLUSIONS These findings highlight the cognitive consequences (i.e., memory impairments) of other-evaluations, which cognitive behavioural therapists should consider when treating individuals with SAD.
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Affiliation(s)
| | | | - Olivia Gardam
- School of Psychology, University of Ottawa, Ottawa, Canada.
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Kyron MJ, Johnson A, Hyett M, Moscovitch D, Wong Q, Bank SR, Erceg-Hurn D, McEvoy PM. Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder. Behav Res Ther 2023; 161:104253. [PMID: 36669272 DOI: 10.1016/j.brat.2023.104253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Improving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment. The current study explores the dynamic temporal associations between theory-driven cognitive and behavioural mechanisms of symptom change both during and following group CBT. METHODS A randomized controlled trial of imagery-enhanced CBT (n = 51) versus traditional verbal CBT (n = 54) for social anxiety was completed in a community mental health clinic setting. This study included data collected from 12-weekly sessions and a 1-month follow-up session. Mixed models were used to assess magnitude of change over the course of treatment. Cross-lagged panel models were fit to the data to examine temporal relationships between mechanisms (social-evaluative beliefs, safety behaviours) and social interaction anxiety symptoms. RESULTS Participants in both CBT groups experienced significant improvements across all cognitive, behavioural, and symptom measures, with no significant differences in the magnitude of changes between treatments. During treatment, greater social-evaluative beliefs (fear of negative evaluation, negative self-portrayals) at one time point (T) were predictive of more severe SAD symptoms and safety behaviours at T+1. Social-evaluative beliefs (fear of negative evaluation, probability and cost of social failure) and safety behaviours measured at post-treatment were positively associated with SAD symptoms at the 1-month follow-up. CONCLUSIONS The current study identifies social-evaluative beliefs that may be important targets for symptom and avoidance reduction during and following CBT. Assessment of these social-evaluative beliefs throughout treatment may be useful for predicting future SAD symptoms and avoidance, and for adapting treatment to promote optimal change for patients.
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Affiliation(s)
- Michael J Kyron
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - Andrew Johnson
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - Matthew Hyett
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - David Moscovitch
- Centre for Mental Health Research and Treatment, Department of Psychology, University of Waterloo, Canada
| | - Quincy Wong
- School of Psychology, Western Sydney University, Sydney, NSW, Australia
| | | | - David Erceg-Hurn
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia
| | - Peter M McEvoy
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia.
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Jin Y, Xu S, Chen C, Wilson A, Gao D, Ji Y, Sun X, Wang Y. Symptom association between social anxiety disorder, appearance anxiety, and eating disorders among Chinese University students: A network analysis to conceptualize comorbidity. Front Public Health 2022; 10:1044081. [PMID: 36620231 PMCID: PMC9814491 DOI: 10.3389/fpubh.2022.1044081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Incidences of social anxiety disorder (SAD), appearance anxiety, and eating disorders (ED) show an increased prevalence among young people. However, symptoms' associations between these disorders have not been investigated in depth. Network analysis is an approach that can be used to explain the relationship(s) between symptoms of different psychological disorders. Using network analysis, this study aimed to explore the association and potential interacting mechanisms between SAD, appearance anxiety, and ED. Methods This study included 96,218 University students from Jilin Province, China. SAD, appearance anxiety and ED were assessed using the Social Anxiety Subscale of the Self-Consciousness Scale (SASS), the Appearance Anxiety Scale Brief Version (AASBV), and the Sick, Control, One, Fat, Food questionnaire (SCOFF), Chinese versions. Network analysis was employed to investigate the symptom associations, while the stability of the network model was analyzed using statistical measures. Results The prevalence of ED among the total sample was 38% (95% CI: 38.1-38.8%), while this figure was 31.2% (95% CI: 30.7-31.6%) in males and 43.6% (95% CI: 43.2-44.0%) in females. Additionally, the total score of SAD was significantly higher in females (11.83 ± 5.37) than it in males (10.02 ± 5.46) (P < 0.001). While the total score of appearance anxiety was also different significantly in gender (39.21 ± 9.49 in females vs. 38 ± 9.42 in males) (P < 0.001). Results showed that ED was associated with all three aspects of appearance anxiety, including "appearance concern," "appearance satisfaction," and "wish for good looks." Appearance anxiety and SAD were also associated; specifically, symptoms of "appearance satisfaction" were significantly associated with the symptoms "easily talk to strangers" and "appearance concern", which was also significantly associated with "embarrassed". Compared with males, females showed significantly stronger associations with appearance anxiety symptoms, while ED symptoms were associated with "troubled by being watched" and "appearance concern". Conclusion Appearance anxiety was associated with both ED and SAD symptoms. ED may have a potential relationship with SAD, affecting appearance anxiety indirectly. Significant differences were found among males and females in symptom associations between appearance anxiety and SAD. This study therefore clarified that young people should have body-positive interventions and challenge the normative body image discourse, which may help alleviate symptoms of SAD and ED.
