Cognitive Constructs and Social Anxiety Disorder: Beyond Fearing Negative Evaluation

Cross-cultural validation of the BFOE model: Best practices and future directions for psychometric evaluation of the Fear of positive evaluation scale - Insights from a Dutch translation

The Bivalent Fear of Evaluation (BFOE) model suggests that Social Anxiety Disorder is not only characterized by fear of negative evaluation (FNE), but also fear of positive evaluation (FPE). While FNE has been firmly established, research of the latter is accumulating. To evaluate the role of the BFOE Model, and particularly FPE, validated measures such as the Fear of Positive Evaluation Scale (FPES) are pivotal. Yet, validation of psychometric properties is often at stake or neglected when translating a scale to other languages. This hampers cross-cultural evaluation of questionnaires and related concepts considerably, including the BFOE Model. To illustrate, a freely available, but not validated Dutch version of the FPES was completed, along with other measures by 354 community participants from the Netherlands and Belgium in an online study. The Dutch FPES showed excellent convergent and discriminant validity. In addition, it explained additional variance in social anxiety above and beyond FNE. These results as well as those from the factor analyses were highly comparable with those deriving from evaluations of the original English version. In conclusion, the Dutch FPES showed excellent psychometric properties and is fit for further exploring consistency or differences in the BFOE model across cultures. Based on this case, practice guidelines for international use and validation of measures are discussed, and recommendations are provided.

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

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

Relationship between fear of evaluation, ambivalence over emotional expression, and self-compassion among university students

BACKGROUND

This study focuses on college students as research subjects, exploring the relationship between fear of evaluation, ambivalence over emotional expression, and self-care, as well as the moderating effect of self-care on the prediction of ambivalence over emotional expression by fear of evaluation.

METHODS

This study selected physical education college students in Sichuan Province as the research participants. Convenience sampling was used to recruit participants through public recruitment information and questionnaire links on online platforms commonly used by college students. The questionnaire was distributed at two different time points to reduce the effect of common method bias. A total of 858 questionnaires were distributed, after excluding duplicate responses, a total of 743 valid questionnaires were obtained.

RESULTS

The result as following: (1) College students exhibit a moderate to high level of negative fear of evaluation, ambivalence over emotional expression, and self-care, with female students having higher negative fear of evaluation; (2) There are significant correlations between fear of evaluation, ambivalence over emotional expression, and self-care; (3) Fear of evaluation and self-care can predict ambivalence over emotional expression, but self-care does not have a moderating effect on the prediction of ambivalence over emotional expression by fear of evaluation; (4) Self-care and negative self-care both have a moderating effect on the prediction of emotion rumination by positive fear of evaluation.

CONCLUSIONS

In the past, rumination has often been considered a manifestation of excessive rumination and anxiety. However, this study found that self-compassion's modulation on fear of positive evaluation intensifies its impact on emotional rumination. Research suggests that moderate emotional rumination may not necessarily be a negative outcome and reflects a positive emotional adjustment process to some extent. Therefore, future studies can further explore the growth and decline of internal rumination processes in self-compassion or counseling, and potentially gain a better understanding of key elements of personal growth.

Fear of positive evaluation differentially predicts social anxiety: a six-month longitudinal panel study

This study investigated whether (a) fear of negative evaluation (FNE) and fear of positive evaluation (FPE) prospectively predict the other, (b) FPE predicts social anxiety controlling for FNE, and (c) FPE predicts social anxiety symptoms but not general anxiety and depression. Data were collected from a student sample at two time points over six months. The cross-lagged structural equation modeling results revealed that FNE and FPE do not prospectively predict the other, FPE positively predicts social anxiety symptoms controlling for FNE, and FPE does not significantly predict general anxiety or depression. These results confirmed that FNE and FPE are distinctively related to social anxiety. Moreover, the study findings indicated that FPE may be a factor unique to social anxiety.

