1
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Tsarpalis-Fragkoulidis A, Tran US, Zemp M. Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis. Dev Psychopathol 2024:1-13. [PMID: 39359015 DOI: 10.1017/s0954579424001366] [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: 10/04/2024]
Abstract
Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals' vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.
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Affiliation(s)
| | - Ulrich S Tran
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Martina Zemp
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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2
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Hosseini K, Pettit JW, Soto FA, Mattfeld AT, Buzzell GA. Toward a mechanistic understanding of the role of error monitoring and memory in social anxiety. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:948-963. [PMID: 38839717 DOI: 10.3758/s13415-024-01198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
Cognitive models state that social anxiety (SA) involves biased cognitive processing that impacts what is learned and remembered within social situations, leading to the maintenance of SA. Neuroscience work links SA to enhanced error monitoring, reflected in error-related neural responses arising from mediofrontal cortex (MFC). Yet, the role of error monitoring in SA remains unclear, as it is unknown whether error monitoring can drive changes in memory, biasing what is learned or remembered about social situations. Motivated by the longer-term goal of identifying mechanisms implicated in SA, in the current study we developed and validated a novel paradigm for probing the role of error-related MFC theta oscillations (associated with error monitoring) and incidental memory biases in SA. Electroencephalography (EEG) data were collected while participants completed a novel Face-Flanker task, involving presentation of task-unrelated, trial-unique faces behind target/flanker arrows on each trial. A subsequent incidental memory assessment evaluated memory biases for error events. Severity of SA symptoms were associated with greater error-related theta synchrony over MFC, as well as between MFC and sensory cortex. Social anxiety also was positively associated with incidental memory biases for error events. Moreover, greater error-related MFC-sensory theta synchrony during the Face-Flanker predicted subsequent incidental memory biases for error events. Collectively, the results demonstrate the potential of a novel paradigm to elucidate mechanisms underlying relations between error monitoring and SA.
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Affiliation(s)
- Kianoosh Hosseini
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, USA.
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, USA.
| | - Jeremy W Pettit
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, USA
| | - Fabian A Soto
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, USA
| | - Aaron T Mattfeld
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, USA
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3
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Hauffe V, Vierrath V, Tuschen-Caffier B, Schmitz J. Daily-life reactivity and emotion regulation in children with social anxiety disorder. J Anxiety Disord 2024; 106:102907. [PMID: 39059189 DOI: 10.1016/j.janxdis.2024.102907] [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: 09/03/2023] [Revised: 06/01/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.
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Affiliation(s)
- Vera Hauffe
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany.
| | - Verena Vierrath
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany
| | - Julian Schmitz
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Germany; Leipzig Research Center for Early Child Development, Leipzig University, Germany
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4
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Edgar EV, Richards A, Castagna PJ, Bloch MH, Crowley MJ. Post-event rumination and social anxiety: a systematic review and meta-analysis. J Psychiatr Res 2024; 173:87-97. [PMID: 38518572 PMCID: PMC11018455 DOI: 10.1016/j.jpsychires.2024.03.013] [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: 10/16/2023] [Revised: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting a correlation between post-event rumination and social anxiety symptomatology. Fisher's z correlation coefficients were calculated through random-effect meta-analyses. Results indicated a moderate association between post-event rumination and social anxiety symptomatology (r = 0.45, p < 0.001, 95%CI [0.40-0.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q = 44.36, df = 3, p < 0.001) and social anxiety (Q = 26.44, df = 8, p < 0.001), as well as the task conducted prior to assessing post-event rumination (Q = 14.31, df = 2, p < 0.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.
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Affiliation(s)
- Elizabeth V Edgar
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Ashlyn Richards
- Department of Psychology, Sewanee the University of the South, Sewanee, TN, USA
| | - Peter J Castagna
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Michael H Bloch
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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5
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Lidle LR, Schmitz J. Assessing Visual Avoidance of Faces During Real-Life Social Stress in Children with Social Anxiety Disorder: A Mobile Eye-Tracking Study. Child Psychiatry Hum Dev 2024; 55:24-35. [PMID: 35708796 PMCID: PMC10796484 DOI: 10.1007/s10578-022-01383-y] [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] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Abstract
This study measured visual attention (fixation count, dwell time) during two real-life social stress tasks using mobile eye-tracking glasses in children (9-13 years) diagnosed with social anxiety disorder (SAD; n = 25) and a healthy control group (HC; n = 30). The influence of state anxiety on attention allocation and negative self-evaluation biases regarding gaze behavior were also examined. Compared to the HC group, children with SAD showed visual avoidance (i.e., fewer fixations) of the faces of interaction partners during the second social stress task. While visual avoidance in HC children decreased with declining state anxiety from the first to the second social stress task, no such effect was found in children with SAD. A negative self-evaluation bias regarding gaze behavior in children with SAD was not found. In sum, measuring visual attention during real-life social situations may help enhance our understanding of social attention in childhood SAD.