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Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, Zhuhai, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China,Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China,China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China,*Correspondence: Shicun Xu ✉
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China,Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Desheng Gao
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Yan Ji
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Xi Sun
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China,Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China,Yuanyuan Wang ✉
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Swee MB, Hudson CC, Heimberg RG. Examining the relationship between shame and social anxiety disorder: A systematic review. Clin Psychol Rev 2021; 90:102088. [PMID: 34598054 DOI: 10.1016/j.cpr.2021.102088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
This paper is the first systematic review of the literature on the relationship between shame and social anxiety (SA). We reviewed a total of 60 peer-reviewed empirical articles that met criteria for inclusion. We begin by summarizing literature investigating the empirical association between shame and SA and review literature on whether this association is impacted by cultural or diagnostic differences. Next, we briefly describe the updated version of Rapee and Heimberg's (1997) cognitive-behavioral model of social anxiety disorder (SAD; Heimberg, Brozovich, & Rapee, 2014) and propose how shame may interact with five processes described therein: environmental experiences, observations/images of the self, perceived negative evaluation by others, post-event cognitive processes, and behavioral manifestations of SA. We review the current literature on shame and SA as it relates to each of these domains. Thereafter, we discuss existing research on the role of shame in the treatment of SAD and the implications of the research discussed in this review. Finally, we conclude with a discussion of some key limitations in the existing literature and areas for future research.
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Affiliation(s)
- Michaela B Swee
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
| | - Chloe C Hudson
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON K7L 3N6, Canada.
| | - Richard G Heimberg
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
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7
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The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder. J Anxiety Disord 2021; 83:102458. [PMID: 34343785 DOI: 10.1016/j.janxdis.2021.102458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/04/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
We examined the use of voice/text and visual mediums and their effects on perceptions and emotions in social anxiety disorder (SAD). Our sample included 88 individuals: 44 individuals with SAD and 44 non-socially-anxious (NSA) individuals. We used an experience sampling methodology (ESM) in which participants received daily links to online measures at random times during the day, for 21 days and reported on social interactions, emotions and perceptions. Results indicated that individuals with SAD used voice/text mediums to a greater extent and used visual mediums to a lesser extent compared to NSA individuals. However, despite preferring voice/text mediums, use of visual mediums resulted in immediate increases in positive perceptions and emotions for individuals with SAD. These findings were above and beyond the effect of depressive symptoms and remained when social anxiety was represented as a continuum of severity. This has important implications for exposure interventions in the treatment of SAD.
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Saint SA, Moscovitch DA. Effects of mask-wearing on social anxiety: an exploratory review. ANXIETY STRESS AND COPING 2021; 34:487-502. [PMID: 34074171 DOI: 10.1080/10615806.2021.1929936] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health. OBJECTIVES Explore the potential effects of mask-wearing on social anxiety. DESIGN We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment. METHODS APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review. RESULTS & CONCLUSIONS The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.
