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Nikolić M, di Plinio S, Sauter D, Keysers C, Gazzola V. The blushing brain: neural substrates of cheek temperature increase in response to self-observation. Proc Biol Sci 2024; 291:20240958. [PMID: 39013420 PMCID: PMC11251765 DOI: 10.1098/rspb.2024.0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Darwin proposed that blushing-the reddening of the face owing to heightened self-awareness-is 'the most human of all expressions'. Yet, relatively little is known about the underlying mechanisms of blushing. Theories diverge on whether it is a rapid, spontaneous emotional response that does not involve reflection upon the self or whether it results from higher-order socio-cognitive processes. Investigating the neural substrates of blushing can shed light on the mental processes underlying blushing and the mechanisms involved in self-awareness. To reveal neural activity associated with blushing, 16-20 year-old participants (n = 40) watched pre-recorded videos of themselves (versus other people as a control condition) singing karaoke in a magnetic resonance imaging scanner. We measured participants' cheek temperature increase-an indicator of blushing-and their brain activity. The results showed that blushing is higher when watching oneself versus others sing. Those who blushed more while watching themselves sing had, on average, higher activation in the cerebellum (lobule V) and the left paracentral lobe and exhibited more time-locked processing of the videos in early visual cortices. These findings show that blushing is associated with the activation of brain areas involved in emotional arousal, suggesting that it may occur independently of higher-order socio-cognitive processes. Our results provide new avenues for future research on self-awareness in infants and non-human animals.
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Affiliation(s)
- Milica Nikolić
- Institute for Child Development and Education, University of Amsterdam, Amsterdam1018 WS, The Netherlands
| | - Simone di Plinio
- Department of Neuroscience, Imaging, and Clinical Sciences, D'Annunzio University of Chieti–Pescara, Pescara66100, Italy
| | - Disa Sauter
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
| | - Christian Keysers
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
- Netherlands Institute for Neuroscience, KNAW, Amsterdam1105 BA, The Netherlands
| | - Valeria Gazzola
- Psychology Institute, University of Amsterdam, Amsterdam1018 WS, The Netherlands
- Netherlands Institute for Neuroscience, KNAW, Amsterdam1105 BA, The Netherlands
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2
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Fernández J, Albayay J, Gálvez-García G, Iborra O, Huertas C, Gómez-Milán E, Caballo VE. Facial infrared thermography as an index of social anxiety. ANXIETY, STRESS, AND COPING 2024; 37:114-126. [PMID: 37029987 DOI: 10.1080/10615806.2023.2199209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Previous research on physiological indices of social anxiety has offered unclear results. In this study, participants with low and high social anxiety performed five social interaction tasks while being recorded with a thermal camera. Each task was associated with a dimension assessed by the Social Anxiety Questionnaire for Adults (1 = Interactions with strangers. 2 = Speaking in public/Talking with people in authority, 3 = Criticism and embarrassment, 4 = Assertive expression of annoyance, disgust or displeasure, 5 = Interactions with the opposite sex). Mixed-effects models revealed that the temperature of the tip of the nose decreased significantly in participants with low (vs. high) social anxiety (p < 0.001), while no significant differences were found in other facial regions of interest: forehead (p = 0.999) and cheeks (p = 0.999). Furthermore, task 1 was the most effective at discriminating between the thermal change of the nose tip and social anxiety, with a trend for a higher nose temperature in participants with high social anxiety and a lower nose temperature for the low social anxiety group. We emphasize the importance of corroborating thermography with specific tasks as an ecological method, and tip of the nose thermal change as a psychophysiological index associated with social anxiety.
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Affiliation(s)
- Jesús Fernández
- Centro de Investigación Mente, Cerebro y Comportamiento, Universidad de Granada, Granada, Spain
| | - Javier Albayay
- Centro Interdipartimentale Mente/Cervello, Università degli Studi di Trento, Rovereto, Italy
| | - Germán Gálvez-García
- Departamento de Psicología, Universidad de La Frontera, Temuco, Chile
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
| | - Oscar Iborra
- Centro de Investigación Mente, Cerebro y Comportamiento, Universidad de Granada, Granada, Spain
| | - Carmen Huertas
- Centro de Investigación Mente, Cerebro y Comportamiento, Universidad de Granada, Granada, Spain
| | - Emilio Gómez-Milán
- Centro de Investigación Mente, Cerebro y Comportamiento, Universidad de Granada, Granada, Spain
| | - Vicente E Caballo
- Centro de Investigación Mente, Cerebro y Comportamiento, Universidad de Granada, Granada, Spain
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Chen H, D’Angelis F, Qian M, Pohl A, Gerlach AL. Temperature Perception in the Blushing Region. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. Background: Individuals with social phobia are characterized by a heightened sensitivity for physical symptom such as blushing. Objectives: We exploratorily examined whether blushing-fearful individuals with / without social phobia were more sensitive to perceiving facial temperature increases compared to healthy controls. Methods: 50 participants were tested using an adaptive two-alternative forced-choice task. A Peltier element was attached to the cheek and repeatedly warmed up in one of two phases. The participants’ task was to indicate in which of the two phases the temperature had increased. Results: Contrary to our hypothesis, blushing-fearful individuals with social phobia ( n = 11) were less sensitive to facial temperature increases, i. e., exhibited higher temperature perception threshold, than the subclinical group ( n = 14) and healthy controls ( n = 23). Limitations: The preliminary nature of our study should be noted, and replication in a larger sample is warranted. Conclusions: The findings may be best understood within a predictive coding framework: Individuals with social phobia may rely on priors when assessing their physical symptoms to form an impression of their public self in social situations.