From fears of evaluation to social anxiety: The longitudinal relationships and neural basis in healthy young adults

BACKGROUND

Social anxiety disorder (SAD) is a common mental health problem, and its core cognitive manifestation is the persistent fear of being evaluated, including both negatively (FNE) and positively (FPE). This study aimed to examine the longitudinal relationships of FNE, FPE and SAD and explore their neural basis.

METHODS

Three samples were retrieved in this study. First, the data of 649 college students who completed a survey and fMRI scan were used to explore the neural basis of FNE, FPE, and SAD symptoms. Next, the data of 450 participants who completed the same survey twice were used to examine the longitudinal relationships of the variables. Finally, the overlapping of the two samples (N = 288) who completed two surveys and the fMRI scan were used to establish a brain-behavior model.

RESULTS

Both FNE and FPE predicted SAD, and SAD also predicted FPE. The neural signals of subregions in prefrontal cortex were correlated with the scores of FNE, FPE and SAD. Abnormal prefrontal signals influenced SAD symptoms via fears of evaluation.

CONCLUSIONS

Our findings explain the behavioral and neural underpinnings of social anxiety from a fear of evaluation angle. This contributes to a better theorical understanding of SAD and clinical practice.

Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play?

OBJECTIVE

Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively.

METHOD

One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events.

RESULTS

Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity.

CONCLUSION

Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.

Intolerance of uncertainty and distress in women with delayed IVF treatment due to the COVID-19 pandemic: The mediating role of situation appraisal and coping strategies

The COVID-19 pandemic has caused delays of numerous medical procedures, including IVF. This study investigates the relationship between Intolerance of Uncertainty (IU), situation appraisal-the perceived threat that COVID-19 poses for infertility treatment, coping strategies, and general distress among women with a delayed IVF procedure. SEM showed that situation appraisal is a partial mediator of the relationship between IU and avoidance, as well as the relationship between IU and general distress. The connection between situation appraisal and general distress is partially mediated by avoidance. In this challenging context for mental health, situation appraisal and coping strategies determine the level of distress, where IU, as a dispositional variable, represents the main determinant of the entire reaction.

Social Anxiety and Depression in Romantic Relationships: A Three-Sample Exploration

Introduction: Social anxiety contributes to a variety of interpersonal difficulties and dysfunctions. Socially anxious adults are less likely to marry and more likely to divorce than are non-anxious adults. The present pre-registered study investigated incremental variance accounted for by social anxiety in relationship satisfaction, commitment, trust, and social support. Methods: Three independent samples of adults (N = 888; 53.7% female; Mage = 35.09 years) involved in a romantic relationship completed online self-report questionnaires. Both social anxiety and depression were significantly correlated with relationship satisfaction, commitment, dyadic trust, and social support. Hierarchical regression analyses were conducted with each sample to investigate the incremental variance accounted for by each of social anxiety and depression in relationship satisfaction, commitment, dyadic trust, and social support. Subsequent meta-analyses were run to determine the strength and replicability of the hierarchical models. Results: Results suggest that social anxiety is a robust predictor of unique variance in both perceived social support and commitment. Depression was a robust predictor of unique variance in relationship satisfaction, dyadic trust, social support, and commitment. Discussion: These results help to further understanding of social anxiety in romantic relationships and provide direction for future research and clinical intervention.

Social Anxiety, Fear of Negative Evaluation, and Distress in a Virtual Reality Environment

According to cognitive theories of social anxiety, fear of negative evaluation (FNE) may be the mechanism whereby social anxiety induces distress. However, studying this can be challenging, as individuals with social anxiety may be reluctant to enter anxiety-provoking social situations, such as speaking in front of others. The present study used virtual reality (VR) to examine if giving a presentation in front of a virtual audience induced distress among undergraduate students and to test the hypothesis that FNE would mediate the relationship between social anxiety and distress. University students (N = 58, 70% female) entered a VR environment where they stood in front of a virtual audience and gave a short, impromptu presentation about their university. Participants also completed self-report measures of social anxiety, FNE, and distress (estimated before, during, and after VR). Distress and FNE had positive relationships with social anxiety and FNE fully mediated the relationship between social anxiety and distress. As far as we are aware, this is the first VR study to show this effect. The findings indicate that FNE could be a useful treatment target to reduce distress when presenting in front of an audience, either in VR or in person.

