Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder

Development and validation of the positive evaluation core beliefs scale for social anxiety

Fear of positive evaluation (FPE) is becoming recognised as an important component of social anxiety that is distinct from fear of negative evaluation (FNE). While core belief scales exist for fear of negative evaluation (FNE), none has been developed for FPE. Therefore, this paper describes the development and validation of a measure of core beliefs that is specific to FPE. An exploratory factor analysis was performed on 60 initial items with an Australian undergraduate sample, in which a confirmatory factor analysis was performed with an independent Australian general population sample. A series of further analyses were performed to test convergent and divergent validity. The Positive Evaluation Core Beliefs Scale (PECS) emerged as a 17-item two-factor psychometrically valid measure that correlates more strongly with measurement of FPE than FNE. The PECS measure offers a new opportunity for researchers and clinicians to better explore cognitions associated with social anxiety.

Investigation of Cognitive Distortions in Panic Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder

The aim of this study was to determine the main cognitive distortions observed in panic disorder (PD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) and to investigate the impact of cognitive distortions on diagnoses, depression levels, disorder type and severity of anxiety. This study consisted of 150 clinical (50 PD, 50 GAD, 50 SAD) and 91 healthy control participants. A sociodemographic data form, the Beck Depression Inventory (BDI), the Dysfunctional Attitudes Scale (DAS), the Cognitive Distortions Scale (CDS) and the State-Trait Anxiety Inventory (STAI) scales were administered to all participants. It was found that cognitive distortions were higher in individuals with PD, GAD and SAD. The PD, SAD and GAD groups were similar for "catastrophizing", "mindreading", "all or nothing thinking", "overgeneralization", "should statements" and "emotional reasoning". "Personalization", "labeling" and "minimizing or disqualifying the positive" were observed at a higher severity in the SAD group compared to the PD group, and "mental filter" was observed at a higher severity in the GAD group compared to the PD group. Our findings emphasize the need to address cognitive distortions in PD, GAD and SAD treatment. The evaluation of cognitive distortions specific to anxiety disorders is significant in guiding therapy goals and pioneering new research.

Validity and reliability of the Chinese version of the core extrusion schema-revised for high school students in China

Objective

This study evaluated the validity and reliability of the Chinese version of the Core Extrusion Schema-Revised (CES-R) for assessing high school students and measures invariance across gender and grade parameters.

Methods

A sample of 1,334 high school students in Wuhan, China, participated in the study for item analysis, internal consistency tests, and measurement invariance tests of the CES-R. Additionally, 1745 high school students in Zhejiang Province, China. provided data for questionnaire validation.

Results

The results of the confirmatory factor analysis showed that the two-dimensional model fit the data well [chi-squared discrepancy = 113.989; degrees of freedom = 26; Tucker-Lewis index (TLI) = 0.949; comparative fit index (CFI) = 0.963; standardized root mean square residual = 0.072]. The Chinese CES-R scores were positively correlated with both the Adolescent Avoidance and Integration Questionnaire scores (r = 0.63, p < 0.01) and the Adolescent Social Anxiety Questionnaire scores (r = 0.70, p < 0.01). The internal consistency coefficient of the questionnaire was 0.94, and the split-half reliability was 0.90. The factor structure invariance, factor loading invariance, and intercept invariance of the Chinese CES-R across gender and grade groups (ΔCFI <0.01, ΔTLI <0.01, ΔRMSEA <0.01) indicated equivalence across gender and grade groups.

Conclusion

The Chinese version of CES-R has good validity and reliability for evaluating high school students and acceptable measurement invariance across genders and grades.

Negative and positive self-beliefs in social anxiety: The strength of believing mediates the affective response

BACKGROUND AND OBJECTIVES

Current cognitive models of social anxiety disorder (SAD) propose that individual, situation-specific self-beliefs are central to SAD. However, the role of differences in the degree to which individuals with social anxiety are convinced of self-beliefs, in particular positive ones, is still not fully understood. We compared how much high and low socially anxious individuals agree with their own negative and positive self-beliefs. Furthermore, we investigated whether agreeing with one's self-belief can explain the relation between negative affect in response to self-beliefs and social anxiety. Specifically, we were interested whether social anxiety increases negative affect in response to self-beliefs through an increase in agreement.

