Information processing in social phobia: a critical review

A systematic review of neuropsychological performance in social anxiety disorder

BACKGROUND

Over the past few years, there has been an increasing interest in the neuropsychological performance of patients with anxiety disorders, yet the literature does not provide a systematic review of the results concerning adult patients with social anxiety disorder (SAD).

AIMS

The primary aim of this paper is to review the literature on neuropsychological performance in adult patients with SAD.

METHODS

This paper is a systematic review of empirical studies investigating neuropsychological performance as assessed by cognitive tests.

RESULTS

30 papers were located comprising a total number of 698 adult patients with SAD. The review revealed indication for decreased performance regarding visual scanning and visuoconstructional ability as well as some indication for verbal memory difficulties.

CONCLUSION

The impact of possible confounding variables on the neuropsychological performance is discussed. It is suggested that the decreased performance should be attributed to an increased level of situational anxiety, and an engagement in disorder-related, cognitively costly activities rather than trait-like cognitive dysfunctions. Future experimental studies are needed to explore the causal relationship between these constructs. Knowledge from such studies is important in order to improve the understanding of why SAD is such a disabling disorder, both educationally and interpersonally, and could assist in the planning and evaluation of psychotherapeutic treatment.

The relationship between the maladaptive self-beliefs characteristic of social anxiety and avoidance

The Clark and Wells (1995) model of social phobia proposes that there are three types of maladaptive self-beliefs responsible for persistent social anxiety (high standard, conditional, and unconditional beliefs). Another prominent feature of social phobia is the avoidance of social-evaluative situations. To our knowledge, there have been no studies that have examined the relationship between these specific maladaptive self-belief types and avoidance. We hypothesised that while accounting for potential confounding variables (i.e., fear of negative evaluation and general symptomology), each of the three maladaptive self-belief types would be significantly and positively associated with cognitive and behavioural avoidance in the social domain, but not these forms of avoidance in the non-social domain. In a sample of undergraduates (N = 361), we found only partial support for our hypotheses. In the social domain, stronger high standard beliefs predicted less behavioural avoidance, stronger unconditional beliefs predicted more behavioural avoidance, and stronger conditional beliefs predicted more cognitive avoidance. In the non-social domain, stronger unconditional beliefs predicted more cognitive avoidance. These relationships were obtained at all levels of social anxiety. Additionally, the unconditional beliefs partially mediated the relationship between social anxiety and behavioural avoidance in the social domain, and the conditional beliefs fully mediated the relationship between social anxiety and cognitive avoidance in the social domain. These results emphasise the distinct nature of each of the maladaptive self-belief types and the need to elucidate their relationship with other components in theoretical models of social phobia.

Negative Social Cognitions in Socially Anxious Youth: Distorted Reality or a Kernel of Truth?

We review studies that investigate negative social cognitions of socially anxious youth in relation to two specific domains: interpretation of ambiguous social situations and self-evaluation of social performance, including social skills and nervous behaviors. In this review, we address the question whether socially anxious youth's negative perceptions are distortions of reality or reflect a kernel of truth as compared to other sources of information including independent adult observers and age peers. Studies key to this question are those that investigate not only the social perceptions themselves but also the social behavior of socially anxious youth. Hence the selection of studies for the review was based on this criterion. From the relevant literature it is, as yet, unclear whether the negative interpretations of ambiguous social situations shown by socially anxious youth are distorted or a reflection of reality. Socially anxious youth's self-evaluations of social skills appear partly distorted and partly true, depending on the person judging the social skills. In contrast, self-evaluations of nervous behaviors appear distorted. The studies reviewed indicate that research would benefit from including a wider range of perceptions from persons relevant to the socially anxious youth's daily social environment, not only parents and teachers but also their age peers.