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Affiliation(s)
- Sidney A Saint
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
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Ho JTK, Dupasquier JR, Scarfe ML, Moscovitch DA. Fears of receiving compassion from others predict safety behaviour use in social anxiety disorder over and above fears of negative self-portrayal. J Anxiety Disord 2021; 80:102387. [PMID: 33799174 DOI: 10.1016/j.janxdis.2021.102387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022]
Abstract
Why do people with social anxiety disorder (SAD) engage in the use of safety behaviours? While past research has established that fears of negative self-portrayal are strongly associated with safety behaviour use in SAD, no research to date has investigated the potential role of fears of receiving compassion. Both types of fears could motivate those with SAD to engage in safety behaviours in order to keep others at a distance. In the present study, 150 participants with a clinical diagnosis of SAD completed measures of fears of negative self-portrayal, fears of receiving compassion, and safety behaviour use. Multiple regression analyses revealed that when controlling for self-portrayal fears, fears of receiving compassion significantly predicted increased use of safety behaviours overall, as well as the use of avoidance and impression management subtypes. Furthermore, there was a significant interaction effect in which greater fears of receiving compassion predicted greater use of impression management at lower levels of self-portrayal fears. We discuss the implications of our findings for addressing safety behaviours in the treatment of SAD.
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Affiliation(s)
- Jolie T K Ho
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| | - Jessica R Dupasquier
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| | - Molly L Scarfe
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
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Rose AL, Kocovski NL. The Social Self-Compassion Scale (SSCS): Development, Validity, and Associations with Indices of Well-Being, Distress, and Social Anxiety. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00302-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Cognitive Bias Modification for the Induction of Negative Versus Benign Interpretations of the Self in Individuals with Elevated Social Anxiety: Effects on Self-related and Anxiety Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-019-10074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Williams BM, Levinson CA. Negative beliefs about the self prospectively predict eating disorder severity among undergraduate women. Eat Behav 2020; 37:101384. [PMID: 32320928 PMCID: PMC7246166 DOI: 10.1016/j.eatbeh.2020.101384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Abstract
Social anxiety disorder (SAD) and eating disorders (EDs) are highly comorbid. Negative self-portrayal, or 'perceived flaws in the self,' is a key feature of SAD and consists of three self-critical aspects that are presumed to be flawed: social competence, physical appearance, and signs of anxiety. Negative self-portrayal has yet to be studied among EDs, despite research suggesting that individuals with EDs have a greater negative self-image and self-criticism. The identification of negative self-portrayal as a shared risk factor for SAD and EDs may have important implications for both prevention and treatment. The current study (N = 300 undergraduate women) aimed to extend negative self-portrayal theory to the EDs. We found that several aspects of negative self-portrayal were related to ED severity and that physical appearance concerns predicted subsequent ED severity. In a cross-sectional model of shared vulnerability, we found that physical appearance concerns were a shared correlate of SAD and ED symptoms. In a prospective shared vulnerability model, we found that (a) physical appearance prospectively predicted ED severity and (b) symptoms of SAD prospectively predicted all aspects of negative self-portrayal. Concerns about flaws in appearance should be targeted in the treatment of EDs, as this aspect of negative self-portrayal was shown to predict subsequent ED severity. Future research should further investigate the theory of negative self-portrayal as it pertains to EDs.
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Affiliation(s)
- Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, United States of America
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, United States of America.