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Affiliation(s)
- Huijing Chen
- Department of Social Work, School of Sociology and Political Science, Shanghai University, Shanghai 200444, PR China
- Department of Psychology, University of Cologne, Germany
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, PR China
| | | | - Mingyi Qian
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, PR China
| | - Anna Pohl
- Department of Psychology, University of Cologne, Germany
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4
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Nikolić M, Majdandžić M, Colonnesi C, de Vente W, Möller E, Bögels S. The unique contribution of blushing to the development of social anxiety disorder symptoms: results from a longitudinal study. J Child Psychol Psychiatry 2020; 61:1339-1348. [PMID: 32080848 PMCID: PMC7754350 DOI: 10.1111/jcpp.13221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood. METHODS One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years. RESULTS Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety. CONCLUSIONS That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.
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Affiliation(s)
- Milica Nikolić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjana Majdandžić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cristina Colonnesi
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Eline Möller
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Susan Bögels
- Developmental PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
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5
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Yuan J, Li L, Tian Y. Automatic Suppression Reduces Anxiety-Related Overestimation of Time Perception. Front Physiol 2020; 11:537778. [PMID: 33192542 PMCID: PMC7642764 DOI: 10.3389/fphys.2020.537778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/25/2020] [Indexed: 01/21/2023] Open
Abstract
Anxiety has been found to lengthen time perception, especially the time perception of negative stimuli. This anxiety-related time overestimation is thought to be mainly associated with massively increased arousal. Suppression, which can be achieved either deliberately or automatically, has been demonstrated to be effective in reducing arousal. Consequently, the present study explored the effectiveness of both deliberate suppression (Experiment 1) and automatic suppression (Experiment 2) in reducing the time distortion in anxiety. A temporal bisection task (TBT), featuring negative and neutral pictures, was used to measure time perception, while the self-reported arousal was used to assess arousal. The deliberate suppression was manipulated by asking participants to suppress their emotional expressions; while automatic suppression was manipulated through a sentence-unscrambling task featuring suppression-related words, which can unconsciously prime suppression. The results of Experiment 1 showed that deliberate suppression did not reduce the anxiety-related time overestimation and arousal. However, Experiment 2 showed that automatic suppression significantly reduced the anxiety-related time overestimation, with significant arousal reduction being observed. In conclusion, automatic suppression, but not deliberate suppression, is effective for reducing the effect of anxiety on time perception.
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Affiliation(s)
- Jiajin Yuan
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Lingjing Li
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yu Tian
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.,Research Center for Psychology and Social Development, Southwest University, Chongqing, China
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6
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Drummond PD, Gatt SJ. Early maladaptive schemas in people with a fear of blushing. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter D. Drummond
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
| | - Sally J. Gatt
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
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Abstract
PURPOSE OF REVIEW To review mechanisms of blushing and fear of blushing from physiological, neuropharmacological and psychological viewpoints, and to evaluate current forms of treatment for blushing-related fear. RECENT FINDINGS Blushing appears to be driven primarily by sympathetic adrenomedullary and neural vasodilator discharge, possibly in association with secondary neurovascular inflammation. Psychological risk factors for fear of blushing include social anxiety, coupled with heightened self-focused attention and inflated beliefs about the likelihood and social costs of blushing. In addition, schemas of emotional inhibition, social isolation and alienation may underlie blushing-related fears. Established psychological treatments for fear of blushing include task concentration training, exposure, cognitive therapy, social skills training, psychoeducation and applied relaxation. More novel approaches include mindfulness and mindful self-compassion, video feedback and imagery rescripting. There are no established pharmacological treatments specifically for fear of blushing. However, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are effective treatments for social anxiety disorder and may thus help some patients manage their fear of blushing. A reactive sympathetic nervous system may interact with psychological predispositions to intensify fear of blushing. These physiological and psychological risk factors could be promising targets for treatment.
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Reichenberger J, Wiggert N, Wilhelm FH, Liedlgruber M, Voderholzer U, Hillert A, Timmer B, Blechert J. Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder. Behav Res Ther 2019; 116:140-148. [PMID: 30921745 DOI: 10.1016/j.brat.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Social anxiety disorder (SAD) is marked by persistent fear of being scrutinized by others. This and most diagnostic symptoms relate to some form of fear of negative evaluation (FNE). More recent accounts of SAD, such as the Bivalent Fear of Evaluation Model, however, complement FNE with fear of positive evaluation (FPE), described as distress and avoidance of positive feedback. An explicit test of the incremental validity of FPE in discriminating SAD patients from controls - over and on top of the explanatory power of FPE - is currently missing and generally, well controlled laboratory experiments with positive and negative social stimuli in this patient group are rare. To fill this gap, we exposed 35 patients with SAD and healthy controls (HCs) to short social-evaluative video clips with actors expressing negative and positive as well as neutral statements while recording reactivity on experiential measures (valence, arousal, and approval ratings) as well as on facial electromyography and electrocardiography. In addition, participants completed questionnaire measures of FNE and FPE. Results revealed that FPE questionnaire scores as well as experiential (valence and appreciation) and electromyographical reactivity measures to positive videos improved prediction of group membership beyond the predictive power of FNE questionnaires scores and reactivity to negative videos. Results document the importance of FPE to more fully characterize and understand social anxiety and SAD. Implications include amendments to future diagnostic criteria, theoretical models, and treatment approaches for SAD.
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Affiliation(s)
- Julia Reichenberger
- Paris-Lodron-University of Salzburg, Department of Psychology, Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Nicole Wiggert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Neuruppin, Germany
| | - Frank H Wilhelm
- Paris-Lodron-University of Salzburg, Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, Salzburg, Austria
| | - Michael Liedlgruber
- Paris-Lodron-University of Salzburg, Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, Salzburg, Austria
| | - Ulrich Voderholzer
- Schön Klinik Roseneck [Schoen Hospital Roseneck], Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Andreas Hillert
- Schön Klinik Roseneck [Schoen Hospital Roseneck], Prien am Chiemsee, Germany
| | - Barbara Timmer
- Schön Klinik Roseneck [Schoen Hospital Roseneck], Prien am Chiemsee, Germany
| | - Jens Blechert
- Paris-Lodron-University of Salzburg, Department of Psychology, Centre for Cognitive Neuroscience, Salzburg, Austria.