Neural correlates of altered general emotion processing in social anxiety disorder

Specific anxiety disorders are characterized by altered emotion processing of phobia-specific stimuli at the neurobiological level. Recent work has concentrated on specific anxiety-provoking stimuli; focusing on arousal- or fear-related brain areas such as the amygdala. We analyzed brain activation during the cued anticipation of unpleasant or uncertain emotional stimuli as a means of modeling an unspecific anxiety-laden situation. Sixteen patients with social anxiety disorder (SAD) and eighteen healthy control subjects completed a task during functional magnetic resonance imaging involving the anticipation of cued visual stimuli with prior known emotional valence (positive, negative, and neutral) or prior unknown/ambiguous emotional content. The anticipated stimuli had no social phobia specific content. During the anticipation of emotional stimuli of prior known negative and prior ambiguous emotional valence, brain activity in patients with SAD was increased in the upper midbrain/dorsal thalamus, the amygdala, and in temporo-occipital and parietal regions as compared to control subjects. Activity was decreased in SAD in left orbitofrontal cortex. Activations in the amygdala and in occipital regions correlated with trait anxiety and social anxiety measures. In conclusion, SAD was associated with enhanced activation in brain regions involved in emotional arousal as well as in attention and perception processing during the anticipation of non-specific, general emotional stimuli. Hence, our results suggest that patients with SAD not only have an altered processing of specific feared stimuli, but also a more generally disturbed emotion processing in basic neural pathways. These findings have implications for diagnostic models and the treatment of SAD.

Morphed emotional faces: emotion detection and misinterpretation in social anxiety

The current study investigated detection and interpretation of emotional facial expressions in high socially anxious (HSA) individuals compared to non-anxious controls (NAC). A version of the morphed faces task was implemented to assess emotion onset perception, decoding accuracy and interpretation, either with time pressure (Restricted Viewing Task, RVT) or with unlimited viewing (Free Viewing Task, FVT). Twenty-seven HSA and 30 NAC viewed sequences of neutral faces slowly changing to full-intensity angry, happy, or disgust expressions. Participants were instructed to assign the expression as soon as possible to one of four given emotion categories (angry, contempt, disgust, or happy). While no group differences were found for emotion onset perception or decoding performance, the results suggest an interpretation bias in HSA. Under the RVT condition, HSA demonstrated a threat bias (disgust interpreted as contempt), contrasting the NAC's positive bias (disgust interpreted as happy). No group differences were found in the FVT. We suggest that socially anxious individuals tend to misinterpret facial expressions as threatening when they must do so quickly and efficiently, as in real life.

[How do the cost bias and probability bias influence social anxiety symptoms?]

The cost and probability bias in social situations are considered to be a maintaining factor for social anxiety disorder (SAD) symptoms. However, the process by which the cost and probability bias influences other SAD symptoms, such as avoidance behavior, self-perception of autonomic responses, and anxiety in social situations has not been investigated. We developed a model of the cost and probability bias and investigated the process through which the cost and probability bias influences SAD symptoms. Undergraduate students (N=290) were administered self-report measures assessing each component of SAD symptoms. A path analysis was conducted using the cost and probability bias model, which indicated high validity for the model (goodness of fit index = .99, adjusted goodness of fit index = .92, root mean square error of approximation = .09). The results also indicated that the cost bias had a strong effect on each component of SAD symptoms, and that the probability bias mediated the relationship between fear of negative evaluation and the cost bias. These findings suggest that changing the cost and probability bias may improve SAD symptoms.

Posttraumatic stress and social anxiety: the interaction of traumatic events and interpersonal fears

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) are frequently comorbid among veteran and community samples. Several studies have demonstrated significant comorbidity between trauma, PTSD, and social anxiety (SA), and a growing number of studies have explored the nature of this association. Although a diagnosis of either PTSD or SAD alone can result in significant impairment in social and occupational functioning, these difficulties are often magnified in persons suffering from both disorders. This review describes the current state-of-the-art regarding the co-occurrence of trauma, PTSD, and SA. First, we provide an overview of empirical data on the prevalence of co-occurring trauma, PTSD, and SAD. Second, we describe possible explanatory models of the co-occurrence, with a specific focus on the shared vulnerability model. Third, we review the available empirical data addressing the postulates of this model, including both genetic and psychological vulnerabilities. Fourth, we describe additional factors-guilt, shame, and depressive symptoms-that may help to explain the co-occurrence of PTSD and SA. A better understanding of this complex relationship will improve the efficacy of treatment for individuals suffering from both disorders. We conclude with key areas for future research.

Attentional biases in clinical populations with alcohol use disorders: is co-morbidity ignored?

OBJECTIVE

To identify how psychiatric co-morbidity was identified and assessed, in studies of attentional bias in clinical samples of patients with alcohol use disorders (AUDs).

DESIGN

Systematic review methodology was used to identify studies and abstract data on alcohol-related attentional biases and measurement of psychiatric co-morbidity.

