Social Anxiety and the Quality of Everyday Social Interactions: The Moderating Influence of Alcohol Consumption

Long-term effects of alcohol consumption on anxiety in adults: A systematic review

OBJECTIVE

Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults.

METHODS

EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool.

RESULTS

From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied.

CONCLUSIONS

A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Perceived psychological control relates to coping-related drinking motives via social anxiety among adolescents: A cross-sectional mediation analysis

Accumulating evidence suggests that particular parenting behaviors (e.g., elevated psychological control) may increase risk for both problematic social anxiety and alcohol use among youth; however, no work has yet examined these factors together in a single model. Building developmentally sensitive models of problematic alcohol use trajectories is key to developing effective prevention and intervention strategies. The present study includes 94 adolescents (ages 14-17 years; 53.3% girls; 89.2% White) entering a treatment facility for a variety of internalizing and externalizing forms of psychological distress. Levels of perceived parental psychological control, social anxiety, and coping-related drinking motives were assessed. Higher levels of perceived psychological control were associated with a greater endorsement of coping-related drinking motives; however, a significant proportion of that association was accounted for by elevated social anxiety symptoms. These data extend the existing literature and lay groundwork for more sophisticated experimental and longitudinal designs to corroborate the findings. Moreover, personality-targeted drinking interventions for adolescents may benefit from identifying elevated perceived psychological control as a developmentally relevant risk factor for social anxiety and problematic drinking motives and administering relevant interventions (e.g., personality-targeted coping skills training, parent-involved care) before drinking patterns are established.

The effects of everyday-life social interactions on anxiety-related autonomic responses differ between men and women

Social buffering, a phenomenon where social presence can reduce anxiety and fear-related autonomic responses, has been studied in numerous laboratory settings. The results suggest that the familiarity of the interaction partner influences social buffering while also providing some evidence for gender effects. In the laboratory, however, it is difficult to mimic the complexity of real-life social interactions. Consequently, the social modulation of anxiety and related autonomic responses in everyday life remains poorly understood. We used smartphone-based Ecological Momentary Assessment (EMA) combined with wearable electrocardiogram sensors to investigate how everyday-life social interactions affect state anxiety and related cardiac changes in women and men. On five consecutive days, 96 healthy young participants (53% women) answered up to six EMA surveys per day, indicating characteristics of their most recent social interaction and the respective interaction partner(s). In women, our results showed lower heart rate in the presence of a male interaction partner. Men showed the same effect with female interaction partners. Moreover, only women showed decreased heart rate and increased heart rate variability with increasing interaction partner familiarity. These findings specify the conditions under which social interactions reduce anxiety-related responses in women and men.

Drunkenness and Regretted Online Social Risk Behaviors: The Role of Social Drinking Motives and Positive Urgency

Background: Alcohol use and the use of social media and other forms of digital communications is characteristic of young adults. The present study prospectively examined the relationship between social drinking motives and positive urgency and the engagement in regretted online social risk behaviors while drunk (having posted on social media, called or texted someone, or been visibly drunk in a photo) among a community sample of young adults. Methods: Using a targeted sampling procedure, we accessed a baseline sample of 360 young adults aged 18-25 years old from the community. Of these, 339 (mean age: 21.1 [SD = 2.21]; female = 50.7%) completed 2-month follow-up measures. Results: Social drinking motives and the tendency to act impulsively under conditions of positive affect (i.e. positive urgency) were measured at baseline, and frequency of regretted online social risk behaviors were measured at follow-up. Results showed that baseline social drinking motives were positively associated with all three regretted online social risk behaviors examined at follow-up. Higher baseline positive urgency scores were associated with a higher frequency of regretted posting on social media and calling or texting someone while drunk at follow-up. Conclusions: Our findings support the inclusion of positive urgency and social drinking motives as key components of preventive interventions aimed at reducing potential negative consequences of using social media and other forms of digital communications while under the effects of alcohol.

