The effect of self-focused attention during mirror gazing on body image evaluations, appearance-related imagery, and urges to mirror gaze

BACKGROUND AND OBJECTIVES

Mirror gazing has been linked to poor body image. Cognitive-behavioral models propose that mirror gazing induces self-focused attention. This activates appearance-related imagery, increases body dissatisfaction, and promotes further mirror gazing. However, evidence for these relationships remains scarce. Our study experimentally investigated how self-focused attention impacts overall and facial appearance satisfaction, perceived attractiveness, distress about appearance and disliked features, vividness and emotional quality of appearance-related imagery, and urges to mirror gaze. Baseline body dysmorphic concerns were studied as a moderator.

METHODS

Singaporean undergraduates (Mage = 21.22, SDage = 1.62; 35 females, 28 males) were randomly assigned to high or low self-focused attention during a mirror gazing task. Dependent variables were measured with visual analogue scales, and body dysmorphic concerns with the Body Image Disturbance Questionnaire (BIDQ). Analysis of variance and moderation analyses were conducted.

RESULTS

Self-focused attention lowered overall and facial appearance satisfaction. Perceived attractiveness decreased only in individuals with high baseline body dysmorphic concerns. Contrary to predictions, distress, appearance-related imagery, and urges to mirror gaze were unaffected.

LIMITATIONS

This study used a non-clinical sample. The BIDQ has not been psychometrically validated in Singaporean samples.

CONCLUSIONS

Self-focused attention during mirror gazing lowers positive body image evaluations. Individuals with higher body dysmorphic concerns are particularly vulnerable to low perceived attractiveness.

Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample

BACKGROUND

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.

METHODS

Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network.

RESULTS

At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.

CONCLUSIONS

Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.

Influence of subjective social class and social mobility beliefs on self-focused attention: the mediating role of sense of control

We verified whether social class shapes different models of the self in China, by integrating individuals' social mobility beliefs and exploring the mediating effect of sense of control. Participants were randomly assigned to one of 2 (subjective social class: upper vs. low class) × 2 (social mobility beliefs: high vs. low mobility) manipulation conditions. They then completed the sense of control questionnaire and self-focused attention task. High mobility belief could alleviate the difference in perception among different subjective social classes and improve lower classes' control perception. Sense of control mediates subjective social class effects and social mobility beliefs on self-focused attention.

Triggers of self-focused attention: an ecological momentary assessment study

BACKGROUND

Self-focused attention (SFA) is a major maintenance factor of social anxiety disorder. The two types of SFA, the observer perspective and self-focus on body sensation, increase anxiety in individuals with high levels of social anxiety. However, the triggers of each SFA remain unclear. This study used ecological momentary assessment to identify the factors that elicit SFA in real-life social scenarios.

METHODS

The study obtained 316 samples from 22 Japanese university students (4 male:18 female) with high social anxiety who completed momentary measures of stimulus perception and two types of SFA for 10 days. Links to online questionnaires were sent to the participants via e-mails 3 times a day. First, multilevel single regression analyses were used to identify the stimuli that induced the two types of SFA. Between-level interaction with gender was done to determine the effect of gender biasing on the female participants. Next, for the variables that were significantly predictive in these analyses, multilevel multiple regression analyses were conducted with fear of each stimulus as a control variable.

RESULTS

Perception of gaze, evaluation, and authority predicted SFA from the observer perspective. Perception of gaze also predicted self-focus on body sensation. In addition, the perception of positive response and that of stranger predicted self-focus on body sensation depended on gender, implying that the positive response perception of female participants predicted self-focus on body sensation. After controlling for corresponding fear, gaze perception predicted both SFAs, and the perception of authority predicted SFA from the observer perspective. In addition, after controlling for relevant fear, the perception of positive response of female participants predicted self-focus on body sensation. In contrast, the fear of evaluation but not the perception of evaluation predicted SFA from the observer perspective.

CONCLUSIONS

The perception of gaze is the most powerful trigger of the two types of SFA, even after controlling for fear of gaze in real-life social scenarios for individuals with social anxiety. SFA from the observer perspective is also triggered by the perception of authority and fear of evaluation. The role of perception of positive responses or strangers should be re-evaluated after correcting for gender imbalance. (350 words / 350 words).