RESULTS

Seventeen papers were identified that met the criteria for inclusion. All but one study were in patients meeting criteria for alcohol dependence. In 10 of the 17 studies, either no mention or minimal statements were made pertaining to possible co-morbid conditions (including other substance use): five excluded patients with psychiatric diagnoses, (variously defined), and two excluded patients on 'psychotropic medication'. Slow response latencies to all word types were found in studies where co-morbid conditions were not considered.

CONCLUSIONS

Despite the high prevalence of psychiatric pathology in patients with AUDs (particularly depression), and the acknowledged impact that this has on aetiology, presentation and outcome, psychiatric co-morbidity has not been consistently measured or described in experimental studies on alcohol-related attentional biases in clinical samples. In order to have an accurate appreciation of the role of attentional biases in patients with AUDs, there needs to be a consistent approach to measuring the co-occurrence of other psychopathology. Further research is needed to assess the impact of co-morbidities on attentional biases in AUDs, to enable the development of more targeted psychological and pharmacological treatments.

Relationship between social anxiety disorder and body dysmorphic disorder

Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) are two separate, but conceptually overlapping nosological entities. In this review, we examine similarities between SAD and BDD in comorbidity, phenomenology, cognitive biases, treatment outcome, and cross-cultural aspects. Our review suggests that SAD and BDD are highly comorbid, show a similar age of onset, share a chronic trajectory, and show similar cognitive biases for interpreting ambiguous social information in a negative manner. Furthermore, research from treatment outcome studies have demonstrated that improvements in SAD were significantly correlated with improvements in BDD. Findings from cross-cultural research suggest that BDD may be conceived as a subtype of SAD in some Eastern cultures. Directions for future research and clinical implications of these findings are discussed.

Social anxiety and its relationship to functional impairment in body dysmorphic disorder

Social anxiety appears to be a prominent characteristic of body dysmorphic disorder (BDD). However, few previous studies have examined social anxiety and its facets (i.e., physiological arousal, fear and avoidance of social situations) and their relationship to psychosocial functioning in BDD. The present study aimed to fill these gaps by examining (a) social anxiety and its facets in BDD, and b) cross-sectional and prospective relationships between social anxiety symptoms and functional impairment in BDD. Individuals with DSM-IV BDD without comorbid social phobia (N=108) completed measures of social anxiety and psychosocial functioning at study intake (T1). Psychosocial functioning was also assessed at a 12-month follow-up interview (T2). Severity of social anxiety (i.e., due to BDD or any other source) was rated with the Social Phobia Inventory (SPIN). In addition, participants were interviewed with the Duke Brief Social Phobia Scale (BSPS) to assess social anxiety independent of BDD. At T1, participants endorsed high levels of social anxiety on the SPIN and subclinical levels of social anxiety on the BSPS. Greater social anxiety was associated with poorer psychosocial functioning in cross-sectional and prospective analyses, particularly fear and avoidance of social situations. These results suggest that certain aspects of social anxiety, especially social fear and avoidance, may be significant contributing factors to functional impairment in individuals with BDD.

Post-event processing and memory bias for performance feedback in social anxiety

Despite predictions following from cognitive theories of anxiety, evidence for memory biases in social anxiety has been mixed. This study extends previous research by using stimuli relevant to participants' concerns and allowing time for post-event processing. Participants high (n=42) or low (n=39) in social anxiety symptoms gave speeches and received standardized feedback on their and a confederate's performance. Participants then took recognition and recall tests for the feedback immediately after it was given and after a two-day delay. Results showed no recall biases. However, the hypothesized recognition biases were found: the high social anxiety group remembered the confederate's feedback more positively than their own, remembered their negative feedback as worse than the low group, and diminished positive feedback over time. Moreover, post-event processing mediated the relationship between social anxiety and memory for negative feedback. Results suggest that biased recognition of social feedback is linked to social anxiety.

The time-course of attention to emotional faces in social phobia

This study investigated the time-course of attentional bias in socially phobic (SP) and non-phobic (NP) adults. Participants viewed angry and happy faces paired with neutral faces (i.e., face-face pairs) and angry, happy and neutral faces paired with household objects (i.e., face-object pairs) for 5000ms. Eye movement (EM) was measured throughout to assess biases in early and sustained attention. Attentional bias occurred only for face-face pairs. SP adults were vigilant for angry faces relative to neutral faces in the first 500ms of the 5000ms exposure, relative to NP adults. SP adults were also vigilant for happy faces over 500ms, although there were no group-based differences in attention to happy-neutral face pairs. There were no group differences in attention to faces throughout the remainder of the exposure. Results suggest that social phobia is characterised by early vigilance for social cues with no bias in subsequent processing.