Social anxiety and alcohol consumption: The role of social context

Research has identified social anxiety as a risk factor for the development of alcohol use disorder. However, studies have produced equivocal findings regarding the relationship between social anxiety and drinking behaviors in authentic drinking environments. This study examined how social-contextual features of real-world drinking contexts might influence the relationship between social anxiety and alcohol consumption in everyday settings. At an initial laboratory visit, heavy social drinkers (N = 48) completed the Liebowitz Social Anxiety Scale. Participants were then outfitted with a transdermal alcohol monitor individually-calibrated for each participant via laboratory alcohol-administration. Over the next seven days, participants wore this transdermal alcohol monitor and responded to random survey prompts (6x/day), during which they provided photographs of their surroundings. Participants then reported on their levels of social familiarity with individuals visible in photographs. Multilevel models indicated a significant interaction between social anxiety and social familiarity in predicting drinking, b = -0.004, p =.003 Specifically, among participants higher in social anxiety, drinking increased as social familiarity decreased b = -0.152, p <.001, whereas among those lower in social anxiety, this relationship was non-significant, b = 0.007, p =.867. Considered alongside prior research, findings suggest that the presence of strangers within a given environment may play a role in the drinking behavior of socially anxious individuals.

Robert Provine: the critical human importance of laughter, connections and contagion

Robert Provine made several critically important contributions to science, and in this paper, we will elaborate some of his research into laughter and behavioural contagion. To do this, we will employ Provine's observational methods and use a recorded example of naturalistic laughter to frame our discussion of Provine's work. The laughter is from a cricket commentary broadcast by the British Broadcasting Corporation in 1991, in which Jonathan Agnew and Brian Johnston attempted to summarize that day's play, at one point becoming overwhelmed by laughter. We will use this laughter to demonstrate some of Provine's key points about laughter and contagious behaviour, and we will finish with some observations about the importance and implications of the differences between humans and other mammals in their use of contagious laughter.

This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.

Alcohol's effects during uncertain and uncontrollable stressors in the laboratory

Alcohol's effects on reactivity to stressors depends on the nature of the stressor and the reactivity being assessed. Research identifying characteristics of stressors that modulate reactivity and clarifies the neurobehavioral, cognitive, and affective components of this reactivity may help prevent, reduce or treat the negative impacts of acute and chronic alcohol use with implications for other psychopathology involving maladaptive reactivity to stressors. We used a novel, multi-measure, cued electric shock stressor paradigm in a greater university community sample of adult recreational drinkers to test how alcohol (N=64), compared to No-alcohol (N=64), effects reactivity to stressors that vary in both their perceived certainty and controllability. Preregistered analyses suggested alcohol significantly dampened subjective anxiety (self-report) and defensive reactivity (startle potentiation) more during uncertain than during certain stressors regardless of controllability, suggesting that stressor uncertainty -but not uncontrollability- may be sufficient to enhance alcohol's stress reactivity dampening and thus negative reinforcement potential.

Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study

People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences-namely positive social experiences-that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.

Are people with social anxiety disorder happier alone?

Quality contact with other people serves as a reliable mood enhancement strategy. We wondered if the emotional benefits of socializing are present even for those with a psychological disorder defined by social distress and avoidance: social anxiety disorder (SAD). We conducted two ecological momentary assessment (EMA) studies and analyzed 7243 total surveys. In both studies, community adults diagnosed with SAD and healthy controls received five surveys each day for 2 weeks. Consistent with research on positivity deficits in SAD, between-person analyses in both studies suggest that, on average, participants with SAD reported lower positive and higher negative affect in social and non-social situations than healthy controls. Within-person analyses, however, revealed that in both studies participants with SAD and healthy controls reported higher positive affect when with others than when alone; no differences were found for negative affect for those with SAD. The difference in positive affect between social and nonsocial situations was smaller for participants with SAD in Study 1, suggesting that people with SAD may experience diminished reward responding when socializing. Our results suggest that even those with a mental illness defined by interpersonal distress can and do derive positive emotions from social interactions.

Associations between simultaneous alcohol and cannabis use and next-day negative affect among young adults: The role of sex and trait anxiety

BACKGROUND AND AIMS

The simultaneous use of alcohol and cannabis ("simultaneous alcohol and marijuana [SAM] use") is common among young adults and associated with negative substance-related consequences. SAM use may be tied to fluctuating mood states such as negative affect and individual characteristics including trait level of anxiety and sex. However, little is understood about their collective role. In this study, we sought to understand the daily link between SAM use and negative affect and whether this link might differ by both trait anxiety and sex.

METHOD

Participants were 154 young adults (57.8% female, 72.7% White, M age = 20.2) who completed baseline surveys on trait anxiety symptoms and up to 14 consecutive daily surveys on their substance use and affective states.

RESULTS

Multilevel models tested for associations of type of substance use day (i.e., alcohol-only days, cannabis-only days, and no use days relative to SAM use days) with next-day negative affect. Three-way and lower order interactions were tested for substance use day type, anxiety, and sex. Two three-way interactions between cannabis-only days, anxiety, and sex and between alcohol-only days, anxiety, and sex emerged such that SAM use was associated with greater next-day negative affect relative to single substance use days particularly among female participants with elevated anxiety.