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Affiliation(s)
- Leonie Rabea Lidle
- Department for Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Neumarkt 9-19, 04109, Leipzig, Germany.
- Leipzig Research Centre for Early Child Development, Leipzig University, Leipzig, Germany.
| | - Julian Schmitz
- Department for Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Neumarkt 9-19, 04109, Leipzig, Germany
- Leipzig Research Centre for Early Child Development, Leipzig University, Leipzig, Germany
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6
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Hosseini K, Pettit JW, Soto FA, Mattfeld AT, Buzzell GA. Towards a mechanistic understanding of the role of error monitoring and memory in social anxiety. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.14.557662. [PMID: 37745333 PMCID: PMC10515949 DOI: 10.1101/2023.09.14.557662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Cognitive models state social anxiety (SA) involves biased cognitive processing that impacts what is learned and remembered within social situations, leading to the maintenance of SA. Neuroscience work links SA to enhanced error monitoring, reflected in error-related neural responses arising from mediofrontal cortex (MFC). Yet, the role of error monitoring in SA remains unclear, as it is unknown whether error monitoring can drive changes in memory, biasing what is learned or remembered about social situations. Thus, we developed a novel paradigm to investigate the role of error-related MFC theta oscillations (associated with error monitoring) and memory biases in SA. EEG was collected while participants completed a novel Face-Flanker task, involving presentation of task-unrelated, trial-unique faces behind target/flanker arrows on each trial. A subsequent incidental memory assessment evaluated memory biases for error events. Severity of SA symptoms were associated with greater error-related theta synchrony over MFC, as well as between MFC and sensory cortex. SA was positively associated with memory biases for error events. Consistent with a mechanistic role in biased cognitive processing, greater error-related MFC-sensory theta synchrony during the Face-Flanker predicted subsequent memory biases for error events. Our findings suggest high SA individuals exhibit memory biases for error events, and that this behavioral phenomenon may be driven by error-related MFC-sensory theta synchrony associated with error monitoring. Moreover, results demonstrate the potential of a novel paradigm to elucidate mechanisms underlying relations between error monitoring and SA.
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Affiliation(s)
- Kianoosh Hosseini
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Jeremy W. Pettit
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Fabian A. Soto
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Aaron T. Mattfeld
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - George A. Buzzell
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
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7
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Lau N, Zhou AM, Yuan A, Parigoris R, Rosenberg AR, Weisz JR. Social skills deficits and self-appraisal biases in children with social anxiety disorder. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:2889-2900. [PMID: 37772042 PMCID: PMC10538948 DOI: 10.1007/s10826-021-02194-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 09/30/2023]
Abstract
Social Anxiety Disorder is highly prevalent among children and leads to poor long-term outcomes if left untreated. Theoretical models of anxiety differ in whether children with Social Anxiety Disorder experience objective social skills deficits, negative self-interpretation biases, or some combination of the two. This pilot study evaluated evidence in support of the "deficit" and "bias" models. Approval was obtained from the ethics committee of a large private university in Cambridge, MA, USA, and data collection was completed in 2015. We recruited 68 parent-child dyads for a study in which anxious children (with Social Anxiety Disorder) and non-anxious children underwent a child-adapted version of the Trier Social Stress Test. Children were aged 8-14, 67.6% male, and self-identified as 54.4% White, 7.4% Black, 4.4% Latinx, 13.2% Asian, 14.7% multiethnic, and 5.9% "other" or no response. Performance ratings were obtained from children, their parents, and external observers. We found evidence of both specific social skills deficits and self-appraisal biases in anxious children. Anxious children struggled with signs of physical discomfort but not with actual speech content. Although children were generally able to accurately evaluate their social performance, older anxious children were most self-critical. Parents were similarly accurate in appraisals of their children's social performance. Anxious children responded favorably to positive feedback with improved self-evaluations of performance and decreased anxiety. Findings suggest that a comprehensive "integrated" theoretical model of Social Anxiety Disorder should include both skills deficits and self-appraisal biases.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Anna M Zhou
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Amanda Yuan
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ryan Parigoris
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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8
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Tsarpalis-Fragkoulidis A, van Eickels RL, Zemp M. Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety. J Clin Med 2022; 11:jcm11205979. [PMID: 36294299 PMCID: PMC9605076 DOI: 10.3390/jcm11205979] [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: 09/19/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.