The Spanish Version of the Self-Statements during Public Speaking Scale: Validation in Adolescents

Contemporary theories of social anxiety emphasize the role of cognitive processes. Although social anxiety disorder is one of the most common mental health problems in adolescents, there are very few self-report instruments available to measure cognitive processes related to social anxiety in adolescents, let alone non-English instruments. The Self-Statements during Public Speaking Scale (SSPS; Hofmann & DiBartolo, 2000) is a brief self-report measure designed to assess self-statements related to public speaking, the most commonly feared social performance situation. In order to fill this gap in the literature, we translated the SSPS into Spanish and administered it to 1,694 adolescents from a community sample, a clinical sample composed of 71 subjects with a principal diagnosis of social anxiety disorder; and a clinical control group consisting of 154 patients. The scale showed good psychometric properties, supporting the use of the Spanish version of the SSPS in adolescents.

Stimulus-reinforcement-based decision making and anxiety: impairment in generalized anxiety disorder (GAD) but not in generalized social phobia (GSP)

BACKGROUND

Generalized social phobia (GSP) involves the fear/avoidance of social situations whereas generalized anxiety disorder (GAD) involves an intrusive worry about everyday life circumstances. It remains unclear whether these, highly co-morbid, conditions represent distinct disorders or alternative presentations of a single underlying pathology. In this study, we examined stimulus-reinforcement-based decision making in GSP and GAD.

METHOD

Twenty unmedicated patients with GSP, 16 unmedicated patients with GAD and 19 age-, IQ- and gender-matched healthy comparison (HC) individuals completed the Differential Reward/Punishment Learning Task (DRPLT). In this task, the subject chooses between two objects associated with different levels of reward or punishment. Thus, response choice indexes not only reward/punishment sensitivity but also sensitivity to reward/punishment level according to between-object reinforcement distance.

RESULTS

We found that patients with GAD committed a significantly greater number of errors than both the patients with GSP and the HC individuals. By contrast, the patients with GSP and the HC individuals did not differ in performance on this task.

CONCLUSIONS

These results link GAD with anomalous non-affective-based decision making. They also indicate that GSP and GAD are associated with distinct pathophysiologies.

Electrophysiological evidence of attentional biases in social anxiety disorder

BACKGROUND

Previous studies investigating attentional biases in social anxiety disorder (SAD) have yielded mixed results. Recent event-related potential (ERP) studies using the dot-probe paradigm in non-anxious participants have shown that the P1 component is sensitive to visuospatial attention towards emotional faces. We used a dot-probe task in conjunction with high-density ERPs and source localization to investigate attentional biases in SAD.

METHOD

Twelve SAD and 15 control participants performed a modified dot-probe task using angry-neutral and happy-neutral face pairs. The P1 component elicited by face pairs was analyzed to test the hypothesis that SAD participants would display early hypervigilance to threat-related cues. The P1 component to probes replacing angry, happy or neutral faces was used to evaluate whether SAD participants show either sustained hypervigilance or decreased visual processing of threat-related cues at later processing stages.

RESULTS

Compared to controls, SAD participants showed relatively (a) potentiated P1 amplitudes and fusiform gyrus (FG) activation to angry-neutral versus happy-neutral face pairs; (b) decreased P1 amplitudes to probes replacing emotional (angry and happy) versus neutral faces; and (c) higher sensitivity (d') to probes following angry-neutral versus happy-neutral face pairs. SAD participants also showed significantly shorter reaction times (RTs) to probes replacing angry versus happy faces, but no group differences emerged for RT.

CONCLUSIONS

The results provide electrophysiological support for early hypervigilance to angry faces in SAD with involvement of the FG, and reduced visual processing of emotionally salient locations at later stages of information processing, which might be a manifestation of attentional avoidance.