CONCLUSIONS

Anxiety and sex are salient factors in the link between SAM use relative to single-substance use and daily negative affect. Study findings reinforce the need to account for all of these factors in order to develop maximally efficacious substance use interventions.

Perceptions towards an interaction partner predict social anxiety: an ecological momentary assessment study

Social anxiety occurs in everyday social interactions, yet the real-world factors that shape the moment-to-moment experience of social anxiety have not been fully explored. Using ecological momentary assessments (smartphone-based, five signals a day for 21 days), the present study examined the associations between state social anxiety (SSA) and characteristics of interaction partners in varied contexts, and how these momentary associations differed with trait social anxiety (TSA). Ninety-two participants (54% female, age from 18 to 34) completed 4185 momentary reports. Results from multilevel models showed that perceived judgmentalness and unfamiliarity of interaction partners were positively associated with SSA, and the associations were stronger for the high TSA group (n = 30) compared to a control group (n = 62). Exploratory analyses with various types of interaction partners and social settings revealed noticeable group differences in how the types were associated with SSA (e.g. acquaintance, close friend/romantic partner) and how they influenced the effect of judgmentalness and unfamiliarity on SSA (e.g. authority, work/school). Overall, the findings highlight the role of contextual associations in social anxiety, and the benefits and the need for more comprehensive approaches with EMA in studying social anxiety, particularly its contextual aspects.

Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.

Concomitant taurine exposure counteracts ethanol-induced changes in locomotor and anxiety-like responses in zebrafish

Taurine (TAU) is a β-amino sulfonic acid with pleiotropic roles in the brain, including the neuromodulatory activity via GABAergic and glycinergic agonism. This molecule is found at high concentrations in energy drinks and is often mixed with alcohol in beverages. Although TAU has a neuroprotective role in the brain, the putative risks of mixing TAU and EtOH are not fully understood. Here, we investigated whether TAU modulates locomotor and anxiety-like behavior in adult zebrafish by using the novel tank and light-dark tests following acute EtOH exposure at anxiogenic and anxiolytic concentrations. Zebrafish were individually exposed to water (control), TAU (42, 150, and 400 mg/L), and EtOH (0.25% (v/v) and 1% (v/v)) both independently and cotreated for 1 h. EtOH 0.25% and TAU produced U-shape anxiolytic-like behavior in the light-dark test, TAU 42 and 400 positively modulated EtOH effects, and TAU 150 exerted a protective effect. All TAU concentrations counteracted EtOH 1%-induced locomotion impairment, as well as the anxiogenic-like behavior. Finally, all TAU concentrations when given independently or cotreated with EtOH 0.25% and 1% decreased the risk assessment of the lit compartment. Principal component analyses revealed that exploration and anxiety-like responses were the main behaviors that contribute to the effects of TAU and EtOH. Overall, we demonstrate that TAU differently modulates EtOH-induced anxiolytic- and anxiogenic-like behaviors depending on the concentration, suggesting a complex mechanism underlying TAU and EtOH interactions.

Acute alcohol exposure dose-dependently alleviates social avoidance in adolescent mice and inhibits social investigation in adult mice

BACKGROUND

Motivations for alcohol consumption often focus on ethanol's purported prosocial effects: social enhancement and reduction of socially focused anxiety. Despite substantial research supporting prosocial effects, contrary research exists demonstrating alcohol-elicited antisocial and asocial behaviours. Additionally, evidence typically fails to delineate whether alcohol-induced prosocial effects are due to alcohol expectancies or pharmacological actions of ethanol. Studies exploring ethanol's pharmacological effects on social behaviour and factors that modulate apparent contradictory prosocial versus asocial effects are lacking.

OBJECTIVES

This study investigated whether factors of age, ethanol dose and social fear modulate ethanol-induced pharmacological effects on sociability and social anxiety-like avoidance.

METHODS

Experiments examined the acute effects of ethanol doses (0, 0.25, 0.8, 1.6 g/kg; i.p.) in adult (10-week-old) and adolescent (PND 31-33) C57BL/6J male mice on social interaction using a social fear conditioning paradigm. Control experiments assessed whether ethanol-induced effects were social-specific.