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9
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Sackl-Pammer P, Özlü-Erkilic Z, Jahn R, Karwautz A, Pollak E, Ohmann S, Akkaya-Kalayci T. Somatic complaints in children and adolescents with social anxiety disorder. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2018; 32:187-195. [PMID: 30218392 PMCID: PMC6290697 DOI: 10.1007/s40211-018-0288-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Associations of social anxiety disorder (SAD) with various somatic symptoms have been already reported in the literature several times. The present study investigated somatic complaints in children and adolescents with SAD compared to controls and evaluated the relationship between social anxiety and somatic symptom severity. METHODS Thirty children and adolescents with SAD were compared with 36 healthy age-matched controls. Self-reported fears were assessed using the Phobiefragebogen für Kinder und Jugendliche (PHOKI); emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL/4-18); and the Gießener Beschwerdebogen für Kinder und Jugendliche (GBB-KJ) was used to assess 59 somatic symptoms. RESULTS Parents and youth with SAD reported higher somatic symptom severity compared to controls. Youth with SAD more frequently reported stomach pain, circulatory complaints, and fatigue than controls. Specific group differences between SAD and control youth were found for the following single somatic symptoms: faintness, quickly exhausted, sensation of heat, stomachache, nausea, dizziness, and sudden heart complaints. Parents of girls with SAD reported higher somatic symptom severity than parents of boys with SAD. CONCLUSIONS The results demonstrated a significant positive association between somatic symptoms and social anxiety in youth. The results of the present study can help to develop improved screening measurements, which increase the proportion of children and adolescents with SAD receiving proper treatment.
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Affiliation(s)
- Petra Sackl-Pammer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rebecca Jahn
- Department for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Eva Pollak
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Türkan Akkaya-Kalayci
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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10
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When gushing leads to blushing: Inflated praise leads socially anxious children to blush. Behav Res Ther 2018; 106:1-7. [DOI: 10.1016/j.brat.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/08/2018] [Accepted: 04/18/2018] [Indexed: 11/23/2022]
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11
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Brummelman E, Nikolić M, Bögels SM. What's in a blush? Physiological blushing reveals narcissistic children's social-evaluative concerns. Psychophysiology 2018; 55:e13201. [DOI: 10.1111/psyp.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Eddie Brummelman
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
- Department of Psychology; Stanford University; Stanford California USA
| | - Milica Nikolić
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education; University of Amsterdam; Amsterdam the Netherlands
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12
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Panayiotou G, Karekla M, Georgiou D, Constantinou E, Paraskeva-Siamata M. Psychophysiological and self-reported reactivity associated with social anxiety and public speaking fear symptoms: Effects of fear versus distress. Psychiatry Res 2017; 255:278-286. [PMID: 28599192 DOI: 10.1016/j.psychres.2017.05.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 11/26/2022]
Abstract
This study examines psychophysiological and subjective reactivity to anxiety-provoking situations in relation to social anxiety and public speaking fear. We hypothesized that social anxiety symptoms would be associated with similar reactivity across types of imaginary anxiety scenes and not specifically to social anxiety-related scenes. This would be attributed to co-existing depression symptoms. Public speaking fear was expected to be associated with more circumscribed reactivity to survival-threat scenes, due to its association with fearfulness. Community participants imagined standardized anxiety situations, including social anxiety and animal fear scenes, while their physiological reactivity and self-reported emotions were assessed. Findings supported that social anxiety was associated with undifferentiated physiological reactivity across anxiety-provoking situations, except with regards to skin conductance level, which was higher during social anxiety imagery. Public speaking fear was associated with increased reactivity to animal phobia and panic scenes. Covariance analyses indicated that the lack of response specificity associated with social anxiety could be attributed to depression levels, while the specificity associated with public speaking fear could be explained by fearfulness. Findings highlight the need to assess not only primary anxiety symptoms but also depression and fearfulness, which likely predict discrepant reactions of individuals to anxiogenic situations.
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13
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Stevens S, Cooper R, Bantin T, Hermann C, Gerlach AL. Feeling safe but appearing anxious: Differential effects of alcohol on anxiety and social performance in individuals with social anxiety disorder. Behav Res Ther 2017; 94:9-18. [DOI: 10.1016/j.brat.2017.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/07/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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14
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Matney B. The effect of specific music instrumentation on anxiety reduction in university music students: A feasibility study. ARTS IN PSYCHOTHERAPY 2017. [DOI: 10.1016/j.aip.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Berle D, Starcevic V, Milicevic D, Hannan A, Dale E, Skepper B, Viswasam K, Brakoulias V. The structure and intensity of self-reported autonomic arousal symptoms across anxiety disorders and obsessive-compulsive disorder. J Affect Disord 2016; 199:81-6. [PMID: 27093491 DOI: 10.1016/j.jad.2016.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/10/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heightened autonomic arousal symptoms (AAS) are assumed to be a central feature of anxiety disorders. However, it is unclear whether the magnitude and profile of AAS vary across anxiety disorders and whether heightened AAS characterises obsessive-compulsive disorder (OCD). AIMS We sought to determine whether the intensity and structure of AAS varied across anxiety disorders and OCD. METHOD A sample of 459 individuals with a primary anxiety disorder or OCD were administered the Symptom Checklist-90R. Nine items referring to prototypic AAS were included in a latent class analysis. RESULTS A 2-class solution (high and low AAS classes) best fitted the data. Participants comprising the high AAS class scored uniformly high across all assessed AAS symptoms. Older age and the presence of panic disorder, social anxiety disorder and generalized anxiety disorder predicted membership in the high AAS class. No OCD symptom dimension was significantly associated with membership in the high AAS class. LIMITATION AAS were assessed using a self-report measure and replication is needed using other methodologies. CONCLUSIONS These findings suggest that OCD may be sufficiently distinct from anxiety disorders and do not support subtyping of anxiety disorders on the basis of the predominant type of AAS. Therapeutic approaches that target AAS might best be applied in the treatment of panic disorder, social anxiety disorder and generalized anxiety disorder.