Covariation bias for social events and signs of (dis)approval in high and low socially anxious individuals

In two covariation bias experiments, we investigated whether socially anxious women overestimate the contingency between social events and signs of rejection and/or to underestimate the contingency between social events and approval. Participants were exposed to descriptions of ambiguous or negative social events, situations involving animals, and nature scenes that were randomly paired with disgusting, happy, and neutral faces. Socially anxious participants reported enhanced belongingness between ambiguous events and signs of rejection, together with reduced belongingness between negative events and approval. This contributes to previous findings suggesting that socially anxious individuals suffer from fear-confirming interpretive biases. There was no evidence for enhanced negative or reduced positive covariation bias in socially anxious individuals.

Social Anxiety and Anger Identification

We investigated the facial information that socially anxious and nonanxious individuals utilize to judge emotions. Using a reversed-correlation technique, we presented participants with face images that were masked with random bubble patterns. These patterns determined which parts of the face were visible in specific spatial-frequency bands. This masking allowed us to establish which locations and spatial frequencies were helping participants to successfully discriminate angry faces from neutral ones. Although socially anxious individuals performed as well as nonanxious individuals on the emotion-discrimination task, they did not utilize the same facial information for the task. The fine details (high spatial frequencies) around the eyes were discriminative for both groups, but only socially anxious participants additionally processed rough configural information (low spatial frequencies).

Processing of facial affect under social threat in socially anxious adults: mood matters

BACKGROUND

An important function of the human face is to communicate approval or disapproval toward others. Because socially anxious individuals are overly concerned about disapproval by others, it has been hypothesized that those individuals are faster at processing negative, specifically angry facial expressions than nonanxious individuals, especially under conditions of social threat.

METHOD

To test this hypothesis, 25 socially anxious individuals and 24 nonanxious controls were asked to classify facial expressions associated with anger, sadness, fear, disgust, happiness, and surprise. Half of the participants performed this task while being confronted with social threat.

RESULTS

High socially anxious participants were faster than controls at classifying angry, sad, and fearful faces when confronted with social threat. No group difference was observed under the no-threat condition.

CONCLUSIONS

The findings suggest that socially anxious individuals are more hypervigilant toward threat-related social cues, and that the processing of facial affect is dependent on the person's emotional state.

Attention in sub-clinical obsessive-compulsive checkers

The aim of the study was to explore differential attention profiles, according to attention types, in sub-clinical obsessive-compulsive checkers compared to controls. To examine attention biases in obsessive-compulsive phenomena, we compared sub-clinical checkers to non-checkers on their recall and recognition performances, using neutral and threat-relevant stimuli in three attention paradigms: focused attention, divided attention, and passive attention. Forty-six volunteer university students participated in the study: 24 checkers (14 males, 10 females), and 22 non-checkers (15 males, 7 females). We found that the checkers' recall and recognition performances were higher than those of the non-checkers for threat-relevant stimuli. Even though instructions and tasks were different in each attention paradigm, the checkers showed similar attention biases in all paradigms. Results indicate that there is an attention bias in obsessive-compulsive checkers that is independent from the type of attention.

Social Anxiety Disorder: Recent Developments in Psychological Approaches to Conceptualization and Treatment

The aim of the present study was to identify and synthesize recent research findings in the aetiology and psychological treatment of social anxiety disorder and consider how these might improve outcome through more effective intervention. The electronic databases Medline, EMBASE and PsychInfo were searched for January 2000–December 2008. Publications of interest referred to in relevant articles were also reviewed. Case reports and publications not in English were excluded. The greatest variance in social anxiety disorder is accounted for by temperamental and personality factors and these may be associated with significant heritability. The environmental contribution is smaller and mainly due to non-shared factors, with a small contribution from shared environmental factors. Epidemiological research confirms that social anxiety disorder is chronic, and among the anxiety disorders has the lowest rates of treatment seeking, receipt of evidence-based treatments and recovery. Effective psychological treatments have been available for some time, and the research emphasis is on increasing the efficacy of treatments through innovations in programme content and delivery. Cognitive science research has contributed a better understanding of cognitive factors that maintain social anxiety disorder and informed enhancement of the cognitive elements of therapy. Internet-based programmes show promise as a novel way to deliver and improve access to effective therapy. Genetic, personality and temperamental factors contribute to the risk for social anxiety disorder. Given the associated comorbidity and disability, energy needs to be directed towards early recognition and treatment, and to increasing engagement and retention in effective therapy. Ongoing professional education is required to ensure that the disorder is recognized and evidence-based treatments received by patients who do seek help. Current cognitive behavioural treatments are being enhanced as the results of cognitive science research are being applied, and novel forms of treatment delivery show promise in increasing access.

