Discrepancies between implicit and explicit self-esteem among adolescents with social anxiety disorder

Testing theoretical processes that maintain paediatric social anxiety: A comparison between children and adolescents with social anxiety disorder, other mental disorders, and non-clinical controls

BACKGROUND

Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples.

METHODS

641 children and adolescents aged 6-17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis.

RESULTS

Participants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks.

CONCLUSIONS

Paediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction.

Beyond Difference Scores: Unlocking Insights with Polynomial Regression in Studies on the Effects of Implicit-Explicit Congruency

The aim of our study was to investigate whether theories of congruence are better tested using polynomial regression analysis, rather than expressing discrepancy between implicit and explicit measures as continuous or categorical difference scores. This paper also aims to make knowledge more accessible by providing a step-by-step explanation of both methods, illustrating differences between them, and making materials openly available for other researchers. In this paper, implicit and explicit measures of self-esteem are used as predictors for depressive symptoms, anxiety, and aggression in a general population sample (N = 135). Explicit self-esteem was measured using the Rosenberg Self-Esteem Scale, implicit self-esteem was measured using the Implicit Association Test, and the Symptom Questionnaire was used to measure depressive symptoms, anxiety, and aggression. The results show those difference score models all imply that the discrepancy between implicit and explicit self-esteem explains depression and anxiety, but not aggression. However, polynomial regression analysis shows that depression and anxiety are not accounted for by the explicit-implicit discrepancy as such, but are foremost explained by explicit self-esteem. Polynomial regression has the potential to evaluate more complex and more detailed hypotheses than what would be possible using statistical approaches based on discrepancy scores. It is therefore recommended for future research aimed at disentangling the roles of explicit and implicit self-esteem in psychological outcomes.

The Course of Anxiety-Specific Cognitive Bias Following Daycare/Inpatient Treatment in Youths with Social Phobia and School Absenteeism

Social phobia (SP) is a common mental disorder in youth often accompanied by absence from school, which may require daycare or inpatient intervention (DC/IN). Objective: The present explorative study investigates changes in anxiety-specific implicit assumptions and interpretation bias following DC/IN. Methods: The study included 16 youths with SP (M age = 15.8 [SD = 1.24], females: 62.5 %) participating in DC/IN. We assessed the main outcomes using the Implicit Association Test and Affective Misattribution Procedure. Results: A large effect was shown for reducing implicit assumptions of feeling anxious (p = .142; η2p = .171) and for reducing the implicit interpretation bias (p = .137; η2p = .162). No change was indicated by effect size in implicit assumptions of feeling socially rejected (p = .649; η2p = .016). Social phobia symptoms initially correlated with changes in implicit assumptions of feeling anxious (r = .45). Conclusion: Effect sizes indicate that implicit anxiety-specific assumptions and interpretation bias descriptively improved following DC/IN. Thus, DC/IN may lead to meaningful improvements of anxiety-specific cognition in some individuals with high SP symptoms, emphasizing the relevance of cognitive behavioral approaches in the treatment of SP. Several limitations are discussed.

Implicit assumptions and interpretation bias in youth with severe, chronic social phobia

Interpretation bias and dysfunctional social assumptions are proposed to play a pivotal role in the development and maintenance of social phobia (SP), especially in youth. In this study, we aimed to investigate disorder-specific implicit assumptions of rejection and implicit interpretation bias in youth with severe, chronic SP and healthy controls (CG). Twenty-seven youth with SP in inpatient/day-care treatment (M age = 15.6 years, 74% female) and 24 healthy controls (M age = 15.7 years, 54% female) were included. The Implicit Association Test (IAT) and the Affect Misattribution Procedure (AMP) were completed to assess implicit assumptions and interpretation bias related to the processing of social and affective stimuli. No group differences were observed for the IAT controlling for depressive symptoms in the analyses. However, group differences were found regarding interpretation bias (p = .017, η²_p = .137). Correlations between implicit scores and explicit questionnaire results were medium to large in the SP group (r =|.28| to |.54|, p_all ≤ .05), but lower in the control group (r =|.04| to |.46|, p_all ≤ .05). Our results confirm the finding of an interpretation bias in youth SP, especially regarding the implicit processing of faces, whereas implicit dysfunctional social assumptions of being rejected do not seem to be specific for SP. Future research should investigate the causal relationship of assumptions/interpretation bias and SP.