RESULTS

In adult mice, no specific effects of ethanol on social avoidance were observed at any dose. However, high-dose ethanol (1.6 g/kg) suppressed social approach in all adult mice. In contrast, low-dose ethanol (0.25 g/kg) alleviated social avoidance in adolescent mice and no social suppression was observed at higher ethanol doses. Thus, higher doses of ethanol impair social behaviour in adult mice, whereas lower doses specifically alleviate social anxiety-like avoidance in adolescent mice.

CONCLUSIONS

Age, dose and social fear are critical modulators of acute ethanol-induced pharmacological effects on social behaviour. Inconsistencies in ethanol-induced social consequences appear at least partly mediated by pharmacological interactions-not solely alcohol expectancies.

Moderate alcohol consumption and depression - a longitudinal population-based study in Sweden

BACKGROUND AND AIMS

The interrelationship between alcohol consumption and depression is complex, and the direction of the association is unclear. We investigated whether alcohol consumption influences the risk of depression while accounting for this potential bidirectionality.

METHODS

A total of 10 441 individuals participated in the PART study in 1998-2000, 8622 in 2001-2003, and 5228 in 2010. Participants answered questions on their alcohol consumption, symptoms of depression, childhood adversity, and sociodemographic, socioeconomic, psychosocial, and lifestyle factors. A total of 5087 participants provided repeated information on alcohol consumption. We used marginal structural models to analyze the association between alcohol consumption and depression while controlling for previous alcohol consumption and depressive symptoms and other time-varying confounders.

RESULTS

Non-drinkers had a higher depression risk than light drinkers (≤7 drinks/week) (risk ratio: 1.7; 95% confidence interval 1.3-2.1). Consumers of seven-fourteen drinks/week had a depression risk similar to that of light drinkers. Hazardous drinking was associated with a higher risk of depression than non-hazardous alcohol consumption (risk ratio: 1.8, 95% confidence interval: 1.4-2.4).

CONCLUSION

Light and moderate alcohol consumption and non-hazardous drinking were associated with the lowest risk of subsequent depression after accounting for potential bidirectional effects. Hazardous drinking increased the risk of depression.

Verbal Abuse Related to Self-Esteem Damage and Unjust Blame Harms Mental Health and Social Interaction in College Population

Verbal abuse is an emotional abuse intended to inflict intense humiliation-denigration-fear as perceived by exposed person. Network-based approaches have been applied to explore the integrative-segregated patterns of associations among the psychological features and external stimuli for diverse populations; few studies reported for verbal abuse effects in college population. Self-reporting measurements acquired form 5,616 college students were used for network analyses. Escalating cascades of verbal abuse from differential sources (parents, peers, or supervisors; network 1) and directed associations among verbal abuse severity-psychopathology-social interaction (network 2) were estimated using the directed acyclic graphs. Principal connectors of verbal abuse–psychopathology–social interaction were shown using the graph theory metrics calculated from the intra-individual covariance networks (network 3). Directed propagating patterns of verbal abuse phenomena differed by source (network 1). Severe peer-related verbal abuse affected psychomotor changes and influenced irritability (network 2). Verbal abuse of self-esteem damage and unjust blame served as connectors in the verbal abuse-psychopathology-social interaction; influence of smartphone overuse-related distress was stronger in cases with more severe verbal abuse (network 3). Verbal abuse that damages self-esteem and conveys unjust blame harms mental health and social interaction for college population.

Tick-tock goes the croc: a high-density EEG study of risk-reactivity and binge-drinking

Links between individual differences in risk processing and high-risk behaviors such as binge-drinking have long been the focus of active research. However, investigations in this area almost exclusively utilize decision-making focused paradigms. This emphasis makes it difficult to assess links between risk behaviors and raw risk reactivity independent of decision and feedback processes. A deeper understanding of this association has the potential to shed light on the role of risk reactivity in high-risk behavior susceptibility. To contribute toward this aim, this study utilizes a popular risk-taking game, the crocodile dentist, to assess links between individual differences in decision-free risk-reactivity and reported binge-drinking frequency levels. In this task, participants engage in a series of decision-free escalating risk responses. Risk-reactivity was assessed by measuring late positive potential responses toward risk-taking action initiation cues using high-density 256-Channel EEG. The results indicate that, after controlling for overall alcohol consumption frequency, higher rates of reported binge-drinking are associated with both increased general risk-taking responsivity and increased risk-reactivity escalation as a function of risk level. These findings highlight intriguing links between risk reactivity and binge-drinking frequency, making key contributions in the areas of risk-taking and affective science.