The influence of self-focused attention on emotional picture processing: An ERP study

Research has documented neurophysiological indicators of anticipation (Stimulus Preceding Negativity [SPN]) and perception (Late Positive Potential [LPP]) of threat, yet little is known as to how self-focused attention manipulations influence emotion processing within the context of cued picture viewing. With self-referent attention moderating attention to external stimuli, it is necessary to document how self-focused attention impacts attention and the ability to emotionally process external threat. The goal of the present study was to evaluate the impact of self-focused attention on the anticipation and perceptual processing of unpleasant pictures within a cued-picture viewing paradigm among 33 participants. Overall, the results suggest that the self-focused attention manipulations disrupted anticipation but not processing of pictures, as indexed by the SPN and LPP respectively. Self-focused attention appears to disrupt the preparatory attention for upcoming unpleasant stimuli, potentially through loading cognitive resources or activation of associative defensive responding. Collectively, these findings demonstrate the impact of self-focused attention within the context of emotional picture processing and suggest further areas of investigation.

Associations between self-absorption and working memory capacity: A preliminary examination of a transdiagnostic process spanning across emotional disorders

Considered a transdiagnostic process spanning across emotional disorders, self-absorption reflects self-focused processing that is excessive, sustained, and inflexible. Working memory capacity is critical for self-regulation, inclusive of mitigating perseverative thinking. Providing the first known examination of associations between self-absorption and working memory capacity, a negative association was expected. A sample of adults (N = 63; 70 % experiencing an anxiety or depressive disorder) completed the study protocol, which included completing a structured diagnostic interview, self-report measures, and a working memory capacity task. Self-absorption, as predicted, negatively correlated with working memory capacity, with an association found for the private, but not public, aspect of self-absorption. The association between private self-absorption and working memory capacity was not attributable to shared variance with public self-absorption or negative affectivity. Diagnostic status (anxiety disorder, depressive disorder, or either disorder) did not moderate the association. The results provide evidence that self-absorption relates to impairments in working memory capacity. Implications and future directions for how these results advance our understanding and treatment efforts of self-absorption are discussed.

Cognitive predictors of adolescent social anxiety

Background

Identifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social anxiety. Despite social anxiety typically starting in adolescence, prospective studies examining these cognitive processes in youth are lacking. The current study examined prospective associations between these five cognitive processes and social anxiety in a sample of 614 participants (53% girls; aged 11–14 years).

Methods

Psychological processes, social anxiety symptoms, and depressive symptoms were assessed using self-report questionnaires at two time points.

Results

Negative social cognitions, safety behaviours, self-focused attention, and post-event processing predicted prospective levels of social anxiety over and above the effect of baseline levels of social anxiety. When these process variables were entered together in a regression model, three of them were independently associated with prospective social anxiety. Neither pre- nor post-event processing independently predicted later social anxiety over and above the effects of other psychological process variables.

Conclusions

The findings indicate that these psychological processes are promising targets for treatment in adolescent social anxiety.

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The applicability of the cognitive model of Clark & Wells was tested in a sample of 614 adolescents.

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Negative social cognitions independently predicted increases in social anxiety.

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Safety behaviours independently predicted increases in social anxiety.

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Self-focused attention independently predicted increases in social anxiety.

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Unexpectedly, neither pre- or post-event processing was an independent predictor of social anxiety.

negative attentional bias during public speech task in socially anxious individuals

Enhanced self-focused attention (SFA) and negative attentional bias (NAB) towards social cues are characteristic hallmarks of social anxiety. It is essential to investigate these two attentional phenomena under socially relevant situations using comparable stimuli. In the present study, individuals with high social anxiety (HSA, n = 32) and low social anxiety (LSA, n = 29) were compared according to their attention toward self-related stimuli and toward positive, neutral, and negative feedback related stimuli. Video stimuli of moving indicators of self-anxiety-status and positive, neutral, and negative feedback from an audience were presented during an impromptu speech task (high anxiety condition) and a re-watching phase (low anxiety condition). Eye movements in response to the different stimuli served as readouts for attentional preference. An interaction effect suggested that the HSA group directed more attention to self-related stimuli relative to other stimuli and the LSA group only during the high anxiety condition. The LSA group exhibited a general attentional preference toward positive feedback, especially during the low anxiety condition. Meanwhile, only the total duration of fixation on positive feedback negatively correlated with subjective anxiety rating. Our results point to increased SFA rather than NAB in HSA individuals under social threats.