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Affiliation(s)
- David Berle
- School of Psychiatry, UNSW, Australia; St John of God Health Care, Richmond Hospital, Australia.
| | - Vladan Starcevic
- Discipline of Psychiatry, Sydney Medical School - Nepean, University of Sydney, Australia
| | - Denise Milicevic
- Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Australia
| | - Anthony Hannan
- Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Australia
| | - Erin Dale
- Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Australia
| | - Brian Skepper
- Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Australia
| | | | - Vlasios Brakoulias
- Discipline of Psychiatry, Sydney Medical School - Nepean, University of Sydney, Australia
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Aroused at Home: Basic Autonomic Regulation during Orthostatic and Physical Activation is Altered in Children with Social Anxiety Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:143-155. [DOI: 10.1007/s10802-016-0147-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Dijk C, de Jong PJ, Peters ML. Judgmental Biases of Individuals with a Fear of Blushing: The Role of Relatively Strict Social Norms. Clin Psychol Psychother 2016; 23:176-82. [DOI: 10.1002/cpp.1958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Corine Dijk
- Programme Group Clinical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Peter J. de Jong
- Department Clinical Psychology and Experimental Psychopathology; University of Groningen; Groningen The Netherlands
| | - Madelon L. Peters
- Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine; Maastricht University; Maastricht The Netherlands
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18
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Brown LA, LeBeau R, Liao B, Niles AN, Glenn D, Craske MG. A comparison of the nature and correlates of panic attacks in the context of Panic Disorder and Social Anxiety Disorder. Psychiatry Res 2016; 235:69-76. [PMID: 26687110 DOI: 10.1016/j.psychres.2015.11.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/19/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Panic attacks occurring outside of Panic Disorder are not well-understood despite their inclusion as a diagnostic specifier in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). This study compares panic attacks in the context of Panic Disorder compared to social anxiety in terms of their symptom frequency, severity, and clinical correlates. METHOD Participants (n=404) were interviewed using the Anxiety Disorders Interview Schedule (ADIS-IV-L; Brown et al., 1994), from which we analyzed interviewer ratings of panic attacks and panic attack symptoms, as well as other demographic and clinical characteristics. RESULTS Panic attacks in the context of Panic Disorder were characterized by a greater number and severity of symptoms compared to panic attacks in the context of Social Anxiety Disorder, and were associated with a history of traumatization, inpatient psychiatric treatment, and benzodiazepine use. Social anxiety panic attacks were associated with reduced physical health concerns. Cognitive panic attack symptoms were more prevalent in Panic Disorder and were associated with a variety of poor clinical correlates. CONCLUSIONS Panic attacks in the context of Panic Disorder are more severe than those in social anxiety, and this may be driven by cognitive disturbances during those attacks.
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Affiliation(s)
- Lily A Brown
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Richard LeBeau
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Betty Liao
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Andrea N Niles
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Daniel Glenn
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, California, USA.
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Nikolić M, Colonnesi C, de Vente W, Drummond P, Bögels SM. Blushing and Social Anxiety: A Meta-Analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Milica Nikolić
- Research Institute of Child Development and Education; University of Amsterdam
| | - Cristina Colonnesi
- Research Institute of Child Development and Education; University of Amsterdam
| | - Wieke de Vente
- Research Institute of Child Development and Education; University of Amsterdam
| | - Peter Drummond
- School of Psychology and Exercise Science; Murdoch University
| | - Susan M. Bögels
- Research Institute of Child Development and Education; University of Amsterdam
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(1)H-magnetic resonance spectroscopy in social anxiety disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:97-104. [PMID: 25549832 DOI: 10.1016/j.pnpbp.2014.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by excessive anxiety about social interaction or performance situations, leading to avoidance and clinically significant distress. A growing literature on the neurobiology of SAD has suggested that the reward/avoidance basal ganglia circuitry in general and the glutamatergic system in particular may play a role. In the current study, we investigated (1)H-magnetic resonance spectroscopy ((1)H-MRS) concentrations in cortical, striatal, and thalamic circuitry, as well as their associations with measures of social anxiety and related symptoms, in patients with primary SAD. METHODOLOGY Eighteen adult individuals with SAD and 19 age- and sex- matched controls participated in this study. (1)H-MRS was used to determine relative metabolite concentrations in the anterior cingulate cortex (ACC) using single voxel spectroscopy (reporting relative N-acetyl-aspartate (NAA), N-acetyl-aspartate with N-acetyl-aspartyl-glutamate (NAA+NAAG), glycerophosphocholine with phosphocholine (GPC+PCh), myo-inositol, glutamate (Glu), and glutamate with its precursor glutamine (Glu+Gln)), and the caudate, putamen and thalami bilaterally using two dimensional chemical shift imaging (reporting relative NAA+NAAG and GPC+PCh). Relationships between metabolite concentrations and measures of social anxiety and related symptoms were also determined. Measures of social anxiety included symptom severity, blushing propensity, and gaze anxiety/avoidance. RESULTS We found, first, decreased relative glutamate concentration in the ACC of SAD and changes in myo-inositol with measures of social anxiety. Second, NAA metabolite concentration was increased in thalamus of SAD, and choline metabolite concentrations were related to measures of social anxiety. Lastly, choline metabolite concentration in the caudate and putamen showed changes in relation to measures of social anxiety. CONCLUSION These findings are consistent with evidence that the reward/avoidance basal ganglia circuitry, as well as the glutamatergic system, play a role in mediating SAD symptoms.