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13
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Mayer C, Vanderheiden E, Oosthuizen RM. Transforming shame, guilt and anxiety through a salutogenic PP1.0 and PP2.0 counselling framework. COUNSELLING PSYCHOLOGY QUARTERLY 2019. [DOI: 10.1080/09515070.2019.1609421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Claude–Hélène Mayer
- Department of Industrial Psychology and People Management, University of Johannesburg, Auckland Park, Kingsway Campus, Johannesburg, South Africa
- Institut für Therapeutische Kommunikation und Sprachgebrauch, Europa Universität, Frankfurt (Oder), Germany
| | | | - Rudolf M Oosthuizen
- Department of Industrial and Organisational Psychology, School of Management Sciences, College of Economic and Management Sciences, Pretoria, South Africa
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14
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Hyett MP, Bank SR, Lipp OV, Erceg-Hurn DM, Alvares GA, Maclaine E, Puckridge E, Hayes S, McEvoy PM. Attenuated Psychophysiological Reactivity following Single-Session Group Imagery Rescripting versus Verbal Restructuring in Social Anxiety Disorder: Results from a Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 87:340-349. [PMID: 30380535 DOI: 10.1159/000493897] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The effectiveness of psychotherapies for social anxiety disorder (SAD) is typically evaluated using self- and clinician-reported symptom change, while biomarkers of treatment response are rarely measured. The current study aimed to compare biomarkers of response following two brief group interventions for SAD. METHODS This randomized controlled trial evaluated the effectiveness of single-session group interventions for SAD (n = 58) - imagery rescripting (IR) and verbal restructuring (VR) versus waitlist control (WC). The IR intervention guided participants to rescript autobiographical memories through visualization whilst the VR intervention focused on thought challenging. Trial outcomes included change in psychophysiological reactivity (heart rate variability (HRV) and electrodermal responding) to social stress, and symptom-based measures (social interaction anxiety, negative self-portrayal, cognitive avoidance, repetitive negative thinking, memory modification, anxious behaviors). RESULTS Psychophysiological reactivity was selectively attenuated following IR treatment, compared to VR and WC groups. The specific influence of the imagery-based intervention in modulating autonomic reactivity was evident across HRV parameters, including the standard deviation of intervals between heartbeats (IR vs. WC, d = 0.67, p = 0.021; IR vs. VR, d = 0.58, p = 0.041), and high frequency power - an indicator of parasympathetically mediated emotion regulation (IR vs. WC, d = 0.75, p = 0.034; IR vs. VR, d = 0.95, p = 0.006). Few group differences were observed across self-report measures. CONCLUSION The current study highlights the specificity of brief imagery-based interventions in influencing psychophysiological reactivity in SAD and establishes the sensitivity of objective markers of treatment response in quantifying change over symptom-based measurements.
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Affiliation(s)
- Matthew P Hyett
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Samantha R Bank
- School of Psychology, Curtin University, Perth, Washington, Australia.,Centre for Clinical Interventions, Perth, Washington, Australia
| | - Ottmar V Lipp
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - David M Erceg-Hurn
- School of Psychology, Curtin University, Perth, Washington, Australia.,Centre for Clinical Interventions, Perth, Washington, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, Washington, Australia
| | - Ellen Maclaine
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Emily Puckridge
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Sarra Hayes
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Washington, .,Centre for Clinical Interventions, Perth, Washington,
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15
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Kamalou S, Shaughnessy K, Moscovitch DA. Social anxiety in the digital age: The measurement and sequelae of online safety-seeking. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2018.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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16
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Ravary A, Baldwin MW. Self-esteem vulnerabilities are associated with cued attentional biases toward rejection. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials 2017. [DOI: 10.1016/j.cct.2017.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Kodal A, Bjelland I, Gjestad R, Wergeland GJ, Havik OE, Heiervang ER, Fjermestad K. Subtyping social anxiety in youth. J Anxiety Disord 2017; 49:40-47. [PMID: 28388458 DOI: 10.1016/j.janxdis.2017.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 01/30/2017] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Abstract
Few empirical studies have examined subtypes of social anxiety disorder (SAD) in youth, and limited consensus resides on the nature of potential subtypes. Identifying subtypes, based on both fear and avoidance patterns, can help improve assessment and treatment of SAD. Subtypes of fear and avoidance were examined in a sample comprising 131 youth (age 8-15 years) diagnosed with SAD using the Anxiety Disorders Interview Schedule for children and parents (ADIS-C/P). Exploratory factor analysis of fear responses revealed three factors, defining fear subtypes linked to: (1) performance, (2) observation, and (3) interaction situations, respectively. Exploratory factor analysis of avoidance responses showed these were best represented by one avoidance factor. Few youth qualified exclusively for either of the fear subtypes, thus calling into question the clinical utility of these subtypes. Nevertheless, the findings indicate distinct contributions of fear and avoidance in SAD presentation. This finding might help clinicians target and improve treatment of the disorder.