Interpretation bias and social anxiety in adolescents

Interpretation bias, described as the tendency to interpret social situations in a negative or threatening manner, has been widely linked to social anxiety in adult populations. This study aimed to extend research on interpretation bias to an adolescent population. Thirty-seven high socially anxious and a control group of 36 non-socially anxious adolescents rated the likelihood of different interpretations of ambiguous social and non-social situations coming to mind and which interpretation they most believed. Results showed that negative interpretations of social situations were more common in the high anxious than control group. Such negative bias could not be accounted for by high levels of negative affect. The groups did not differ as to their positive interpretations. Furthermore, there was evidence for content specificity of interpretation bias; high anxious adolescents were not more negative than control participants in their interpretations of non-social situations. Findings are discussed in relation to the adult literature and their clinical relevance is considered.

Examining the dynamics of the implicit and the explicit self-concept in social anxiety: changes in the Implicit Association Test-Anxiety and the Social Phobia Anxiety Inventory following treatment

In this study, we analyzed changes in the strength of self-anxiety associations--as measured by the Implicit Association Test-Anxiety (IAT-Anxiety; Egloff & Schmukle, 2002) and the Social Phobia Anxiety Inventory (SPAI; Turner, Beidel, Dancu, & Stanley, 1989)--following treatment of social anxiety. We assessed socially anxious participants (N = 24) prior to and following a group-based treatment; and we assessed healthy controls (N = 24) at matched time points. Results showed (a) higher implicit and explicit anxiety in socially anxious participants (as compared to controls) prior to treatment and (b) reductions in IAT-Anxiety and SPAI scores of socially anxious participants following treatment. We discuss implications of these results for clinical applications of the IAT.

Effects of alcohol on ratings of emotional facial expressions in social phobics

Social phobics have an increased risk of alcoholism. The mechanism behind this co-morbidity is not well understood. According to the appraisal-disruption model [Sayette, M. A. (1993). An appraisal-disruption model of alcohol's effects on stress responses in social drinkers. Psychological Bulletin, 114, 459-476], alcohol disrupts appraisal of threat stimuli unless the stimuli are easy to process. We investigated whether alcohol alters the judgment of emotional facial expressions in social phobics and controls. We also tested the judgment of emotionally ambiguous faces which should be more difficult to process. Forty social phobics and controls rated faces depicting five emotional expressions on an animosity rating scale. For two ambiguous facial expressions, angry, respectively, happy faces were blended with neutral faces. Half of the participants consumed alcohol. Socially phobic participants rated neutral and happy facial expressions as less friendly than controls, irrespective of alcohol consumption. In both groups, consuming alcohol reduced the perceived rejection of angry faces. In line with current theories of social phobia, patients interpreted neutral facial expressions as more rejecting than controls. The rejection perceived in explicitly angry facial expressions was less after drinking alcohol. This reduction of the adversity of socially threatening stimuli by alcohol might act as negative reinforcement and thus contributes to alcohol problems.

Social anxiety and evaluation of social crowds: explicit and implicit measures

To investigate whether social anxiety disorder is indeed characterized by a biased negative evaluation of facial expressions, 25 highly socially anxious (SA) participants and 30 non-anxious controls (NACs) were asked to respond to different ratios of neutral-angry or happy-angry face combinations (crowds). In an indirect Approach-Avoidance Task (AAT), participants used a joystick to pull the crowds towards themselves (approach) or push them away (avoidance). SAs showed faster avoidance of neutral-angry crowds when the number of angry faces in the crowd increased. The happy-angry crowds were generally avoided, independent of the ratio of the two emotions. NACs did not show any specific response tendency. When directly rating the friendliness of the crowds, the two groups did not differ.

Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.

Electrophysiological correlates of spatial orienting towards angry faces: a source localization study

The goal of this study was to examine behavioral and electrophysiological correlates of involuntary orienting toward rapidly presented angry faces in non-anxious, healthy adults using a dot-probe task in conjunction with high-density event-related potentials and a distributed source localization technique. Consistent with previous studies, participants showed hypervigilance toward angry faces, as indexed by facilitated response time for validly cued probes following angry faces and an enhanced P1 component. An opposite pattern was found for happy faces suggesting that attention was directed toward the relatively more threatening stimuli within the visual field (neutral faces). Source localization of the P1 effect for angry faces indicated increased activity within the anterior cingulate cortex, possibly reflecting conflict experienced during invalidly cued trials. No modulation of the early C1 component was found for affect or spatial attention. Furthermore, the face-sensitive N170 was not modulated by emotional expression. Results suggest that the earliest modulation of spatial attention by face stimuli is manifested in the P1 component, and provide insights about mechanisms underlying attentional orienting toward cues of threat and social disapproval.