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Shalom JG, Israeli H, Markovitzky O, Lipsitz JD. Social anxiety and physiological arousal during computer mediated vs. face to face communication. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.11.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Intrapersonal and interpersonal concomitants of facial blushing during everyday social encounters. PLoS One 2015; 10:e0118243. [PMID: 25679216 PMCID: PMC4334548 DOI: 10.1371/journal.pone.0118243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Facial blushing may usually be undesirable but may have an ameliorative function for some individuals under some circumstances. Researchers have studied the blush in laboratory settings, but not in daily life. In the present research, conducted with young adults, we employed for the first time an event-contingent recording method for assessing facial blushing during every-day social encounters. Blushing was associated with feeling embarrassed, ashamed, and exposed. These findings, though based on correlational analyses, are consistent with the idea that blushing is often unpleasant and can be maladaptive, and may contribute to the common belief that blushing is an undesirable response. Frequent blushers generally reported lower levels of dominant behavior, higher levels of submissive behavior, and perceived their social interaction partners as more powerful and less affiliative. This was independent of whether they blushed or not, suggesting that altered social behaviors and perceptions are associated with blushing-associated traits rather than with the blushing state. The experience of the blush varied as a function of the frequency with which a person blushed. Blushing was associated with higher levels of shame in frequent blushers than in infrequent blushers. In infrequent blushers, blushing was associated with higher levels of pleasant affect, suggesting that for infrequent blushers the blush may occur in positive social encounters.
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The reaction to social stress in social phobia: discordance between physiological and subjective parameters. PLoS One 2014; 9:e105670. [PMID: 25153526 PMCID: PMC4143269 DOI: 10.1371/journal.pone.0105670] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/26/2014] [Indexed: 11/22/2022] Open
Abstract
Background Research on the biopsychological background of social phobia (SP) is scarce and inconsistent. We investigated endocrine and autonomic markers along with subjective responses to a standardized stress situation (Trier Social Stress Test, TSST) in SP patients and healthy controls (HC). Methods We examined 88 patients with the primary diagnosis of SP as well as 78 age and sex comparable HCs with the TSST. Blood and saliva samples were obtained before and after the TSST for the assessment of salivary cortisol, plasma cortisol, salivary alpha-amylase (sAA), and prolactin. Heart rate (HR) and heart rate variability (HRV) were recorded continuously. Scalp-near hair samples were collected for the assessment of long-term cortisol secretion. The self-reported stress response was measured with different state and trait scales. Results While self-reported anxiety was elevated in SP before, during, immediately after, and one week after the TSST, no significant differences in biological stress responses were observed between SP and HC. There was a trend for SP to show higher baseline stress markers. Also long-term cortisol deposition in hair remained unaltered. Conclusions Our results suggest that the excessive self-reported stress in SP is not reflected by a respective biological stress response. Patients with SP apparently show neither an extreme form of focused fear reactivity nor excessive defensive impairment.
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Dalrymple K, D'Avanzato C. Differentiating the subtypes of social anxiety disorder. Expert Rev Neurother 2014; 13:1271-83. [PMID: 24175725 DOI: 10.1586/14737175.2013.853446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Since the inclusion of subtypes of social anxiety disorder (SAD) in the DSM-III-R, the most studied have been generalized versus specific subtypes. Previous research indicated that the generalized subtype was associated with greater severity, comorbidity and functional impairment compared to the specific subtype, but more recent evidence supports a dimensional conceptualization of SAD. Earlier studies also possessed limitations, such as heterogeneity in definitions of generalized SAD. Based on the more recent findings and the limitations of the earlier studies, the DSM-5 eliminated the generalized specifier. However, it also retained a categorical system by including a performance-based fear specifier, thus leaving an open debate on whether or not a dimensional or categorical system best describes SAD. Future research could examine other, more recent concepts as potential subtypes (e.g., attentional biases), or perhaps the larger question of the overall utility in subtyping SAD.
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Affiliation(s)
- Kristy Dalrymple
- Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA and
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Siess J, Blechert J, Schmitz J. Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2014; 23:127-42. [PMID: 23812865 DOI: 10.1007/s00787-013-0443-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/12/2013] [Indexed: 01/11/2023]
Abstract
Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.
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Affiliation(s)
- Julia Siess
- Department for Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany
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Stevens S, Cludius B, Bantin T, Hermann C, Gerlach AL. Influence of alcohol on social anxiety: An investigation of attentional, physiological and behavioral effects. Biol Psychol 2014; 96:126-33. [DOI: 10.1016/j.biopsycho.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 12/31/2022]
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McAleavey AA, Castonguay LG, Goldfried MR. Clinical experiences in conducting cognitive-behavioral therapy for social phobia. Behav Ther 2014; 45:21-35. [PMID: 24411111 DOI: 10.1016/j.beth.2013.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/16/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.