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Affiliation(s)
- A Kodal
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - I Bjelland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - R Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - G J Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Health, Uni Research, Bergen, Norway
| | - O E Havik
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - E R Heiervang
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K Fjermestad
- Department of Psychology, University of Oslo, Oslo, Norway
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19
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Rodebaugh TL, Levinson CA, Langer JK, Weeks JW, Heimberg RG, Brown PJ, Menatti AR, Schneier FR, Blanco C, Liebowitz MR. The structure of vulnerabilities for social anxiety disorder. Psychiatry Res 2017; 250:297-301. [PMID: 28199950 PMCID: PMC5346047 DOI: 10.1016/j.psychres.2017.01.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/18/2016] [Accepted: 01/27/2017] [Indexed: 11/23/2022]
Abstract
Social anxiety disorder symptoms are generally proposed to be related to broad temperamental vulnerabilities (e.g., a low level of approach and high level of avoidance temperament), specific psychological vulnerabilities (e.g., fears of negative and positive evaluation), and additional disorders (e.g., major depressive disorder). However, existing tests of such a model have either not considered depressive symptoms or relied on samples of undergraduates. We examined these and related questions via a latent variable model in a large dataset (N=2253) that combined participants across a variety of studies. The model had adequate fit in the whole sample, and good fit in a subsample in which more participants completed the depression measure. The model indicated that low level of approach and high level of avoidance temperament contributed to fears of evaluation and social anxiety symptoms, and that fears of evaluation additionally contributed independently to social anxiety symptoms. The relationship between social anxiety and depressive symptoms was entirely accounted for by these vulnerabilities: Depressive symptoms were only predicted by avoidance temperament.
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Affiliation(s)
- Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Julia K Langer
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Justin W Weeks
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Patrick J Brown
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Franklin R Schneier
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY, USA
| | - Carlos Blanco
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY, USA
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20
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Koban L, Schneider R, Ashar YK, Andrews-Hanna JR, Landy L, Moscovitch DA, Wager TD, Arch JJ. Social anxiety is characterized by biased learning about performance and the self. ACTA ACUST UNITED AC 2017; 17:1144-1155. [PMID: 28358557 DOI: 10.1037/emo0000296] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
People learn about their self from social information, and recent work suggests that healthy adults show a positive bias for learning self-related information. In contrast, social anxiety disorder (SAD) is characterized by a negative view of the self, yet what causes and maintains this negative self-view is not well understood. Here the authors use a novel experimental paradigm and computational model to test the hypothesis that biased social learning regarding self-evaluation and self-feelings represents a core feature that distinguishes adults with SAD from healthy controls. Twenty-one adults with SAD and 35 healthy controls (HCs) performed a speech in front of 3 judges. They subsequently evaluated themselves and received performance feedback from the judges and then rated how they felt about themselves and the judges. Affective updating (i.e., change in feelings about the self over time, in response to feedback from the judges) was modeled using an adapted Rescorla-Wagner learning model. HCs demonstrated a positivity bias in affective updating, which was absent in SAD. Further, self-performance ratings revealed group differences in learning from positive feedback-a difference that endured at an average of 1 year follow up. These findings demonstrate the presence and long-term endurance of positively biased social learning about the self among healthy adults, a bias that is absent or reversed among socially anxious adults. (PsycINFO Database Record
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Affiliation(s)
- Leonie Koban
- Institute of Cognitive Science, University of Colorado Boulder
| | | | - Yoni K Ashar
- Institute of Cognitive Science, University of Colorado Boulder
| | | | - Lauren Landy
- Institute of Cognitive Science, University of Colorado Boulder
| | | | - Tor D Wager
- Institute of Cognitive Science, University of Colorado Boulder
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder
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21
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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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22
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Stein JE, Modini M, Hunt C, Abbott MJ. A Systematic Review of the Psychometric Properties of Trait Cognitive Self-Report Measures in Social Anxiety. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9573-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Abstract
Cognitive behavioral models of social anxiety disorder (SAD) suggest that fear of negative evaluation is a core fear or vulnerability for SAD. However, why negative evaluation is feared is not fully understood. It is possible that core beliefs contribute to the relationship between fear of negative evaluation and SAD. One of these beliefs may be a core extrusion schema: a constellation of beliefs that one’s true self will be rejected by others and therefore one should hide one’s true self. In the current study ( N = 699), we extended research on the Core Extrusion Schema and created a shortened and revised version of the measure called the Core Extrusion Schema–Revised. The Core Extrusion Schema–Revised demonstrated good factor fit for its two subscales (Hidden Self and Rejection of the True Self) and was invariant across gender and ethnicity. The Hidden Self subscale demonstrated excellent incremental validity within the full sample as well as in participants diagnosed with generalized SAD. Specifically, the Hidden Self subscale may help explain severity of social interaction anxiety. This measure could be used with individuals diagnosed with generalized SAD to design exposures targeting these core beliefs.