Mirror, mirror on the wall, tell me that I have succeeded at it all: Self-esteem and the defensive mechanisms against failure

Students face frequent formal and informal tests, both in the academic context and social life. On each of these occasions, they risk falling short of their own or others’ expectations. Facing failure is a psychological challenge, and people can react with defensive strategies, which may have negative consequences. Here we investigated the role of self-esteem as a possible buffer against these defensive strategies. Previous research has demonstrated that, in the face of failure, individuals with discrepant (fragile: high explicit and low implicit, or damaged: high implicit and low explicit) self-esteem are more likely to engage in defensive mechanisms than individuals with consistent implicit and explicit self-esteem. Two studies investigate the relationship between implicit and explicit self-esteem and two defensive strategies against the threat of failure: subjective overachievement and retroactive excuses. In Study 1 (N = 176 high school students), we find an association between fragile self-esteem and subjective overachievement. In Study 2 (N = 101 university students), damaged self-esteem is related to the increased use of retroactive excuses as a form of self-serving bias. These results add to the growing body of evidence documenting the maladaptive nature of fragile and damaged self-esteem.

Relationship of explicit/implicit self-esteem discrepancies, suicide ideation, and suicide risk in patients with major depressive disorder

The present study was conducted to explore the associations between explicit self-esteem (ESE), implicit self-esteem (ISE), ESE/ISE discrepancies, depression severity, suicidal ideation (SI), and suicide risk among patients with major depressive disorder (MDD). To this end, 36 MDD patients with SI, 35 MDD patients without SI, and 32 healthy controls were recruited. All participants were interviewed using the Mini International Neuropsychiatric Interview (MINI), and they also completed the Beck Depression Inventory (BDI). The Beck Scale for Suicide Ideation-Chinese Version (BSI-CV) and the Rosenberg Self-Esteem Scale (SES) were used for the analysis. Further, the Implicit Association Test (IAT) was conducted to assess participants' ISE. The study revealed significant differences in ESE among the three groups, F(2, 90) = 44.88, p < .001. In particular, the group of MDD patients with SI had the lowest score. The interaction between the size and direction of ESE/ISE discrepancy was associated with depression severity, β = -.50, p = .004, and SI, β = -.39, p = .045. Among the four types of self-esteem, individuals with diminished self-esteem had the highest SI score whereas individuals with low congruent self-esteem had the highest suicide risk score. Based on these findings, the study suggested that diminished self-esteem could help in the early detection of depression and SI. Low-congruent self-esteem may also be considered a screening factor for suicide risk.

Social Achievement Goals in Chinese Undergraduates: Associations With Self-Esteem and Symptoms of Social Anxiety and Depression

The pursuit of relationship goals is critical to the wellbeing of young adults. This study investigated different achievement goals toward social competence as potential predictors of social anxiety and depression symptoms. It proposed that self-esteem may function as a mediator on the pathway from endorsing social achievement goals to undergraduates' concurrent and longitudinal social anxiety and depression symptoms. Social achievement goal theory proposes three types of goals: social mastery goals (striving to improve one's social competence), social performance-approach goals (striving to prove one's social competence and win positive evaluation), and social performance-avoid goals (striving to avoid incompetent social behaviors and negative evaluation). One hundred and eighty-five Chinese undergraduates aged from 18 to 23 (50% female) completed this study across two-time points. Path analyses indicated that social mastery (marginally) and performance-approach goals were positively associated with self-esteem, whereas social performance-avoid goals were negatively associated with self-esteem; self-esteem was negatively associated with the concurrent social anxiety and depression symptoms and the longitudinal depression symptoms. The proposed mediation effects of self-esteem on the links from three types of social achievement goals to the concurrent and longitudinal social anxiety and depression symptoms were significant except on the links from social mastery goals and social performance-approach goals to the subsequent social anxiety symptoms. Self-esteem and the baseline social anxiety and depressive symptoms have a chain mediating effect between social achievement goals and the longitudinal symptoms of social anxiety and depression. These findings suggest that the pursuit of social mastery goals and performance-approach goals in initiating and maintaining social relationships boosts undergraduates' self-worth and reduces their concurrent and longitudinal depression experiences. However, the strivings to hide inadequacy and avoid negative evaluation in social contexts impede one's self-worth and increase concurrent and longitudinal social anxiety and depression symptoms. Implications and limitations are discussed.