Recognition and evaluation of emotional prosody in individuals with generalized social phobia: A pilot study

Studies using facial emotional expressions as stimuli partially support the assumption of biased processing of social signals in social phobia. This pilot study explored for the first time whether individuals with social phobia display a processing bias towards emotional prosody. Fifteen individuals with generalized social phobia and fifteen healthy controls (HC) matched for gender, age, and education completed a recognition test consisting of meaningless utterances spoken in a neutral, angry, sad, fearful, disgusted or happy tone of voice. Participants also evaluated the stimuli with regard to valence and arousal. While these ratings did not differ significantly between groups, analysis of the recognition test revealed enhanced identification of sad and fearful voices and decreased identification of happy voices in individuals with social phobia compared with HC. The two groups did not differ in their processing of neutral, disgust, and anger prosody.

Acceptance and mindfulness-based therapy: new wave or old hat?

Some contemporary theorists and clinicians champion acceptance and mindfulness-based interventions, such as Acceptance and Commitment Therapy (ACT), over cognitive-behavioral therapy (CBT) for the treatment of emotional disorders. The objective of this article is to juxtapose these two treatment approaches, synthesize, and clarify the differences between them. The two treatment modalities can be placed within a larger context of the emotion regulation literature. Accordingly, emotions can be regulated either by manipulating the evaluation of the external or internal emotion cues (antecedent-focused emotion regulation) or by manipulating the emotional responses (response-focused emotion regulation). CBT and ACT both encourage adaptive emotion regulation strategies but target different stages of the generative emotion process: CBT promotes adaptive antecedent-focused emotion regulation strategies, whereas acceptance strategies of ACT counteract maladaptive response-focused emotion regulation strategies, such as suppression. Although there are fundamental differences in the philosophical foundation, ACT techniques are fully compatible with CBT and may lead to improved interventions for some disorders. Areas of future treatment research are discussed.

Neuropsychological effects of stress on social phobia with and without comorbid depression

BACKGROUND

The influence of stress on neuropsychological functioning was assessed in socially phobic (SP), comorbid socially phobic/major depression (CM), and asymptomatic control subjects (AC) under baseline and stressor conditions.

METHODS

Subjects were 33 clinically diagnosed undergraduates aged 18 to 41 years. Neuropsychological measures included the Trail Making Test, Wisconsin Card Sorting Test (WCST), Spatial Span, and Digit Span administered during a baseline condition and a psychosocial stress condition (videotaping).

RESULTS

Spatial Span scores were reduced for SP during stress, improved for AC, and showed no change for CM. TMT B times showed an interaction effect, with completion time improving significantly less for SP than for AC and CM during stress. Analyses of the normative data for WCST total errors indicated that AC and CM improved significantly during stress, while SP performance declined during stress.

CONCLUSIONS

The present findings suggest that comorbid depressed versus non-depressed SP subjects respond uniquely to stress in terms of their neuropsychological functioning and self-reported mood and experiences; generalized social phobia may be associated with spatial working memory disturbance during social stress. Therefore, situations involving potential social and personal evaluation (e.g., examinations or presentations) may have a significant impact on the neuropsychological functioning of SP individuals.

Social anxiety and fear of negative evaluation: construct validity of the BFNE-II