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28
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Drummond PD, Minosora K, Little G, Keay W. Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing. Eur Neuropsychopharmacol 2013; 23:1747-53. [PMID: 23958575 DOI: 10.1016/j.euroneuro.2013.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 11/30/2022]
Abstract
The flush that develops during whole-body heat stress depends partly on prostaglandins production in the skin. Variations in the strength of this local mechanism may contribute to individual differences in susceptibility to blushing and associated anxiety. To investigate this in the present study, the anti-inflammatory agent ibuprofen (which blocks prostaglandins formation) was applied topically to a small area of the cheek in 16 participants with a fear of blushing and in another 14 without this fear. Changes in skin blood flow were monitored at the ibuprofen-treated site and at a mirror image control site while participants sang (to induce embarrassment and blushing) and during aerobic exercise (to induce flushing). The topical ibuprofen treatment inhibited increases in cheek blood flow in both groups during both of these tasks. However, increases in cheek blood flow were greater in participants with high than low fear of blushing immediately after exercise. These findings suggest that prostaglandins contribute to dilatation of facial blood vessels both during emotional arousal (embarrassment) and aerobic exercise. Furthermore, fear of blushing may be associated with mechanisms that delay the resumption of normal vascular tone after a period of vasodilatation. Whether topical ibuprofen gel is suitable for intermittent or long-term use as an aid for blushing control requires further investigation.
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Affiliation(s)
- Peter D Drummond
- School of Psychology and Exercise Science, Murdoch University, Perth, 6150 Western Australia, Australia.
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29
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Drummond PD, Bailey T. Eye Contact Evokes Blushing Independently of Negative Affect. JOURNAL OF NONVERBAL BEHAVIOR 2013. [DOI: 10.1007/s10919-013-0155-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Aderka IM, McLean CP, Huppert JD, Davidson JRT, Foa EB. Fear, avoidance and physiological symptoms during cognitive-behavioral therapy for social anxiety disorder. Behav Res Ther 2013; 51:352-8. [PMID: 23639301 PMCID: PMC3669252 DOI: 10.1016/j.brat.2013.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 02/21/2013] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
Abstract
We examined fear, avoidance and physiological symptoms during cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Participants were 177 individuals with generalized SAD who underwent a 14-week group CBT as part of a randomized controlled treatment trial. Participants filled out self-report measures of SAD symptoms at pre-treatment, week 4 of treatment, week 8 of treatment, and week 14 of treatment (post-treatment). Cross-lagged Structural Equation Modeling indicated that during the first 8 weeks of treatment avoidance predicted subsequent fear above and beyond previous fear, but fear did not predict subsequent avoidance beyond previous avoidance. However, during the last 6 weeks of treatment both fear and avoidance predicted changes in each other. In addition, changes in physiological symptoms occurred independently of changes in fear and avoidance. Our findings suggest that changes in avoidance spark the cycle of change in treatment of SAD, but the cycle may continue to maintain itself through reciprocal relationships between avoidance and fear. In addition, physiological symptoms may change through distinct processes that are independent from those involved in changes of fear and avoidance.
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Pujol J, Giménez M, Ortiz H, Soriano-Mas C, López-Solà M, Farré M, Deus J, Merlo-Pich E, Harrison BJ, Cardoner N, Navinés R, Martín-Santos R. Neural response to the observable self in social anxiety disorder. Psychol Med 2013; 43:721-731. [PMID: 22895096 DOI: 10.1017/s0033291712001857] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping. RESULTS Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range. CONCLUSIONS Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.
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Affiliation(s)
- J Pujol
- Institut d'Alta Tecnologia-PRBB, CRC Mar, Hospital de Mar, Barcelona, Spain.
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Moukheiber A, Rautureau G, Perez-Diaz F, Jouvent R, Pelissolo A. Gaze behaviour in social blushers. Psychiatry Res 2012; 200:614-9. [PMID: 22951333 DOI: 10.1016/j.psychres.2012.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/10/2012] [Accepted: 07/14/2012] [Indexed: 10/28/2022]
Abstract
Gaze aversion could be a central component of social phobia. Fear of blushing is a symptom of social anxiety disorder (SAD) but is not yet described as a specific diagnosis in psychiatric classifications. Our research consists of comparing gaze aversion in SAD participants with or without fear of blushing in front of pictures of different emotional faces using an eye tracker. Twenty-six participants with DSM-IV SAD and expressed fear of blushing (SAD+FB) were recruited in addition to twenty-five participants with social phobia and no fear of blushing (SAD-FB). Twenty-four healthy participants aged and sex matched constituted the control group. We studied the number of fixations and the dwell time in the eyes area on the pictures. The results showed gaze avoidance in the SAD-FB group when compared to controls and when compared to the SAD+FB group. However we found no significant difference between SAD+FB and controls. We also observed a correlation between the severity of the phobia and the degree of gaze avoidance across groups. These findings seem to support the claim that social phobia is a heterogeneous disorder. Further research is advised to decide whether fear of blushing can constitute a subtype with specific behavioral characteristics.
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Objective and perceived arousal during performance of tasks with elements of social threat: the influence of anxiety sensitivity. J Behav Ther Exp Psychiatry 2012; 43:967-74. [PMID: 22487103 DOI: 10.1016/j.jbtep.2012.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/27/2012] [Accepted: 03/07/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Physiological arousal serves to maintain social anxiety disorder by skewing self-perception. Anxiety sensitivity is associated with the disorder and exaggerated perceptions of arousal, but has not been tested as explaining exaggerated perceived arousal in social contexts. The aim of this investigation was to address this issue. METHODS A total of 42 individuals participated in three tasks associated with potential social threat (i.e., a speech, typing task, hyperventilation) and completed measures of trait social anxiety and anxiety sensitivity. State anxiety, perceived arousal, and objective arousal were assessed during each task. RESULTS Trait social anxiety and anxiety sensitivity were correlated with state anxiety and perceived arousal, but not objective arousal, during the tasks. Anxiety sensitivity mediated the relationships between trait social anxiety and perceived arousal and between trait social anxiety and state anxiety for the typing and hyperventilation tasks. LIMITATIONS Although the sample likely included a number of individuals with social anxiety disorder, the sample was mostly comprised of individuals without a diagnosis. The current results can be extended to clinical presentations to some extent, but future research is needed to further explore the demonstrated relationships in samples of individuals with social anxiety disorder. CONCLUSIONS Anxiety sensitivity may play a crucial role in perceptions of arousal and state anxiety in the context of potential social threats, warranting attention from researchers and clinicians focussing on social anxiety disorder.