Explicit and implicit self-esteem in youth with autism spectrum disorders

Although the link between self-esteem and psychopathology has been well established, studies on self-esteem in individuals with autism spectrum disorder are lacking. In this study, we aimed to (1) compare explicit and implicit self-esteem of youth with autism spectrum disorder to typically developing peers and to (2) explore relationships of implicit-, explicit-, and discrepant self-esteem measures with co-occurring internalizing and externalizing problems in youth with autism spectrum disorder. For this purpose, 25 individuals with autism spectrum disorder and 24 individuals as age- and intelligence quotient–matched controls aged 8–16 years participated in this study. Results showed lower explicit self-esteem in autism spectrum disorder compared to typically developing youth and no differences in implicit self-esteem between groups. In youth with autism spectrum disorder, low explicit self-esteem was related to co-occurring depression symptoms, whereas lower implicit self-esteem was related to externalizing symptoms. These results show that youth with autism spectrum disorder are at risk for developing low explicit self-esteem, which appears to be related to often co-occurring internalizing symptoms. This emphasizes the need to focus more on self-esteem in assessment and treatment of youth with autism spectrum disorder.

Self-esteem, symptom severity, and treatment response in adolescents with internalizing problems

BACKGROUND

Adolescents with low self-esteem often experience internalizing psychopathology (i.e., anxiety, depression). Self-esteem may therefore be a clinically relevant construct for assessment and treatment outcomes. We examined whether general and domain-specific (family, peer, academic) self-esteem are related to adolescents' internalizing symptom severity and response to cognitive behavioural therapy (CBT).

METHOD

Participants were 89 adolescents ages 14 to 18 years (M = 16.3, 70% females) from an outpatient clinic who were referred for CBT. Adolescents completed measures of self-esteem at baseline and measures of internalizing symptoms at baseline and at the end of a manualized group CBT intervention.

RESULTS

Lower peer and family self-esteem, but not academic self-esteem, were associated with more internalizing symptoms at baseline, after controlling for general self-esteem. However, only higher general self-esteem, and not any of the specific self-esteem domains, predicted lower internalizing symptoms at posttreatment. Follow-up analyses revealed differential associations between family and peer self-esteem domains and anxious and depressive symptoms.

LIMITATIONS

Only self-report measures were used. The relatively small sample size may have limited power to detect small effects.

CONCLUSIONS

Self-esteem in domains regarding family and peer relationships may be important in the evaluation of adolescents with internalizing problems. Adolescents with low general self-esteem may benefit less from CBT than other adolescents. Addressing negative self-perceptions may be necessary to reduce internalizing symptoms for adolescents with low self-esteem.

The relationship between explicit self-esteem and subjective well-being: The moderating effect of implicit self-esteem

Explicit self-esteem (ESE) is an important factor influencing subject well-being (SWB). However, the relationship between ESE and SWB is not clear. Due to the complex nature of self-esteem, implicit self-esteem (ISE) might moderate the relationship between ESE and SWB. Furthermore, providing the consistency between ISE and ESE, the interacting effect of ISE and ESE would only be significant for the cognitive component of SWB rather than the emotional component. To examine these assumptions, the present study recruited a total of 134 undergraduate students and measured their ISE, ESE, and SWB using Implicit Association Test (IAT) and self-report measures. The results showed that (a) ESE, rather than ISE, was significantly correlated to SWB; and (b) the interaction between ISE and ESE could significantly predict the cognitive components of SWB rather than the emotional components. Those findings contribute to the further understanding of the relationship between self-esteem and SWB.

Behavioral inhibition system and self-esteem as mediators between shyness and social anxiety

Shyness has been demonstrated to be an important factor associating with social anxiety. However, it is less clear on the mechanisms responsible for such association. The aim of the present study was to examine whether behavioral inhibition system (BIS) and self-esteem mediated the relationship between shyness and social anxiety. A sample of 521 healthy volunteers in the age range of 18-25 years completed self-report measures of BIS, self-esteem, shyness and social anxiety. Our correlational analyses showed that shyness was positively associated with social anxiety, supporting the overlapping and continuum hypotheses. Furthermore, BIS was positively correlated with shyness and social anxiety while self-esteem was negatively related to them, indicating that BIS and self-esteem were different in the relation between shyness and social anxiety. Importantly, results from structural equation modeling revealed that the relation between shyness and social anxiety was partially mediated by BIS and self-esteem, which suggested that they might play important roles in the relation between shyness and social anxiety.