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

LAY ABSTRACT

People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

Amygdala hyperreactivity to faces conditioned with a social-evaluative meaning- a multiplex, multigenerational fMRI study on social anxiety endophenotypes

Social anxiety disorder (SAD) runs in families, but the neurobiological pathways underlying the genetic susceptibility towards SAD are largely unknown. Here, we employed an endophenotype approach, and tested the hypothesis that amygdala hyperreactivity to faces conditioned with a social-evaluative meaning is a candidate SAD endophenotype. We used data from the multiplex, multigenerational Leiden Family Lab study on Social Anxiety Disorder (eight families, n = 105) and investigated amygdala activation during a social-evaluative conditioning paradigm with high ecological validity in the context of SAD. Three neutral faces were repeatedly presented in combination with socially negative, positive or neutral sentences. We focused on two endophenotype criteria: co-segregation of the candidate endophenotype with the disorder within families, and heritability. Analyses of the fMRI data were restricted to the amygdala as a region of interest, and association analyses revealed that bilateral amygdala hyperreactivity in response to the conditioned faces co-segregated with social anxiety (SA; continuous measure) within the families; we found, however, no relationship between SA and brain activation in response to more specific fMRI contrasts. Furthermore, brain activation in a small subset of voxels within these amygdala clusters was at least moderately heritable. Taken together, these findings show that amygdala engagement in response to conditioned faces with a social-evaluative meaning qualifies as a neurobiological candidate endophenotype of social anxiety. Thereby, these data shed light on the genetic vulnerability to develop SAD.

Fear of positive evaluation and social anxiety: A systematic review of trait-based findings

BACKGROUND

Although fear of negative evaluation (FNE) has long been recognized as a core cognitive bias in social anxiety, fear of positive evaluation (FPE) has received considerable attention over the past several years. The literature would benefit from a synthesis of the current state of the research in order to contribute to our understanding of FPE.

METHODS

A systematic review of the literature was conducted in order to address several questions: (a) Is self-reported FPE distinct from self-reported FNE? (b) Is self-reported FPE related to social anxiety symptomatology? and (c) Is self-reported FPE uniquely related to social anxiety symptomatology when accounting for self-reported FNE? Inclusion criteria included studies published in English, testing FPE and FNE with trait-based measures, and testing social anxiety with either self-report or diagnostic interviews.

RESULTS

There were 33 studies identified in this review that provided convincing empirical support for each of these questions across community and clinical samples of adolescents, undergraduates, and adults.

LIMITATIONS

The systematic review did not have access to null results, present meta-analytic results, or include studies that evaluated FPE or social anxiety with experimental designs.

CONCLUSIONS

The findings from the systematic review support updated theoritical models of social anxiety and highlight the importance of assessing and treating FPE in clinical interventions.

Factorial validity and measurement invariance of the uncertainty response scale

This study presents the adaptation of the Uncertainty Response Scale (Greco & Roger, Pers. Individ. Differ, 31:519-534, 2001) to Portuguese. This instrument was administered to a non-clinical community sample composed of 1596 students and professionals, allowing a thorough validity and invariance analysis by randomly dividing participants into three subsamples to perform: an exploratory factor analysis (sample one: N = 512); a preliminary confirmatory factor analysis to identify the final solution for the scale (sample two: N = 543); and the confirmatory factor analysis (sample three: N = 541). Samples two and three were also used for multi-group analysis to assess measurement invariance, invariance across gender, sociocultural levels, and students versus active professionals. Results showed the scale reflects the original factorial structure, as well as good internal consistency and overall good psychometric qualities. Invariance results across groups reached structural invariance which provides a confident invariance measurement for this scale, while invariance across gender and sociocultural levels reached metric invariance. Accordingly, differences between these groups were explored, by comparing means with multi-group analysis to establish the scale's sensitivity toward social vulnerability, by demonstrating the existence of statistically significant differences regarding gender and sociocultural levels on how individuals cope with uncertainty, specifically in terms of emotional strategies, as a self-defeating strategy. Thus, females scored higher on emotional uncertainty, as well as low sociocultural levels, compared with higher ones. Therefore, it is proposed that this scale could be a sound alternative to explore strategies for coping with uncertainty, when considering social, economic, or other environmental circumstances that may affect them.