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24
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Moscovitch DA. Early memories in social anxiety: A meaningful and enduring collaboration with my Dad. Neuropsychologia 2016; 90:286-92. [PMID: 26994594 DOI: 10.1016/j.neuropsychologia.2016.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/26/2016] [Accepted: 03/15/2016] [Indexed: 12/01/2022]
Abstract
In this short paper in honour of my father's Festschrift, I describe a recent collaboration with him in which we joined forces to investigate the nature of autobiographical images and memories in social anxiety. I outline our work together and the unique insights that were gleaned from our interactive contributions. Then, I reflect on how this collaboration has helped to lay the foundation for subsequent work in my lab and illuminate new directions in my program of research, enhance my career as a scientist-practitioner, and ultimately, enrich both my personal and professional identities. In so doing, I aim to highlight one of the most important and enduring aspects of my father's legacy: the profound positive impact he has on the people with whom he has worked.
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Affiliation(s)
- David A Moscovitch
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Canada.
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25
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Kizilcik IN, Gregory B, Baillie AJ, Crome E. An empirical analysis of Moscovitch's reconceptualised model of social anxiety: How is it different from fear of negative evaluation? J Anxiety Disord 2016; 37:64-70. [PMID: 26643013 DOI: 10.1016/j.janxdis.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 11/05/2015] [Accepted: 11/07/2015] [Indexed: 11/18/2022]
Abstract
Cognitive-behavioural models propose that excessive fear of negative evaluation is central to social anxiety. Moscovitch (2009) instead proposes that perceived deficiencies in three self attributes: fears of showing signs of anxiety, deficits in physical appearance, or deficits in social competence are at the core of social anxiety. However, these attributes are likely to overlap with fear of negative evaluation. Responses to an online survey of 286 participants with a range of social anxiety severity were analysed using hierarchical multiple regression to identify the overall unique predictive value of Moscovitch's model. Altogether, Moscovitch's model provided improvements in the prediction of safety behaviours, types of fears and cognitions; however only the fear of showing anxiety subscale provided unique information. This research supports further investigations into the utility of this revised model, particularly related to utility of explicitly assessing and addressing fears of showing anxiety.
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Affiliation(s)
- Isilay N Kizilcik
- Centre of Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia
| | - Bree Gregory
- Centre of Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
| | - Andrew J Baillie
- Centre of Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use/Centre of Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
| | - Erica Crome
- NHMRC Centre of Research Excellence in Mental Health and Substance Use/Centre of Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
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26
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Out of the shadows and into the spotlight: Social blunders fuel fear of self-exposure in social anxiety disorder. J Anxiety Disord 2015; 34:24-32. [PMID: 26113039 DOI: 10.1016/j.janxdis.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 11/24/2022]
Abstract
In a study designed to clarify and extend previous research on social blunders in social anxiety, 32 participants with social anxiety disorder (SAD), 25 anxious control (AC) participants with anxiety disorders other than SAD, and 25 healthy control (HC) participants with no history of anxiety problems estimated the costs of hypothetical blunders committed by either themselves or by others. Participants with SAD rated the costs of their own imagined blunders as highly inflated relative to both AC and HC participants. In contrast, for blunders participants imagined others committing, only SAD and healthy control participants' cost estimates differed from one another. Moreover, concerns about revealing self-flaws--and, in particular, about appearing socially incompetent--accounted for significant, unique variance in SAD participants' exaggerated cost estimates of self blunders, over and above symptoms of social anxiety and depression. These results enhance our understanding of how and why socially anxious individuals negatively appraise social blunders and help to clarify the potential function and role of social mishap exposures in the treatment of SAD.