The heterogeneity of social anxiety symptoms among Chinese adolescents: Results of latent profile analysis

BACKGROUND

The main objective of the current study was to investigate the symptoms of social anxiety in Chinese adolescents by conducting latent profile analysis (LPA), a person-centered statistical approach, with items from the Social Anxiety Scale for Adolescents (SAS-A).

METHOD

In total, a sample of 2,755 adolescents aged 11‒19 years were recruited from six urban public schools in the Beijing District and Sichuan Province, China. Latent profile analysis, regression mixture modelling, and multinomial logistical regression were adopted to investigate the latent profiles and profiles validity.

RESULTS

A four-profile model was suggested as the optimum: low group with diffuse social anxiety, moderate group with difficulties in new situations, moderate group with cognitive disturbance, and high group with diffuse social anxiety. With regression mixture modelling, results showed a greater possibility for older adolescents and girls fall into the high group with diffuse social anxiety. Finally, to examine the validity and interpretability of the social anxiety profiles, two cognitive factors-post-event rumination and self-focused attention-were adopted for their potential to significantly predict the moderate and high group social anxiety profiles.

CONCLUSIONS

The current study, which was the first effort to investigate the features of social anxiety among Chinese adolescents with LPA, supports an innovative model of social anxiety symptoms in a large, non-Western sample. Limitations and clinical implications are included.

Fears and fear-related cognitions in children with selective mutism

Selective mutism (SM) is classified under the category of anxiety disorders in DSM-5 [1], although concrete fears that underlie the condition are not specified contrary to all other anxiety disorders. Given the lack of studies systematically investigating fears in SM, content and frequency of concrete fears as well as related cognitions have remained unclear so far. One hundred and twenty-four participants [M = 13.25 years (SD = 3.24), range 8-18 years] with SM (n = 65), social phobia (SP n = 18) or with typical development (TD n = 51) took part in an online survey. Participants with SM (n = 65) answered an open-ended question concerning fears that might cause the consistent failure to speak in select situations. Additionally, participants with SM, SP and TD completed a survey containing 34 fear-related cognitions that might occur in speech-demanding situations. Open text answers were systematically evaluated by extracting higher-order categories using a Qualitative Content Analysis. Single item scores of the survey were compared between the three groups. 59% of all spontaneously reported fears were assigned to the cluster of social fears. Other reported fears represented the categories fear of mistakes (28%), language-related fears (8%) and voice-related fears (5%). The SM- and SP group only differed regarding the cognition that one's own voice might sound funny (SM > SP). Social fears and the fear of mistakes account for the majority of fears in SM. Therefore, future interventions should consider specifically targeting these types of fears.

The attention training technique causally reduces self-focus following worry provocation and reduces cognitive anxiety among self-focused individuals

BACKGROUND AND OBJECTIVES

The attention training technique (ATT) is a component of metacognitive therapy developed to interrupt self-focused, threat-based processing underlying anxiety disorders. Whereas extant research supports the benefits of ATT, including in relation to anxiety reduction, study findings lead to equivocal conclusions as to whether ATT causally interrupts self-focused attention (SFA) as intended. An additional gap in the literature relates to investigating if ATT is especially effective for reducing anxiety among individuals experiencing a heightened self-focused state. The present study sought to address those two gaps in the literature.

METHOD

Participants scoring high on a measure of general worry severity completed a worry provocation that increased SFA and then were randomized to ATT (n = 45), a mindfulness task (n = 44), or a distraction task (n = 44).

RESULTS

ATT caused large reductions in SFA, whereas there were no changes in focus of attention following the mindfulness or distraction task. Anxiety reduction was found in relation to all three tasks; however, ATT, relative to distraction, was found to cause greater reduction in cognitive anxiety for individuals highly self-focused before the task.

LIMITATIONS

The present study used an analogue sample and the design did not allow for an examination of the long-term benefit of ATT.

CONCLUSIONS

Results support ATT causally interrupting self-focused states and that ATT is particularly effective in reducing cognitive anxiety among individuals who are self-focused.

Depersonalization Under Academic Stress: Frequency, Predictors, and Consequences

BACKGROUND

Based on the assumptions that depersonalization symptoms are relevant for test anxiety maintenance, we examined their frequency, psychological predictors, association with anxiety symptoms, and association with test performance.

SAMPLING AND METHODS

In Study 1, 203 students rated their test anxiety severity and depersonalization in their last oral examination. In Study 2, we assessed test anxiety 1 week before an oral examination, depersonalization, safety behaviors, self-focused attention, and negative appraisals of depersonalization directly after the examination, and post-event processing 1 week later among 67 students.