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9
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Lidle LR, Schmitz J. Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing. Res Child Adolesc Psychopathol 2021; 49:1447-1459. [PMID: 34143352 PMCID: PMC8455401 DOI: 10.1007/s10802-021-00837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/01/2022]
Abstract
According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n = 30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.
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Affiliation(s)
- Leonie Rabea Lidle
- Institute of Psychology, Department for Clinical Child and Adolescent Psychology, Leipzig University, Neumarkt 9-19, 04109, Leipzig, Germany.
- Leipzig Research Centre for Early Child Development, Leipzig University, Leipzig, Germany.
| | - Julian Schmitz
- Institute of Psychology, Department for Clinical Child and Adolescent Psychology, Leipzig University, Neumarkt 9-19, 04109, Leipzig, Germany
- Leipzig Research Centre for Early Child Development, Leipzig University, Leipzig, Germany
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10
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Vogel F, Reichert J, Hartmann D, Schwenck C. Cognitive Variables in Social Anxiety Disorder in Children and Adolescents: A Network Analysis. Child Psychiatry Hum Dev 2021; 54:625-638. [PMID: 34708304 PMCID: PMC10150579 DOI: 10.1007/s10578-021-01273-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Clark and Wells' prominent model of social anxiety disorder (SAD) assumes that cognitive variables such as negative expectations or dysfunctional cognitions play a central role in the symptomatology of SAD. In contrast to adults, it is less clear how well the cognitive model can be applied to children and adolescents. A network analysis with seven nodes was conducted to explore the importance of cognitive variables and their interaction with symptoms of SAD based on N = 205 children and adolescents (8-18 years, M = 11.54 years). Cognitive variables had a high but differential impact within the positively connected network of SAD. Dysfunctional cognitions were most strongly connected within the network. Dysfunctional cognitions, as predicted by Clark and Wells' model, seem to act as a hub affecting several symptoms. The association between negative expectations and avoidance indicates that negative expectations may particularly contribute to the maintenance of SAD.
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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 10 E, 35394, Gießen, Germany.
| | - Julian Reichert
- Medical School Hamburg, University of Applied Science and Medical University, Hamburg, Germany.,Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Hartmann
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10 E, 35394, Gießen, Germany
| | - Christina Schwenck
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10 E, 35394, Gießen, Germany
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11
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Wong QJ. Anticipatory Processing and Post‐Event Processing in Social Anxiety Disorder: An Update on the Literature. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Quincy Jj Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University,
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12
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Golombek K, Lidle L, Tuschen-Caffier B, Schmitz J, Vierrath V. The role of emotion regulation in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1479-1501. [PMID: 31201527 DOI: 10.1007/s00787-019-01359-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/27/2019] [Indexed: 01/04/2023]
Abstract
While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.
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Affiliation(s)
- Kristin Golombek
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Leonie Lidle
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Julian Schmitz
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Verena Vierrath
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany.
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13
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Asbrand J, Schmitz J, Krämer M, Nitschke K, Heinrichs N, Tuschen-Caffier B. Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1945-1956. [PMID: 31073879 DOI: 10.1007/s10802-019-00558-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models and previous research suggest that post-event processing (PEP) after social situations maintains social anxiety disorder (SAD). To date, little is known about PEP in childhood, a critical period for disorder development, or about possible positive effects of cognitive behavioral therapy (CBT) on PEP in children. Children with SAD (n = 71; aged 9-13 years) and healthy controls (n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated in children with SAD after either 12 sessions of CBT or a waiting period. PEP was assessed daily with regard to both valence and frequency, as well as in more detail regarding specific negative and positive ruminative thoughts 1 week after each TSST-C. Daily PEP after the TSST-C was more frequent and more negative in children with SAD compared to healthy controls, in particular during the first 2 days after the TSST-C. After CBT treatment, children with SAD reported more positive PEP but not less negative PEP compared to children in the waitlist control group. The current study suggests that negative PEP in children with SAD is most pronounced in the first days following social stress. Group-based CBT seems to be effective in building up positive cognitions after social stress in children, but developing specific interventions targeting negative PEP immediately after a social stressor may be necessary to further increase treatment efficacy.