METHODS

We developed a new experimental self-belief task containing positive and negative semi-idiosyncratic, situation specific self-beliefs typical of high social anxiety and included a direct measure of agreement with these beliefs. Using extreme group sampling, we a-priori selected high (n = 51) and low (n = 50) socially anxious individuals. By multi-level mediation analysis, we analyzed agreement with self-beliefs in both groups and its association with affect.

RESULTS

High and low socially anxious individuals chose similar self-beliefs. However, high socially anxious individuals (HSA) agreed more with negative self-beliefs and less with positive self-beliefs compared to low socially anxious individuals (LSA). HSA individuals reported increased negative affect after both, exposition to negative and positive self-beliefs compared to LSA. We found that social anxiety increases affective responses towards negative-self beliefs through an increase in agreeing with these self-beliefs.

CONCLUSIONS

These findings suggest that cognitive models of social anxiety can be improved by including not only the content of a self-belief but also the strength of such a belief. In addition, they emphasize the relevance of positive self-beliefs in social anxiety, which has frequently been overlooked.

Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial

Background

Generalized anxiety disorder (GAD) is a chronic mental health condition that results in a significant individual and societal burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, many patients experience logistical barriers when accessing face-to-face CBT. Remotely delivered treatments remove many of these barriers. Despite emerging evidence demonstrating the efficacy of remotely delivered CBT for GAD, studies examining the efficacy of remote methods for GAD that are analogous to standard face-to-face treatment, in particular synchronous treatments such as CBT delivered via online videoconferencing (VCBT), are needed.

Methods

The authors propose a two-group randomized controlled trial comparing the efficacy of VCBT for GAD against a waitlist control group. The recruitment target will be 78 adults with primary GAD of at least moderate severity. The manualized high-intensity VCBT intervention will be delivered weekly over a 10-week period. After treatment completion, waitlist participants will receive the same VCBT delivered in a brief format (i.e., weekly over a 5-week period). Treatment for both groups will be delivered in real time via an online teleconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up.

Discussion

This trial will report findings on the efficacy of a remote synchronous high-intensity VCBT intervention for GAD. The results have the potential to contribute towards advancing our knowledge on the evidence base for GAD, as well as increase the dissemination of VCBT for GAD.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12621000786897. Registered on 22 June 2021

Psychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder

Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD.

Natural language processing for cognitive therapy: Extracting schemas from thought records

The cognitive approach to psychotherapy aims to change patients’ maladaptive schemas, that is, overly negative views on themselves, the world, or the future. To obtain awareness of these views, they record their thought processes in situations that caused pathogenic emotional responses. The schemas underlying such thought records have, thus far, been largely manually identified. Using recent advances in natural language processing, we take this one step further by automatically extracting schemas from thought records. To this end, we asked 320 healthy participants on Amazon Mechanical Turk to each complete five thought records consisting of several utterances reflecting cognitive processes. Agreement between two raters on manually scoring the utterances with respect to how much they reflect each schema was substantial (Cohen’s κ = 0.79). Natural language processing software pretrained on all English Wikipedia articles from 2014 (GLoVE embeddings) was used to represent words and utterances, which were then mapped to schemas using k-nearest neighbors algorithms, support vector machines, and recurrent neural networks. For the more frequently occurring schemas, all algorithms were able to leverage linguistic patterns. For example, the scores assigned to the Competence schema by the algorithms correlated with the manually assigned scores with Spearman correlations ranging between 0.64 and 0.76. For six of the nine schemas, a set of recurrent neural networks trained separately for each of the schemas outperformed the other algorithms. We present our results here as a benchmark solution, since we conducted this research to explore the possibility of automatically processing qualitative mental health data and did not aim to achieve optimal performance with any of the explored models. The dataset of 1600 thought records comprising 5747 utterances is published together with this article for researchers and machine learning enthusiasts to improve upon our outcomes. Based on our promising results, we see further opportunities for using free-text input and subsequent natural language processing in other common therapeutic tools, such as ecological momentary assessments, automated case conceptualizations, and, more generally, as an alternative to mental health scales.

Exploring the Relationship Between Interpersonal Emotion Regulation and Social Anxiety Symptoms: The Mediating Role of Negative Mood Regulation Expectancies

Background

This study aimed to investigate the relationship between interpersonal emotion regulation (IER) and social anxiety symptoms and the mediating role of negative mood regulation expectancies (NMRE). We hypothesised that IER is positively associated with social anxiety symptoms, controlling for depression and intrapersonal emotion regulation strategies of suppression and reappraisal, and NMRE mediate this relationship.