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27
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Titchener K, Wong QJJ. A weighty issue: explaining the association between body mass index and appearance-based social anxiety. Eat Behav 2015; 16:13-6. [PMID: 25464060 DOI: 10.1016/j.eatbeh.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/14/2014] [Accepted: 10/23/2014] [Indexed: 01/10/2023]
Abstract
Research has indicated that individuals who are overweight or obese are more likely to experience mental health difficulties. One line of research has indicated that body mass index (BMI) is positively associated with appearance-based social anxiety, rather than social anxiety more generally. However, there is a lack of research that has attempted to explain this association. Thus, the current study recruited an undergraduate sample (N=90) and aimed (a) to replicate previous research by examining the associations between BMI, social anxiety, and appearance-based social anxiety and (b) to extend previous research by examining two potential mediators in the relationship between BMI and appearance-based social anxiety suggested in the literature (i.e., body image dissatisfaction and emotional eating). Analyses indicated that BMI was not associated with social anxiety but positively associated with appearance-based social anxiety. The association between BMI and appearance-based social anxiety was only mediated by body image dissatisfaction, and the model of these relationships emerged as the best fitting model relative to a plausible alternative model. The findings replicate and extend previous research on weight status and psychological factors and highlight the need for future longitudinal research on BMI, appearance-based social anxiety, and body image dissatisfaction so that interventions for obesity and weight loss maintenance programs can be ultimately enhanced.
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Affiliation(s)
- Kristen Titchener
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia.
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28
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Moscovitch DA, Rowa K, Paulitzki JR, Antony MM, McCabe RE. What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9645-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Zimmerman J, Morrison AS, Heimberg RG. Social anxiety, submissiveness, and shame in men and women: A moderated mediation analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:1-15. [DOI: 10.1111/bjc.12057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 04/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob Zimmerman
- Department of Psychology; Temple University; Philadelphia Pennsylvania USA
| | - Amanda S. Morrison
- Department of Psychology; Temple University; Philadelphia Pennsylvania USA
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30
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Moscovitch DA, Chiupka CA, Gavric DL. Within the mind's eye: Negative mental imagery activates different emotion regulation strategies in high versus low socially anxious individuals. J Behav Ther Exp Psychiatry 2013; 44:426-32. [PMID: 23787175 DOI: 10.1016/j.jbtep.2013.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/03/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The link between social anxiety (SA) and maladaptive emotion regulation has been clearly established, but little is known about the spontaneous regulation strategies that may be activated during social stress by negative involuntary mental images and whether the nature of such strategies might distinguish individuals with high vs. low trait SA. METHODS Participants with high (n = 33) or low (n = 33) trait SA performed an evaluative speech and reported whether they experienced an involuntary negative mental image during the task. They also rated their negative affect (NA) and positive affect (PA) and the extent to which they viewed their image as being controllable and malleable. Finally, they described the types of strategies they spontaneously used to try to control or change their image intrusions. Reported strategies were then subjected to a content analysis and categorized by blinded coders. RESULTS Among high SA participants, image controllability was both diminished overall and positively correlated with PA. Whereas 90% of low SA individuals reported that they spontaneously self-regulated by altering the content or perceptual features of their images, only about half of the high SA participants used this strategy, with the other 50% reporting that they either suppressed their images or succumbed passively to them in whatever form they took. LIMITATIONS AND CONCLUSIONS Although these initial findings require replication in future experimental studies on clinical samples, they also help to enrich our understanding of the strategies that are commonly used by high and low SA individuals to manage their image intrusions during in-vivo stress and suggest potential avenues for future research on the role of imagery in adaptive and maladaptive emotion regulation.
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Affiliation(s)
- David A Moscovitch
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Waterloo, ON, Canada.