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Affiliation(s)
- Julia Asbrand
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Julian Schmitz
- Department for Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Martina Krämer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Nitschke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nina Heinrichs
- Institute of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions. Behav Cogn Psychother 2020; 49:159-171. [PMID: 32720630 DOI: 10.1017/s1352465820000430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD. AIM The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children. METHOD We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis. RESULTS SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis. CONCLUSIONS Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.
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Halldorsson B, Castelijn S, Creswell C. Are children with social anxiety disorder more likely than children with other anxiety disorders to anticipate poor social performance and reflect negatively on their performance? J Affect Disord 2019; 245:561-568. [PMID: 30445381 DOI: 10.1016/j.jad.2018.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The cognitive theory of social anxiety disorder (SAD) suggests that adults with SAD have a tendency to anticipate poor social performance and reflect negatively on their performance following a social event. While a number of studies with socially anxious adults have supported the role of poor performance anticipation and post-event rumination in SAD, to date, only a few studies have addressed whether this also applies to children with SAD. METHODS Children (7-12 years) diagnosed with SAD (n = 40), other anxious children (n = 40) and non-anxious children (n = 34) were exposed to a social stressor speech task and their pre- and post-performance appraisals assessed, taking into account objective performance ratings. RESULTS Although observers rated some aspects of performance as significantly worse among children with SAD than children with other anxiety disorders, children with SAD were not more likely than their anxious or non-anxious peers to show a general bias in pre- or post-performance appraisals. Furthermore, children with SAD were just as likely as their anxious and non-anxious peers to recognize good performance but were more critical of themselves when their performance was poor. LIMITATIONS The speech task did not involve a same-age peer. Participants were relatively affluent group of predominantly non-minority status. Specificity for SAD in relation to other anxiety disorders remains unclear. CONCLUSIONS Focusing on counteracting pre- and post-event social performance appraisals may potentially be inappropriate for childhood SAD. Children with SAD might benefit from interventions that focus on helping them to become less critical of themselves after social interactions have not gone well.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK.
| | - Saskia Castelijn
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
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Halldorsson B, Creswell C. Social anxiety in pre-adolescent children: What do we know about maintenance? Behav Res Ther 2017; 99:19-36. [PMID: 28881221 DOI: 10.1016/j.brat.2017.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology and Clinical Language Sciences, University of Reading, UK.
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Keil V, Asbrand J, Tuschen-Caffier B, Schmitz J. Children with social anxiety and other anxiety disorders show similar deficits in habitual emotional regulation: evidence for a transdiagnostic phenomenon. Eur Child Adolesc Psychiatry 2017; 26:749-757. [PMID: 28078476 DOI: 10.1007/s00787-017-0942-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/05/2017] [Indexed: 12/26/2022]
Abstract
Deficits in emotion regulation (ER) are an important factor in maintaining social anxiety disorder (SAD) in adults. As SAD and ER problems typically develop during childhood and adolescence, and are maintained dynamically within the parent-child dyad, research on families can help to reveal the role ER plays in the early development of SAD. The current study assessed self-reported habitual ER in dyads of children with SAD (n = 31), children with mixed anxiety disorders (MAD; n = 41) and healthy control children (HC; n = 36), and their parents. Results indicate a transdiagnostic quality of ER in that, children with SAD and children with MAD similarly reported less adaptive and more maladaptive ER strategies than HC children, whereas no group differences in parental ER strategies emerged. Furthermore, children's ER strategies aggressive action, withdrawal and self-devaluation and the parental ER strategy reappraisal were associated with social anxiety symptoms. These results suggest that there may be deficits in ER which generalize across childhood anxiety disorders. Our results are discussed in relation to current theories and their implications for treatment of childhood SAD.