RESULTS

In Study 1, 47.3% reported at least one moderate depersonalization symptom. In Study 2, test anxiety and negative appraisals of depersonalization significantly predicted depersonalization. Depersonalization was linked to a higher intensity of safety behaviors and post-event processing but not to self-focused attention. It was not related to performance.

CONCLUSION

Results are limited by the non-random sampling and the small sample size of Study 2. However, by showing that depersonalization contributes to the processes the maintenance of test anxiety, the findings confirm that depersonalization - normally understood as an adaptive mechanism to cope with stressful events - can become maladaptive.

Genuine eye contact elicits self-referential processing

The effect of eye contact on self-awareness was investigated with implicit measures based on the use of first-person singular pronouns in sentences. The measures were proposed to tap into self-referential processing, that is, information processing associated with self-awareness. In addition, participants filled in a questionnaire measuring explicit self-awareness. In Experiment 1, the stimulus was a video clip showing another person and, in Experiment 2, the stimulus was a live person. In both experiments, participants were divided into two groups and presented with the stimulus person either making eye contact or gazing downward, depending on the group assignment. During the task, the gaze stimulus was presented before each trial of the pronoun-selection task. Eye contact was found to increase the use of first-person pronouns, but only when participants were facing a real person, not when they were looking at a video of a person. No difference in self-reported self-awareness was found between the two gaze direction groups in either experiment. The results indicate that eye contact elicits self-referential processing, but the effect may be stronger, or possibly limited to, live interaction.

How do I look? Self-focused attention during a video chat of women with social anxiety (disorder)

We investigated the role of self-focused attention (SFA) in social anxiety (disorder) in an ecologically valid way. In Experiment 1 high (n = 26) versus low (n = 25) socially anxious single women between 18 and 30 years had a video ("Skype") conversation with an attractive male confederate, while seeing themselves and the confederate on-screen. The conversation was divided in four phases: (I) warm-up, (II) positive (confederate was friendly to the participant), (III) critical (confederate was critical to the participant), and (IV) active (participant was instructed to ask questions to the confederate). Participant's SFA was measured by eye-tracked gaze duration at their own image relative to the confederates' video image and other places at the computer screen. Results show that high socially anxious participants were more self-focused in the critical phase, but less self-focused in the active phase than low socially anxious participants. In Experiment 2 women diagnosed with SAD (n = 32) and controls (n = 30) between 18 and 30 years conducted the same experiment. Compared to controls participants with SAD showed increased SFA across all four phases of the conversation, and SFA predicted increased self-rated anxiety during the conversation. In conclusion, in subclinical social anxiety SFA is high only when the interaction partner is critical, whereas instructions to ask questions to the confederate reduces subclinical socially anxious' SFA, while clinical SAD is characterized by heightened self-focused attention throughout the interaction. Results support theories that social anxiety disorder is maintained by SFA, and imply that interventions that lower SFA may help prevent and treat social anxiety disorder, but that SFA can also be adaptive in certain types of interaction, such as when receiving compliments.

Adaptive functions of self-focused attention: Insight and depressive and anxiety symptoms

Maladaptive forms of self-focus, such as rumination, are considered transdiagnostic factors that contribute to depressive and anxiety symptoms. However, no or few studies have explored the possibility that adaptive forms of self-focus can also be a common factor that is negatively associated with depressive and anxiety symptoms. To test this possibility, we first examined the psychometric properties of a scale measuring adaptive forms of self-focus (the Self-Reflection and Insight Scale) on Japanese undergraduates (n=117). We replicated the two-factor structure of the scale: (a) self-reflection, which is a tendency to focus purposefully on self for self-regulation, and (b) insight, which is a sense of clear self-understanding. Second, we tested our specific hypothesis that these two factors negatively predict a common factor of depressive and anxiety symptoms. The results of structural equation modeling showed that insight (but not self-reflection) has a significant negative association with a latent variable that explains both depressive and anxiety symptoms. Furthermore, this common-factor model explained the data better than a control model in which insight predicts depressive and anxiety symptoms individually. These results suggest that (lack of) insight plays an important role in psychological (mal)adjustment as a shared process in depressive and anxiety symptoms.

The effect of self-focused attention and mood on appearance dissatisfaction after mirror-gazing: An experimental study

BACKGROUND AND OBJECTIVES

Self-focused attention is hypothesized to be a maintenance factor in body dysmorphic disorder (BDD). The aim of this study was to use an experimental paradigm to test this hypothesis by studying the effect of self-focused attention during mirror-gazing on appearance dissatisfaction.