On the context dependency of implicit self-esteem in social anxiety disorder

BACKGROUND AND OBJECTIVES

Cognitive models assume that negative self-evaluations are automatically activated in individuals with Social Anxiety Disorder (SAD) during social situations, increasing their individual level of anxiety. This study examined automatic self-evaluations (i.e., implicit self-esteem) and state anxiety in a group of individuals with SAD (n = 45) and a non-clinical comparison group (NC; n = 46).

METHODS

Participants were randomly assigned to either a speech condition with social threat induction (giving an impromptu speech) or to a no-speech condition without social threat induction. We measured implicit self-esteem with an Implicit Association Test (IAT).

RESULTS

Implicit self-esteem differed significantly between SAD and NC groups under the speech condition but not under the no-speech condition. The SAD group showed lower implicit self-esteem than the NC group under the speech-condition. State anxiety was significantly higher under the speech condition than under the no-speech condition in the SAD group but not in the NC group. Mediation analyses supported the idea that for the SAD group, the effect of experimental condition on state anxiety was mediated by implicit self-esteem.

LIMITATIONS

The causal relation between implicit self-esteem and state anxiety could not be determined.

CONCLUSION

The findings corroborate hypotheses derived from cognitive models of SAD: Automatic self-evaluations were negatively biased in individuals with SAD facing social threat and showed an inverse relationship to levels of state anxiety. However, automatic self-evaluations in individuals with SAD can be unbiased (similar to NC) in situations without social threat.

Stress-testing the affect misattribution procedure: Heterogeneous control of affect misattribution procedure effects under incentives

The affect misattribution procedure (AMP) is widely used to measure sensitive attitudes towards classes of stimuli, by estimating the effect that affectively charged prime images have on subsequent judgements of neutral target images. We test its resistance to efforts to conceal one's attitudes, by replicating the standard AMP design while offering small incentives to conceal attitudes towards the prime images. We find that although the average AMP effect remains positive, it decreases significantly in magnitude. Moreover, this reduction in the mean AMP effect under incentives masks large heterogeneity: one subset of individuals continues to experience the 'full' AMP effect, while another reduces their effect to approximately zero. The AMP thus appears to be resistant to efforts to conceal one's attitudes for some individuals but is highly controllable for others. We further find that those individuals with high self-reported effort to avoid the influence of the prime are more often able to eliminate their AMP effect. We conclude by discussing possible mechanisms.

Understanding Negative Self-Evaluations in Borderline Personality Disorder-a Review of Self-Related Cognitions, Emotions, and Motives

Self-conscious emotions, such as guilt, shame, or self-disgust, as well as self-related motives, such as self-enhancement or self-verification, influence how people perceive, evaluate, memorize, and respond to self-related information. They not only influence peoples' concepts of themselves but may also affect their behavior in social environments. In the current review, we describe alterations of self-related processing in borderline personality disorder (BPD). We chose BPD as an example of a mental disorder of which impairments in self-functioning and identity constitute a major feature. Since terminology used in clinical research on self-referential processing is diverse and often confusing, we start with reviewing some of the main concepts in this area of research using a conceptual framework provided from social psychology. Most studies on self-referential processing in BPD focused on descriptions of self-esteem and revealed a negative self-concept, particularly expressed by explicitly reported low self-esteem. Moreover, self-esteem is unstable in BPD and likely reactive to self-relevant cues. BPD patients are prone to negative emotions with respect to themselves, such as self-disgust and shame. First data point to altered self-related motives, too. In conclusion, although explicit self-esteem is widely studied as a global and trait-like feature of BPD, there is a strong lack of studies that take the complexity of the construct self-esteem into account. Further studies on alterations in self-related processes are required to deepen our understanding of impairments of the self-concept in BPD and enable the improvement of psychosocial therapeutic approaches.

Review: Low self-esteem and internalizing disorders in young people - a systematic review

BACKGROUND

Cognitive behavioural therapy for low self-esteem (LSE) has shown promise as a trans-diagnostic model for treating mental health difficulties in adults. To ascertain the potential value of this treatment approach in working with young people with internalizing disorders, we need to develop our understanding of LSE within these mental health conditions. The aim of this review is to explore (a) the co-occurrence of clinically significant anxiety/depression and LSE in young people (aged 18 years and younger), and (b) the association between LSE in childhood and adolescence and mental health difficulties in later adolescence and emerging adulthood.