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Erythrophobia--problems of diagnostics and treatment. POLISH JOURNAL OF SURGERY 2012; 84:322-7. [PMID: 22842746 DOI: 10.2478/v10035-012-0054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Drummond PD, Su D. The relationship between blushing propensity, social anxiety and facial blood flow during embarrassment. Cogn Emot 2012; 26:561-7. [DOI: 10.1080/02699931.2011.595775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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36
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Drummond PD, Lazaroo D. The effect of facial blood flow on ratings of blushing and negative affect during an embarrassing task: preliminary findings. J Anxiety Disord 2012; 26:305-10. [PMID: 22257642 DOI: 10.1016/j.janxdis.2011.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 12/20/2011] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
Abstract
Expecting to blush is a common source of social anxiety, and is associated with heightened perceptions of blushing and embarrassment. To assess whether sensory cues associated with heightened facial blood flow are an additional source of anxiety, the vasodilator niacin (100mg) or placebo was administered double-blind to 33 participants, and facial blood flow was investigated when they sang a children's song. Vasodilatation during singing was greater in the niacin than placebo condition, and niacin-evoked flushing and increases in pulse rate were greater in participants with high than low fear of negative evaluation. Nevertheless, ratings of embarrassment, anxiety, blushing and facial heat were similar in both drug conditions. This dissociation implies that cognitive appraisals or negative affect overrode more subtle physiological cues of blushing during embarrassment. Clarifying how judgments about blushing are made could be crucial for correcting faulty assumptions about blushing in people who are frightened of this response.
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Affiliation(s)
- Peter D Drummond
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
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Schmitz J, Blechert J, Krämer M, Asbrand J, Tuschen-Caffier B. Biased Perception and Interpretation of Bodily Anxiety Symptoms in Childhood Social Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:92-102. [DOI: 10.1080/15374416.2012.632349] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pelissolo A, Moukheiber A, Lobjoie C, Valla J, Lambrey S. Is there a place for fear of blushing in social anxiety spectrum? Depress Anxiety 2012; 29:62-70. [PMID: 21769994 DOI: 10.1002/da.20851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 05/10/2011] [Accepted: 05/18/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD. METHODS SAD patients with FB but without other social threat (n = 142), the majority of whom were referred by a department of surgery after an initial request of sympathetic block for facial blushing, were compared to SAD patients with FB and other associated social fears (n = 97), and to SAD patients without FB (n = 190). They were assessed and compared with a structured diagnostic interview for DSM-IV and various scales measuring social anxiety, other anxiety and depressive symptoms, impairment and personality traits. RESULTS The group with pure FB showed specific profiles when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, and higher self-esteem. However, their levels of social anxiety and impairment were high. No important differences appeared between the two other groups. CONCLUSION The specificity of FB should be considered in the social anxiety spectrum, and could be viewed either as a SAD subtype or as SAD form secondary to facial blushing. Further epidemiological and therapeutic studies on this disorder are necessary.
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Affiliation(s)
- Antoine Pelissolo
- Department of adults Psychiatry, Hôpital Pitié-Salpêtrière, Paris, France.
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Schmitz J, Krämer M, Tuschen-Caffier B, Heinrichs N, Blechert J. Restricted autonomic flexibility in children with social phobia. J Child Psychol Psychiatry 2011; 52:1203-11. [PMID: 21615735 DOI: 10.1111/j.1469-7610.2011.02417.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychophysiological hyperresponsiveness to social-evaluative stress plays a key role in current theories of social phobia (SP). Owing to the early onset of this disorder, the study of children with SP can help to improve etiological models. However, research to date has failed to clarify whether children with SP are physiologically hyperresponsive to stress or not. In addition, the existence of elevated pre-stressor baseline group differences complicates the interpretation of acute stress responses and therefore poses a challenge for this line of research. Drawing on current models of autonomic control to explain the relationship between baseline and stress responding in SP children and healthy controls (HC), we acquired a broad set of autonomic measures in our study. METHOD To index baseline and stress reactivity and to assess autonomic flexibility, we assessed a comprehensive array of sympathetic and parasympathetic measures in SP children (aged 8 to 12 years; n = 30) and healthy control children (HC, n = 26), while exposing them to the Trier Social Stress Test for Children (TSST-C). RESULTS At baseline, the SP children showed higher levels of sympathetic (heart rate, electrodermal activity) and lower levels of parasympathetic (respiratory sinus arrhythmia, RSA) activation when compared to the HC children. During the TSST-C, the SP children showed similar HR responses but a limited RSA reactivity and a slower HR recovery relative to the HC children. CONCLUSION Our study extends previous research by showing elevated baseline arousal and comparable stress responding in SP children relative to HC children. In addition, based on the autonomic flexibility model, we provide a potential explanation for the null findings of previous studies during stress. The pattern of elevated baseline heart rates and reduced RSA point to restricted autonomic flexibility in children with SP.
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Affiliation(s)
- Julian Schmitz
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany.
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The negative self-portrayal scale: development, validation, and application to social anxiety. Behav Ther 2011; 42:183-96. [PMID: 21496505 DOI: 10.1016/j.beth.2010.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 04/27/2010] [Accepted: 04/27/2010] [Indexed: 01/04/2023]
Abstract
The Negative Self-Portrayal Scale (NSPS) is a new questionnaire designed to assess the extent to which individuals are concerned that specific self-attributes they view as being deficient will be exposed to scrutiny and evaluation by critical others in social situations. These concerns have been proposed to drive symptoms of social anxiety and account for individual differences in social fears and avoidance behaviors (Moscovitch, 2009). Here, we introduce the NSPS and examine its factor structure and psychometric properties across two large samples of North American undergraduate students with normally distributed symptoms of social anxiety. Exploratory and confirmatory factor analyses supported a 3-factor solution representing concerns about (a) social competence; (b) physical appearance; and (c) signs of anxiety. The NSPS was found to have good internal consistency and test-retest reliability, strong convergent validity, and adequate discriminant validity. In addition, NSPS total scores accounted for a significant proportion of unique variance in self-concealment (i.e., safety) behaviors over and above established symptom measures of social interaction anxiety, social performance anxiety, and depression. Results are discussed in relation to theoretical models of social anxiety and the potential utility of the NSPS for both clinical research and practice.