METHODS

An experimental group design was used, in which 173 women were randomly allocated to one of three conditions before mirror-gazing for 2 min: (a) external focus of attention, (b) self-focus of attention, and (c) self-focus of attention with a negative mood induction.

RESULTS

After mirror-gazing, participants across all groups rated themselves as being more dissatisfied with their appearance. In both the self-focus conditions, there was an increase in sadness from pre to post mirror gazing, and there was a significant difference in focus of attention for participants in the self-focused, mood-induced group from pre to post manipulation, suggesting mood induction had more of an effect than focus of attention.

LIMITATIONS

(1) there was no condition involving an external focus with a negative mood induction, and (2) due to the level of information provided to patients on the nature of the task, we cannot rule out demand characteristics as an influencing factor on our results.

CONCLUSIONS

Self-focused attention during mirror-gazing may act indirectly to increase appearance dissatisfaction via the effect of negative mood. Further studies are required to establish the relative contribution of self-focused attention and negative mood to increases in appearance dissatisfaction as a function of mirror-gazing.

Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study

Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.

Self-focused attention affects subsequent processing of positive (but not negative) performance appraisals

BACKGROUND AND OBJECTIVES

Cognitive-behavioral models highlight the conjoint roles of self-focused attention (SFA), post-event processing (PEP), and performance appraisals in the maintenance of social anxiety. SFA, PEP, and biased performance appraisals are related to social anxiety; however, limited research has examined how SFA affects information-processing following social events. The current study examined whether SFA affects the relationships between performance appraisals and PEP following a social event..

METHODS

137 participants with high (n = 72) or low (n = 65) social anxiety were randomly assigned to conditions of high SFA or low SFA while engaging in a standardized social performance. Subsequent performance appraisals and PEP were measured.

RESULTS

Immediate performance appraisals were not affected by SFA. High levels of SFA led to a stronger, inverse relationship between immediate positive performance appraisals and subsequent negative PEP. High levels of SFA also led to a stronger, inverse relationship between negative PEP and changes in positive performance appraisals..

LIMITATIONS

Future research should examine whether the current findings, which involved a standardized social performance event, extend to interaction events as well as in a clinical sample.

CONCLUSIONS

These findings suggest that SFA affects the processing of positive information following a social performance event. SFA is particularly important for understanding how negative PEP undermines positive performance appraisals..

Can't stand the look in the mirror? Self-awareness avoidance in borderline personality disorder

BACKGROUND

Patients with Borderline Personality Disorder (BPD) expect and perceive social rejection stronger than healthy individuals. Shifting ones attention from oneself to others has been suggested as a mechanism to deal with the experience of social rejection. Here, we investigated whether BPD participants avoid increased self-awareness and whether this is done intentionally.

METHODS

Thirty BPD patients and 30 healthy control participants, all naïve of the study's purpose, were asked to choose either a seat facing a mirror (self-awareness) or not facing the mirror (avoidance of self-awareness). Afterwards they were asked to indicate if they have chosen the seat intentionally.

RESULTS

BPD patients avoided as a trend the chair facing the mirror more often than healthy control participants. 90 % of the patients reported that they made their seating decision intentionally in contrast to 26.7 % of the healthy participants (odd ratio = 24.75).

CONCLUSIONS

Results revealed altered reactions to self-awareness cues in BPD. While BPD patients avoided such a cue slightly more often, they were more often aware of their behavior than healthy participants. As possible explanations, a negative body related, shame-prone self-concept as well as a simultaneously increased degree of self-focused attention are suggested.

Eye contact elicits bodily self-awareness in human adults

Eye contact is a typical human behaviour known to impact concurrent or subsequent cognitive processing. In particular, it has been suggested that eye contact induces self-awareness, though this has never been formally proven. Here, we show that the perception of a face with a direct gaze (that establishes eye contact), as compared to either a face with averted gaze or a mere fixation cross, led adult participants to rate more accurately the intensity of their physiological reactions induced by emotional pictures. Our data support the view that bodily self-awareness becomes more acute when one is subjected to another's gaze. Importantly, this effect was not related to a particular arousal state induced by eye contact perception. Rejecting the arousal hypothesis, we suggest that eye contact elicits a self-awareness process by enhancing self-focused attention in humans. We further discuss the implications of this proposal.