METHOD

A systematic search of three electronic databases (PsychInfo/Pubmed/Google Scholar) was conducted to identify relevant studies.

RESULTS

Ten studies examining the association between LSE and clinically significant anxiety/depression in young people met the inclusion criteria, as did eight studies investigating the association between LSE in young people with internalizing difficulties in later adolescence/emerging adulthood. Although relatively few studies were identified, studies consistently supported the co-occurrence of LSE and internalizing disorders in young people, particularly in young people with co-morbid anxiety and depression. LSE in childhood and adolescence appears to be a relatively weak predictor of the development of anxiety and depression in later adolescence and early adulthood.

CONCLUSIONS

Further research investigating the relationship between low self-esteem and mental health difficulties in young people and its implications for treatment in this age group is indicated.

Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy

BACKGROUND AND OBJECTIVES

Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP.

METHODS

An AMP with illness, symptom and neutral primes was used in 70 patients with HYP before and after treatment (wait-list respectively).

RESULTS

There was no significant change in negative implicit affective evaluations in both CT and ET, compared to wait-list. However, comparisons between the two active treatments revealed an interaction effect, that only for CT were the affective reactions on illness-as well as symptom-related prime trials (but not neutral primes) significantly more positive at post-compared to pre-treatment. In CT but not in ET, the reduction of implicit negative evaluation bias regarding symptom-related primes was significantly related to the reduction of self-reported health anxiety.

LIMITATIONS

The small subsample sizes for CT and ET, in comparison to wait-list, prohibit the detection of smaller effects.

CONCLUSIONS

Formal cognitive restructuring is necessary for reducing implicit negative evaluation bias in HYP, but the latter is not a prerequisite for reducing health anxiety. Thus, the importance of the negative implicit evaluation bias for the maintenance of HYP remains questionable.

Self-esteem discrepancies and identity-expressive consumption: Evidence from Norwegian adolescents

Prior research established that simultaneously holding discrepant explicit (deliberate, controlled) and implicit (automatic, uncontrolled) self-esteem gives rise to self-enhancing behaviours. Given that individuals tend to enhance their self-concepts with brands that are associated with positive identities, this study examined whether self-esteem discrepancy was related to the extent to which individuals developed connections with brands that are associated with their in-groups. Findings from an adolescent sample (ages 16-18) indicated that adolescents with larger discrepancies between explicit and implicit self-esteem were more likely to construct their self-concepts using in-group-linked brands.

Implications of the Implicit Association Test D-Transformation for Psychological Assessment

Psychometricians strive to eliminate random error from their psychological inventories. When random error affecting tests is diminished, tests more accurately characterize people on the psychological dimension of interest. We document an unusual property of the scoring algorithm for a measure used to assess a wide range of psychological states. The “D-score” algorithm for coding the Implicit Association Test (IAT) requires the presence of random noise in order to obtain variability. Without consequential degrees of random noise, all individuals receive extreme scores. We present results from an algebraic proof, a computer simulation, and an online survey of implicit racial attitudes to show how trial error can bias IAT assessments. We argue as a result that the D-score algorithm should not be used for formal assessment purposes, and we offer an alternative to this approach based on multiple regression. Our critique focuses primarily on the IAT designed to measure unconscious racial attitudes, but it applies to any IAT developed to provide psychological assessments within clinical, organizational, and developmental branches of psychology—and in any other field where the IAT might be used.

Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure

Cognitive theories of hypochondriasis (HYP) suggest that catastrophic misinterpretations of benign body sensations are a core feature for the maintenance of the disorder. There is tentative support from an analog sample that the interpretation of illness-related information also involves an implicit affective component. This is the first study to examine this negative affective evaluation bias implicitly in patients with HYP. An adapted version of the Affect Misattribution Procedure (AMP) with illness, symptom and neutral primes was used in 80 patients with HYP, and compared to 83 patients with an anxiety disorder (AD), as well as 90 healthy controls (CG). The HYP group showed significantly more negative affective reactions in illness prime trials, compared to both control groups, as well as more negative implicit evaluations on symptom prime trials, compared to the CG. Significant inverse relationships were observed only between the implicit evaluations of illness words and health anxiety questionnaires. Thus, an implicit negative affective evaluation bias of serious illnesses rather than symptoms is a unique feature of HYP.