Methods

Study 1 was conducted with a student sample (N = 400) and Study 2 included a community sample with 271 participants.

Results

Study 1 showed that, of four IER strategies, soothing and social modeling were positively, and perspective-taking was negatively related to social anxiety symptoms controlling for depression, suppression and reappraisal. Study 2 replicated these findings and extended them by showing the mediated relationship between the two IER strategies (i.e. enhancing positive affect and soothing) and social anxiety symptoms through NMRE.

Conclusions

The results contribute to the limited research on IER by portraying its relationship with social anxiety symptoms and revealing the mediating role of NMRE in this relationship.

Psychometric properties of the Self-Beliefs related to Social Anxiety (SBSA) scale in a sample of individuals with social anxiety disorder

The Self-Beliefs related to Social Anxiety (SBSA) scale assesses maladaptive social-evaluative beliefs, a key aspect in models of social anxiety disorder (SAD) that is frequently measured in research and clinical contexts. The SBSA has been evaluated psychometrically in student samples, but not in a large sample of individuals diagnosed with SAD. The current study tested the psychometric properties of the SBSA in a sample of individuals with SAD pooled from several studies (total N = 284). Results showed that the optimal factor structure for the SBSA was a correlated three-factor model (high standard beliefs factor, conditional beliefs factor, unconditional beliefs factor). The SBSA total and its subscales (formed based on the factors) exhibited good internal consistency. In terms of construct validity, the SBSA total, the high standard beliefs subscale, and conditional beliefs subscale had stronger associations with a measure of social anxiety than with a measure of depression, although the unconditional beliefs subscale was similarly related to both measures of social anxiety and depression. In terms of discriminative validity, the sample of individuals with SAD had higher SBSA total and subscale scores compared with a sample of individuals without SAD (N = 32). These findings provide a psychometric evidence base justifying the use of the SBSA for the assessment of maladaptive social-evaluative beliefs.

Unique Relationships Between Self-Related Constructs, Social Anxiety, and Depression in a Non-Clinical Sample

Self-related constructs feature prominently in cognitive models of both social anxiety and depression. However, few studies have simultaneously investigated the unique relationship between self-related constructs and social anxiety and depression, while also controlling for the association between the two variables. In the present study, 522 undergraduate students completed measures of maladaptive self-beliefs, self-esteem, self-criticism, self-focused attention, self-concept clarity, social comparison, and social anxiety and depression. Bivariate correlations demonstrated that self-related constructs not only significantly correlated with social anxiety but also with depression and other self-variables. When entered simultaneously, multiple regression analyses indicated that maladaptive self-beliefs were uniquely and positively associated with social anxiety and depression, while self-esteem and self-concept clarity were uniquely and negatively associated with social anxiety and depression. A unique positive association between private self-consciousness and depression was also found. Maladaptive self-beliefs and self-esteem were the constructs most strongly associated with social anxiety and depression respectively. These findings underscore the importance of a negative self-concept even in subclinical presentations and suggest that several key self-related constructs may represent transdiagnostic vulnerability factors linking social anxiety and depression. Future research should continue to uncover unique relationships between self-related variables and social anxiety and depression in both clinical and non-clinical samples.

Social cognition and metacognition in social anxiety: A systematic review

Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.

The Cognitive Distortions Questionnaire (CD-Quest): Validation in a Sample of Adults with Social Anxiety Disorder

Cognitive distortions are thought to be central to the development and maintenance of anxiety disorders and are a widely acknowledged treatment target in cognitive-behavioral interventions. However, little research has focused on the measurement of cognitive distortions. The Cognitive Distortions Questionnaire (CD-Quest; de Oliveira, 2015), a brief, 15-item questionnaire, assesses the frequency and intensity of cognitive distortions. The CD-Quest has been shown to have sound psychometric properties in American, Australian, and Brazilian undergraduate samples and one Turkish-speaking outpatient clinical sample. The current study aimed to provide the first evaluation of the psychometric properties of the English version of the CD-Quest in a clinical sample and the first evaluation of any version of the CD-Quest in a sample of adults diagnosed with social anxiety disorder (SAD). In a sample of treatment-seeking adults with SAD, the CD-Quest demonstrated good convergent validity, discriminant validity, known-groups validity, and treatment sensitivity. It also showed good internal consistency, and both confirmatory and exploratory factor analyses supported the previously reported unitary factor structure. Findings extend prior research indicating the reliability and validity of the CD-Quest.

Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review

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.