Beliefs about safety behaviours in the prediction of safety behaviour use

BACKGROUND

Safety behaviours are ubiquitous across anxiety disorders and are associated with the aetiology, maintenance and exacerbation of anxiety. Cognitive behavioural models posit that beliefs about safety behaviours directly influence their use. Therefore, beliefs about safety behaviours may be an important component in decreasing safety behaviour use. Unfortunately, little empirical research has evaluated this theorized relationship.

AIMS

The present study aimed to examine the predictive relationship between beliefs about safety behaviours and safety behaviour use while controlling for anxiety severity.

METHOD

Adults with clinically elevated levels of social anxiety (n = 145) and anxiety sensitivity (n = 109) completed an online survey that included established measures of safety behaviour use, quality of life, and anxiety severity. Participants also completed the Safety Behaviour Scale (SBS), a measure created for the current study which includes a transdiagnostic checklist of safety behaviours, as well as questions related to safety behaviour use and beliefs about safety behaviours.

RESULTS

Within both the social anxiety and anxiety sensitivity groups, positive beliefs about safety behaviours predicted greater safety behaviour use, even when controlling for anxiety severity. Certain beliefs were particularly relevant in predicting safety behaviour use within each of the clinical analogue groups.

CONCLUSIONS

Findings suggest that efforts to decrease safety behaviour use during anxiety treatment may benefit from identifying and modifying positive beliefs about safety behaviours.

Malaise with praise: A narrative review of 10 years of research on the concept of Fear of Positive Evaluation in social anxiety

Social anxiety is characterized by a fear of being negatively evaluated by others (i.e., Fear of Negative Evaluation [FNE]). In 2008, Weeks, Heimberg, and Rodebaugh proposed Fear of Positive Evaluation (FPE) as a second cognitive component in social anxiety. The article presents an overview of FPE, its psycho-evolutionary theoretical foundation and assessment by the Fear of Positive Evaluation Scale as well as relevant psychometric research on demographic characteristics. The relationship of FPE with a wide range of established dimensions from clinical, personality, and social psychology (i.e., self-esteem, perfectionism, or quality of life) will be reviewed. The role of FPE for psychological comorbidities such as other anxiety disorders, depression, eating, and substance use disorders as well as for treatment of social anxiety will be discussed. Future research might address questions of causality of FPE relative to related constructs, further data on psychometric properties, as well as on its independence from FNE in longitudinal studies. In sum, FPE seems to be a valid and reliable construct that explains cognitions, emotions, and behavior related to social anxiety at subclinical and clinical levels and therefore enriches the psychometric repertoire in the fields of social psychology, personality, and clinical psychology.

Intolerance of uncertainty moderates the relations among religiosity and motives for religion, depression, and social evaluation fears

OBJECTIVES

Intolerance of uncertainty (IU) underlies several psychological disorders, and religion may help some individuals cope with IU and/or protect against psychological symptoms. It was hypothesized that IU would moderate the relations between coping motives for being religious, as well as religiosity, and common psychological disorder symptoms: Depression and social evaluation fears.

METHODS

Study 1 included 473 self-reporting community members (M _age  = 48, 48% female, 80% Protestant/Catholic). Study 2 included 412 self-reporting undergraduates ( M _age  = 19, 71% female, 76% Protestant/Catholic).