Implicit affective evaluation of somatosensory sensations in patients with noncardiac chest pain

BACKGROUND AND OBJECTIVES

Etiological models of noncardiac chest pain (NCCP) stress the importance of abnormal implicit affective evaluations of somatosensory sensations, but this has never been studied empirically. The aim was therefore to assess implicit affective evaluations of somatosensory stimuli in NCCP using an experimental design.

METHODS

A total of 34 patients with NCCP, 24 patients with cardiac chest pain, and 46 healthy controls, took part in the study. Participants completed a tactile modification of the Affect Misattribution Procedure (tAMP) and answered self-report measures on anxiety sensitivity, somatosensory amplification, and somatic symptom distress.

RESULTS

A 3 × 3-ANOVA revealed that most negative judgments were found in the aversive condition, but this effect was not specific to patients with NCCP. Anxiety sensitivity was positively associated with negative implicit evaluations of aversive tactile stimuli in the tAMP.

LIMITATIONS

The task seemed to be too difficult for older participants. Also, future studies should apply clinically more relevant, e.g., heart related, stimuli that are more ecologically valid than the electrical stimulation of the finger used as a proxy for aversive somatosensory sensations here.

CONCLUSIONS

Against theoretical assumptions, patients with NCCP do not seem to show a stronger implicit negative interpretation bias concerning somatosensory sensations in comparison to patients either with cardiac chest pain, or without chest pain. Nevertheless, anxiety sensitivity seems to contribute significantly to implicit affective interpretations of somatic sensations. Further studies are required investigating the relevance of implicit interpretative processes for the course of NCCP and distressing somatic symptoms in general.

Assessment of implicit self-esteem in bipolar manic and euthymic patients using the implicit association test

OBJECTIVE

Although self-esteem is thought to be an important psychological factor in bipolar disorder, little is known about implicit and explicit self-esteem in manic patients. In this study, we investigated differences in implicit and explicit self-esteem among bipolar manic patients, bipolar euthymic patients, and healthy controls using the Implicit Association Test (IAT).

METHODS

Participants included 19 manic patients, 27 euthymic patients, and 27 healthy controls. Participants completed a self-esteem scale to evaluate explicit self-esteem and performed the self-esteem IAT to evaluate implicit self-esteem.

RESULTS

There were no differences among groups in explicit self-esteem. However, there were significant differences among groups in implicit self-esteem. Manic patients had higher IAT scores than euthymic patients and a trend toward higher IAT scores than healthy controls.

CONCLUSIONS

Our findings suggest that, on the latent level, a manic state is not simply the opposite of a depressed state. Furthermore, there may be a discontinuity of implicit self-esteem between manic and euthymic states. These unexpected results may be due to characteristics of the study participants or the methods used to assess implicit self-esteem. Nevertheless, they provide greater insights on the psychological status of manic patients.

Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: a longitudinal study in adolescents

BACKGROUND AND OBJECTIVES

A negative self-view is a prominent factor in most cognitive vulnerability models of depression and anxiety. Recently, there has been increased attention to differentiate between the implicit (automatic) and the explicit (reflective) processing of self-related evaluations. This longitudinal study aimed to test the association between implicit and explicit self-esteem and symptoms of adolescent depression and social anxiety disorder. Two complementary models were tested: the vulnerability model and the scarring effect model.

METHOD

Participants were 1641 first and second year pupils of secondary schools in the Netherlands. The Rosenberg Self-Esteem Scale, self-esteem Implicit Association Test and Revised Child Anxiety and Depression Scale were completed to measure explicit self-esteem, implicit self-esteem and symptoms of social anxiety disorder (SAD) and major depressive disorder (MDD), respectively, at baseline and two-year follow-up.

RESULTS

Explicit self-esteem at baseline was associated with symptoms of MDD and SAD at follow-up. Symptomatology at baseline was not associated with explicit self-esteem at follow-up. Implicit self-esteem was not associated with symptoms of MDD or SAD in either direction.

LIMITATIONS

We relied on self-report measures of MDD and SAD symptomatology. Also, findings are based on a non-clinical sample.

CONCLUSIONS

Our findings support the vulnerability model, and not the scarring effect model. The implications of these findings suggest support of an explicit self-esteem intervention to prevent increases in MDD and SAD symptomatology in non-clinical adolescents.