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31
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Moscovitch DA, Rowa K, Paulitzki JR, Ierullo MD, Chiang B, Antony MM, McCabe RE. Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behav Res Ther 2013; 51:476-86. [DOI: 10.1016/j.brat.2013.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/15/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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32
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Merrifield C, Balk D, Moscovitch DA. Self-portrayal concerns mediate the relationship between recalled teasing and social anxiety symptoms in adults with anxiety disorders. J Anxiety Disord 2013; 27:456-60. [PMID: 23845454 DOI: 10.1016/j.janxdis.2013.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022]
Abstract
Previous research on individuals with anxiety disorders has demonstrated that both childhood peer maltreatment and concerns about negative self-portrayal are related to elevated symptoms of social anxiety (SA). In the present study, we examined whether concerns about negative self-portrayal might either moderate or mediate the relation between recalled childhood teasing history and current symptoms of SA in a non-treatment-seeking clinical sample of 238 individuals with anxiety disorders. Participants completed the Teasing Questionnaire-Revised (TQ-R), the Negative Self-Portrayal Scale (NSPS), and the Social Phobia Inventory (SPIN). Analyses using structural equation modeling (SEM) indicated that self-portrayal concerns mediated, but did not moderate, the relationship between recalled teasing and current SA, accounting for 51% of the total effect. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Colleen Merrifield
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Canada.
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33
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Physical appearance anxiety impedes the therapeutic effects of video feedback in high socially anxious individuals. Behav Cogn Psychother 2013; 42:92-104. [PMID: 23317480 DOI: 10.1017/s1352465812001038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video feedback (VF) interventions effectively reduce social anxiety symptoms and negative self-perception, particularly when they are preceded by cognitive preparation (CP) and followed by cognitive review. AIMS In the current study, we re-examined data from a study on the efficacy of a novel VF intervention for individuals high in social anxiety to test the hypothesis that physical appearance anxiety would moderate the effects of VF. METHOD Data were analyzed from 68 socially anxious participants who performed an initial public speech, and were randomly assigned to an Elaborated VF condition (VF plus cognitive preparation and cognitive review), a Standard VF condition (VF plus cognitive preparation) or a No VF condition (exposure alone), and then performed a second speech. RESULTS As hypothesized, when appearance concerns were low, both participants who received Elaborated and Standard VF were significantly less anxious during speech 2 than those in the No VF condition. However, when levels of appearance concern were high, neither Elaborated nor Standard VF reduced anxiety levels during speech 2 beyond the No VF condition. CONCLUSIONS Results from our analog sample suggest the importance of tailoring treatment protocols to accommodate the idiosyncratic concerns of socially anxious patients.
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34
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Chiupka CA, Moscovitch DA, Bielak T. In Vivo Activation of Anticipatory vs. Post-Event Autobiographical Images and Memories in Social Anxiety. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2012. [DOI: 10.1521/jscp.2012.31.8.783] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Moscovitch DA, Rodebaugh TL, Hesch BD. How awkward! Social anxiety and the perceived consequences of social blunders. Behav Res Ther 2011; 50:142-9. [PMID: 22137365 DOI: 10.1016/j.brat.2011.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 11/24/2022]
Abstract
Seventy high socially anxious (HSA) and 74 low socially anxious (LSA) participants rated perceived interpersonal and emotional consequences of both (a) autobiographical social blunders recalled from their own lives and (b) imagined blunders presented in standardized hypothetical social scenarios. Ratings of participants' autobiographical blunders were also provided by research assistants who were blind to hypotheses. Results indicated that HSA participants overestimated the negative consequences of their own autobiographical blunders. These negative perceptions among HSA participants extended to imagined blunders, even when participants were instructed to imagine a third party other than themselves as the person committing the blunder. This pattern of results suggests the conclusion that the perceived consequences of social blunders among HSA individuals are driven by the belief that social standards are high, inflexible, or both.
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Affiliation(s)
- David A Moscovitch
- Department of Psychology, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
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36
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Moscovitch DA, Gavric DL, Merrifield C, Bielak T, Moscovitch M. Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: Outcomes with a new measure. Behav Res Ther 2011; 49:505-17. [DOI: 10.1016/j.brat.2011.05.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/22/2011] [Accepted: 05/18/2011] [Indexed: 11/24/2022]
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