RESULTS

For Study 1, coping-based motives related to greater depression for young adults with above-average IU and to lower depression for young adults with below-average IU. For Study 2, religiosity related to lower depression and fear of negative evaluation for individuals with above-average IU and to greater fear of positive evaluation for individuals with below-average IU.

CONCLUSION

IU may be an important mechanism between aspects of religion and psychological disorder symptoms.

Pain anxiety differentially mediates the association of pain intensity with function depending on level of intolerance of uncertainty

Uncertainty about symptom duration, cause, prognosis and treatment is common in patients who seek medical care, yet individual ability to manage this uncertainty varies. Intolerance of uncertainty is considered an important factor in the etiology and persistence of negative emotions- in particular, depression and anxiety. We explored the contribution of intolerance of uncertainty to anxiety due to pain and physical function in patients seeking care at an orthopedic medical practice. Participants (N = 105, mean age of 51 ± 17, 63% male) were administered PROMIS Physical Function v1.2 Upper Extremity CAT, Numerical Rating Scale (NRS), Pain Anxiety Symptoms Scale-short form (PASS-20), and the Intolerance of Uncertainty Scale-short version (IUS-12). Results showed that the mediating role of pain anxiety is contingent upon the level of intolerance of uncertainty. Specifically, a minimum level of intolerance of uncertainty is required for the development of pain anxiety and its effect on function, and as intolerance of uncertainty rises from low to medium to high levels, the effect of pain on function goes from being independent of the anxiety to being more and more carried by and through anxiety about pain. These findings support the contention that intolerance of uncertainty plays a crucial role in the relationship between pain, pain anxiety, and physical function. Intolerance of uncertainty appears to be a trans-diagnostic target for coping skills training.

Social anxiety is characterized by biased learning about performance and the self

People learn about their self from social information, and recent work suggests that healthy adults show a positive bias for learning self-related information. In contrast, social anxiety disorder (SAD) is characterized by a negative view of the self, yet what causes and maintains this negative self-view is not well understood. Here the authors use a novel experimental paradigm and computational model to test the hypothesis that biased social learning regarding self-evaluation and self-feelings represents a core feature that distinguishes adults with SAD from healthy controls. Twenty-one adults with SAD and 35 healthy controls (HCs) performed a speech in front of 3 judges. They subsequently evaluated themselves and received performance feedback from the judges and then rated how they felt about themselves and the judges. Affective updating (i.e., change in feelings about the self over time, in response to feedback from the judges) was modeled using an adapted Rescorla-Wagner learning model. HCs demonstrated a positivity bias in affective updating, which was absent in SAD. Further, self-performance ratings revealed group differences in learning from positive feedback-a difference that endured at an average of 1 year follow up. These findings demonstrate the presence and long-term endurance of positively biased social learning about the self among healthy adults, a bias that is absent or reversed among socially anxious adults. (PsycINFO Database Record

Fear of the unknown: One fear to rule them all?

The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.

Into the unknown: A review and synthesis of contemporary models involving uncertainty

The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the importance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty.

Latent dimensions of social anxiety disorder: A re-evaluation of the Social Phobia Inventory (SPIN)

The Social Phobia Inventory (SPIN; Connor et al., 2000) is a well-validated instrument for assessing severity of social anxiety disorder (SAD). However, evaluations of its factor structure have produced inconsistent results and this aspect of the scale requires further study. Primary care patients with SAD (N=397) completed the SPIN as part of baseline assessment for the Coordinated Anxiety Learning and Management study (Roy-Byrne et al., 2010). These data were used for exploratory and confirmatory factor analysis of the SPIN. A 3-factor model provided the best fit for the data and factors were interpreted as Fear of Negative Evaluation, Fear of Physical Symptoms, and Fear of Uncertainty in Social Situations. Tests of a second-order model showed that the three factors loaded strongly on a single higher-order factor that was labeled Social Anxiety. Findings are consistent with theories identifying Fear of Negative Evaluation as the core feature of SAD, and with evidence that anxiety sensitivity and intolerance of uncertainty further contribute to SAD severity.