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Affiliation(s)
- Verena Keil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Julia Asbrand
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Julian Schmitz
- Department of Clinical Child and Adolescent Psychology, University of Leipzig, Leipzig, Germany.,Leipzig Research Center for Early Child Development, University of Leipzig, Leipzig, Germany
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18
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Wong QJJ, Rapee RM. The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord 2016; 203:84-100. [PMID: 27280967 DOI: 10.1016/j.jad.2016.05.069] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/24/2016] [Accepted: 05/28/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD. METHODS A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model. RESULTS A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model. LIMITATIONS There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model. CONCLUSIONS The IAM model provides a framework for future investigations into the development and persistence of SAD.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Wong QJJ, Gregory B, McLellan LF. A Review of Scales to Measure Social Anxiety Disorder in Clinical and Epidemiological Studies. Curr Psychiatry Rep 2016; 18:38. [PMID: 26893236 DOI: 10.1007/s11920-016-0677-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To advance research into social anxiety disorder (SAD) and provide efficacious treatments for individuals with SAD, researchers and clinicians must have effective assessment instruments for identifying the disorder in terms of its diagnostic criteria, symptoms, and the presence of specific maintaining factors. This review highlights the main lines of existing adult and youth research on scales that form part of diagnostic instruments that assess SAD, scales that measure social anxiety symptoms, and scales that measure theory-based psychological maintaining factors associated with SAD. The review also highlights methodological issues that impact on the use of the aforementioned scales. The continued refinement and comparative evaluation of measures for SAD, culminating in the ascertainment of optimal measures, will improve the assessment and identification of the disorder. Improved identification of the disorder will contribute to the advancement of SAD research and treatment.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
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20
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Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
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Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder. J Cogn Psychother 2016; 30:94-104. [PMID: 32755909 DOI: 10.1891/0889-8391.30.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.
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Rowa K, Paulitzki JR, Ierullo MD, Chiang B, Antony MM, McCabe RE, Moscovitch DA. A false sense of security: safety behaviors erode objective speech performance in individuals with social anxiety disorder. Behav Ther 2015; 46:304-14. [PMID: 25892167 DOI: 10.1016/j.beth.2014.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/03/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
In the current study, 55 participants with a diagnosis of generalized social anxiety disorder (SAD), 23 participants with a diagnosis of an anxiety disorder other than SAD with no comorbid SAD, and 50 healthy controls completed a speech task as well as self-reported measures of safety behavior use. Speeches were videotaped and coded for global and specific indicators of performance by two raters who were blind to participants' diagnostic status. Results suggested that the objective performance of people with SAD was poorer than that of both control groups, who did not differ from each other. Moreover, self-reported use of safety behaviors during the speech strongly mediated the relationship between diagnostic group and observers' performance ratings. These results are consistent with contemporary cognitive-behavioral and interpersonal models of SAD and suggest that socially anxious individuals' performance skills may be undermined by the use of safety behaviors. These data provide further support for recommendations from previous studies that the elimination of safety behaviors ought to be a priority in cognitive behavioral therapy for SAD.
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Affiliation(s)
- Karen Rowa
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, and McMaster University.
| | | | - Maria D Ierullo
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton
| | | | | | - Randi E McCabe
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, and McMaster University
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Lange S, Tröster H. Strategien der Emotionsregulation bei sozial ängstlichen Kindern und Jugendlichen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Theoretischer Hintergrund: Bisherige Studien lassen vermuten, dass Kinder und Jugendliche mit sozialer Angststörung nicht nur emotionale Kompetenzdefizite in der Erkennung und im Ausdruck von Emotionen aufweisen, sondern auch Schwierigkeiten bei der Emotionsregulation bestehen. Fragestellung: Unterscheiden sich Kinder und Jugendliche mit sozialer Angststörung und sozial nicht ängstliche Kinder und Jugendliche in ihren adaptiven und maladaptiven Emotionsregulationsstrategien? Methode: Erhebung der Emotionsregulationsstrategien von sozial ängstlichen (mit und ohne Diagnose, n = 59 vs. n = 36) und sozial nicht ängstlichen Kindern und Jugendlichen (n = 146) mittels standardisiertem Fragebogen FEEL-KJ. Ergebnisse: Kinder und Jugendliche mit sozialer Angststörung berichten von signifikant weniger adaptiven und mehr maladaptiven Emotionsregulationsstrategien im Vergleich zu einer Kontrollgruppe. Schlussfolgerungen: Auffälligkeiten in der Regulierung negativer Emotionen scheinen mit sozialen Ängsten assoziiert zu sein.
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Abstract
Abstract
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