The Brief Fear of Negative Evaluation Scale [BFNE; Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375] is a self-report measure designed to assess fear of negative evaluation, a characteristic feature of social anxiety disorders [Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756]. Recent psychometric assessments have suggested that a 2-factor model is most appropriate, with the first factor comprising the straightforwardly worded items and the second factor comprising the reverse-worded items [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]. Some researchers recommend the reverse-worded items be removed from scoring [e.g., Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]; however [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the fear of negative evaluation scale. Journal of Anxiety Disorders, 19, 345-359] recommend that these items be reworded to maintain scale sensitivity. The present study examined the reliability and validity of the BFNE-II, a version of the BFNE evaluating revisions of the reverse-worded items in a community sample. A unitary model of the BFNE-II resulted in excellent confirmatory factor analysis fit indices. Moderate convergent and discriminant validity were found when BFNE-II items were correlated with additional independent measures of social anxiety [i.e., Social Interaction Anxiety & Social Phobia Scales; Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], and fear [i.e., Anxiety Sensitivity Index; Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss, R. R. Bootzin (Eds.), Theoretical issues in behaviour therapy (pp. 107--121). New York: Academic Press. and the Illness/Injury Sensitivity Index; Carleton, R. N., Park, I., & Asmundson, G. J. G. (in press-b). The Illness/Injury Sensitivity Index: an examination of construct validity. Depression & Anxiety). These findings support the utility of the revised items and the validity of the BFNE-II as a measure of the fear of negative evaluation. Implications and future research directions are discussed.

Anxiety sensitivity and its dimensions across the anxiety disorders

Anxiety sensitivity (AS) refers to the fear of anxiety-related sensations, which is thought to arise from beliefs about their harmful consequences. AS is a multidimensional construct that consists of fears of somatic, social, and cognitive aspects of anxiety. In the present study, we examined the relationship between AS dimensions, assessed by factor-analytically derived subscales of the Anxiety Sensitivity Index-Revised (ASI-R), and anxiety-related psychopathology in a sample of 232 treatment-seeking patients with anxiety disorders. Correlational analyses and comparisons among anxiety disorder patient groups and undergraduate students revealed a specific pattern of relationships between ASI-R subscale scores and anxiety-related psychopathology. In contrast, ASI-R total scores evidenced less discriminant validity. Implications for theoretical models of anxiety and directions for future research are discussed.

Phenomenal characteristics of autobiographical memories for social and non-social events in social phobia

Previous studies failed to show clear differences between people with social phobia and non-anxious individuals regarding the specificity and affective intensity of their autobiographical memories for social events. However, these studies did not assess the subjective experience associated with remembering. In this study, people with social phobia and non-anxious control participants recalled social and non-social events, and rated the phenomenal characteristics of their memories. The memories of people with social phobia for social events contained fewer sensorial details but more self-referential information than controls' memories. In addition, people with social phobia remembered social situations from an observer perspective, viewing themselves as if from outside, to a greater extent than controls. By contrast, the two groups did not differ concerning their memories for non-social events. These findings are discussed in relation to cognitive models of social phobia.

When ambiguity hurts: social standards moderate self-appraisals in generalized social phobia

Thirty-nine individuals with generalized social phobia (social anxiety disorder) and 39 nonclinical controls performed a public speech after receiving cues about social standards. Using a novel video manipulation paradigm, one third of participants received cues indicating that standards for performance were high, one third received cues that standards were low, and the remaining third were given no explicit information about expected standards (i.e., standards were ambiguous). Individuals with social phobia performed objectively worse than controls in all conditions, but rated their performance as being worse only in the high and ambiguous standards conditions. These results suggest that in social phobia, negative self-perception is context-dependent. Implications for the cognitive model and treatment are discussed.

Fear-relevant selective associations and social anxiety: absence of a positive bias

An illusory correlation paradigm was used to compare high and low socially anxious individuals' initial, on-line and a posteriori covariation estimates between emotional faces and aversive, pleasant and neutral outcomes. Overall, participants demonstrated an initial expectancy bias for aversive outcomes following angry faces, and pleasant outcomes following happy faces. On-line expectancy biases indicated that initial biases were extinguished during the task, with the exception of low socially anxious individuals who continued to over-associate positive social cues with pleasant outcomes. In addition to lacking this protective positive on-line bias, the high social anxiety group reported retrospectively more negative social cues than the low socially anxious group. Findings are discussed in relation to similar evidence from recent interpretive and memory paradigms.

Cognitive bias via the Internet: a comparison of Web-based and standard emotional Stroop tasks in social phobia

There is accumulating evidence to suggest that social phobia is associated with attentional bias for words related to social threat. Information processing in individuals with social phobia (n = 87) was investigated in the present study using 2 versions of the emotional Stroop task. Results from a standard emotional Stroop task indicated delayed colour naming of socially threatening words relative to neutral words, in line with previous research, whereas results from a Web-based emotional Stroop task indicated a facilitation effect, with faster manual indication of colour choice for socially threatening words than for neutral words. Possible explanations for these contrasting findings and issues for further research are discussed.