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Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety 2010; 26:1066-85. [PMID: 19957279 DOI: 10.1002/da.20633] [Citation(s) in RCA: 279] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of co-morbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA.
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Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010; 27:168-89. [PMID: 20143427 DOI: 10.1002/da.20670] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. METHOD A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. RESULTS/CONCLUSIONS Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
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Affiliation(s)
- Susan M Bögels
- Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.
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Dijk C, Voncken MJ, de Jong PJ. I blush, therefore I will be judged negatively: influence of false blush feedback on anticipated others’ judgments and facial coloration in high and low blushing-fearfuls. Behav Res Ther 2009; 47:541-7. [DOI: 10.1016/j.brat.2009.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/05/2009] [Accepted: 03/13/2009] [Indexed: 11/26/2022]
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What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2009. [DOI: 10.1016/j.cbpra.2008.04.002] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Voncken MJ, Bögels SM. Physiological blushing in social anxiety disorder patients with and without blushing complaints: Two subtypes? Biol Psychol 2009; 81:86-94. [DOI: 10.1016/j.biopsycho.2009.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 01/18/2009] [Accepted: 02/13/2009] [Indexed: 11/17/2022]
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Fearful imagery in social phobia: generalization, comorbidity, and physiological reactivity. Biol Psychiatry 2009; 65:374-82. [PMID: 18996510 PMCID: PMC2735121 DOI: 10.1016/j.biopsych.2008.09.023] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 09/15/2008] [Accepted: 09/23/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Social phobia has been characterized as a disorder of exaggerated fear of social threat and heightened sensitivity to imagery of social failure. METHODS To assess the physiological basis of this description, social phobia patients (n=75) and demographically matched control participants (n=75) imagined neutral and fearful events while acoustic startle probes were occasionally presented and eye-blink responses (orbicularis occuli) recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed. In addition to comparing control participants and social phobia patients, the influences of diagnostic subtype (circumscribed, generalized), comorbid depression, and chronicity were assessed. RESULTS Patients exceeded control participants in startle reflex and autonomic responding during imagery of social threat, whereas the groups evinced commensurate reactivity to contents depicting commonly shared fears (survival threat). Individuals with circumscribed performance phobia were similar to control participants, with the exception of more robust reactions to idiographic, performance fear imagery. In contrast, generalized phobic patients were characterized by longer disorder chronicity and demonstrated heightened sensitivity to a broader range of fear contents. Those with generalized phobia plus comorbid depression showed attenuation of fear-potentiated startle and reported the most protracted social anxiety. CONCLUSIONS Subtypes of social phobia can be objectively distinguished in patterns of physiological reactivity. Furthermore, subtypes vary systematically in chronicity and defensive engagement with the shortest disorder duration (circumscribed phobia) associated with the most robust and focal physiological reactivity, followed by broader defensive sensitivity in more chronic generalized phobia, and finally attenuation of the formerly exaggerated fear potentiation in the comorbidly depressed, the most chronic form.
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Blushing propensity in social anxiety disorder: influence of serotonin transporter gene variation. J Neural Transm (Vienna) 2008; 116:663-6. [DOI: 10.1007/s00702-008-0090-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 06/19/2008] [Indexed: 11/27/2022]
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Abstract
Die Soziale Phobie (oder Soziale Angststörung) stellt eine häufige psychische Störung dar, die insbesondere aufgrund ihres chronischen Verlaufs mit umfassenden Beeinträchtigungen einhergeht. Voraussetzung für die langfristig wirksame Behandlung oder Prävention der Störung ist ein umfassendes Verständnis bedingender und aufrecht erhaltender Faktoren. Mittlerweile liegen neben einer Reihe deskriptiver Störungsmodelle zur Entstehung und Aufrechterhaltung eine Vielfalt empirischer Ergebnisse zu Risikofaktoren sozialer Ängste vor. Neben einem Überblick über Phänomenologie und Epidemiologie Sozialer Angststörungen liegt der Schwerpunkt der Arbeit auf der Diskussion möglicher Einflussfaktoren in einer Entwicklungspsychopathologie der Sozialen Phobie. Dabei werden internale Faktoren, wie Familiengenetik, Temperament, kognitive Stile und soziale Fertigkeiten, sowie externe Faktoren, wie Erziehungsverhalten der Eltern und Erfahrungen mit der sozialen Umwelt, berücksichtigt. Zur Integration dieser Befunde werden differenzierte Modelle zur Ausbildung und zu differenziellen Entwicklungsverläufen generalisierter und isolierter sozialer Ängste vorgeschlagen.
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Affiliation(s)
- Sylvia Helbig
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Bögels SM, Voncken M. Social Skills Training Versus Cognitive Therapy for Social Anxiety Disorder Characterized by Fear of Blushing, Trembling, or Sweating. Int J Cogn Ther 2008. [DOI: 10.1521/ijct.2008.1.2.138] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen V, Drummond PD. Fear of negative evaluation augments negative affect and somatic symptoms in social-evaluative situations. Cogn Emot 2007. [DOI: 10.1080/02699930701273815] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Velda Chen
- a Murdoch University , Perth, Western Australia
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