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

Exploring the construct validity of the Camouflaging Autistic Traits Questionnaire: A factor analytic study

'Camouflaging' is a set of strategies used by autistic people to hide or compensate for their autistic characteristics to fit into predominantly non-autistic social environments. Many researchers have used the Camouflaging Autistic Traits Questionnaire (CAT-Q) to measure camouflaging. However, there have been questions about the construct validity of the CAT-Q as a measurement of camouflaging. The present study examined the extent to which CAT-Q items were distinguishable from other theoretically and empirically related measures of social anxiety, fear of negative evaluation and autistic social traits. Autistic adults (N = 308) completed the CAT-Q and social anxiety, fear of negative evaluation and autistic social traits measures. The small-to-large positive associations between camouflaging and social anxiety, fear of negative evaluation and autistic social traits (r = 0.14-0.65) were not indicative of collinearity. Three exploratory factor analyses, in which CAT-Q items were factor-analysed together with social anxiety, fear of negative evaluation and autistic social traits items respectively, showed that CAT-Q items generally loaded onto different factors from social anxiety, fear of negative evaluation and autistic social traits items, with the exception of the CAT-Q Assimilation subscale items, which cross-loaded mostly with autistic social traits items. Overall, the CAT-Q items were positively associated with, but also differentiated from, most social anxiety, fear of negative evaluation and autistic social traits items, providing support for the measure's construct validity.Lay abstractAutistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.

The relationship between fear of negative evaluation, physical activity, eating behavior and psychological distress among nursing students

BACKGROUND

The aim of this research is to explore the interrelationships between different psychological issues and the potential role of eating behavior and physical activity among nursing students.

METHODS

Undergraduate nursing students (n = 892) from some medical universities in China were recruited through convenience and snowball sampling methods using online platforms. Participants completed measures on demographics, fear of negative evaluation (FNE), social avoidance and distress (SAD), psychological distress (DASS), disordered eating behavior (TFEQ) and physical activity. The relationship models among the aforementioned variables were established using Process 3.5.

RESULTS

A total of 290 males and 602 females were included in this study. The average FNE score of students was (39.44 ± 8.78), SAD was (13.83 ± 7.06), DASS was (22.45 ± 20.47), and TFEQ was (56.09 ± 12.57), respectively. TFEQ and SAD independently and jointly acted as mediators in the relationship between FNE and DASS. Physical activity played a moderating role, with the interaction effect between FNE and groups Q2, Q3, and Q4 determined to be 0.407 (95%CI 0.136 to 0.678), 0.328 (95%CI 0.061 to 0.596) and 0.332 (95%CI 0.073 to 0.591), respectively.

CONCLUSIONS

This study supports that disordered eating behaviors have a negative impact on mechanisms of psychological changes, and enhancing physical activity is an effective prevention strategy for psychological distress and disordered eating behaviors among nursing students.

Examining an integrated path model of psychological and sociocultural predictors of camouflaging in autistic adults

LAY ABSTRACT

Many autistic people use strategies known as 'camouflaging' to change how noticeable their autistic traits are in social situations. Previous research suggests that camouflaging is largely motivated by psychological and social factors. However, most studies so far have only looked at a few psychosocial factors related to camouflaging. In this study, we explored a model that included several individual psychological factors (such as fear of being negatively judged, self-esteem and autistic identity) and broader social and cultural factors (such as perceived stigma, negative life events, cultural emphasis on conformity and desire to fit in or stand out). We surveyed 225 autistic adults aged 18-77 years online. Our findings showed that several sociocultural factors were indirectly linked to camouflaging through individual psychological factors. Fear of being negatively judged emerged as a strong predictor of camouflaging. Specifically, autistic adults who perceived greater stigma, felt greater pressure to conform, had a lesser desire to stand out and a greater desire to fit in tended to experience a greater fear of being negatively judged and reported more camouflaging. In addition, those who experienced more negative life events were more likely to engage in camouflaging. Our study identifies key psychological and social factors as potential targets for social change. Our findings emphasise that our societies need to shift away from stigmatising attitudes towards accepting and including autistic people, which could reduce the pressure on autistic individuals to camouflage in social situations.

Paranoia and Social Anxiety: Predicting Aggressive Behavior

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety.

Unmet expectations: social inclusion and the interaction between social anxiety and ambiguous or positive feedback

Introduction

This study explores the impact of preferential inclusion on fulfilling basic needs following ambiguous or positive social feedback, considering the moderating effect of social anxiety.

Methods

Participants (N = 438) received either positive or ambiguous social feedback and engaged in a social participation or preferential social inclusion task. They completed measures of the fulfillment of their fundamental needs, social anxiety, and other personality traits.

Results

The results indicate that preferential social inclusion (Uberball condition) enhances the fulfillment of fundamental needs compared to social participation (Cyberball inclusion condition). Furthermore, receiving positive social feedback considerably strengthens the negative relationship between social anxiety and fundamental need fulfillment when followed by ordinary social participation relative to preferential social inclusion presumably because these individuals react more strongly to unmet expectations of extreme social acceptance.

Discussion

This research suggests that individuals with high social anxiety may not experience the usual benefits of social participation unless they experience extreme social inclusion.

An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study

Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.

An Initial examination of fear of negative and positive evaluation in youth

Fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are both core features of social anxiety. The majority of research with these constructs has been done with older adolescents and adults, with only one previous study examining FNE and FPE in childhood. However, this previous work relied exclusively on parent-report of youth FNE and FPE. Here, we examined the factor structure of FNE and FPE using youth self-reports. Moreover, we examined the associations with dimensions of internalizing and externalizing problems. We found that two-factor structure of FNE and FPE was a marginal fit to the data. Exploratory models identified three items that showed significant cross-loadings on non-target factors. Overall, we found that FNE was associated with dimensions of internalizing problems reported by youth and their mothers. FPE was associated with internalizing problems reported by youth, but not parents. Associations between FNE and clinical outcomes were stronger than those for FPE. This study demonstrates promise of FNE and FPE in youth and highlights important directions for future research.

The role of personality traits in mediating the relation between fear of negative evaluation and social interaction anxiety

Introduction

Social interaction anxiety and fear of negative evaluation have many maladaptive outcomes and, in order to counteract their effects, it is essential to identify those psychological or social factors that make people vulnerable to them. One of these factors is the individual's personality structure: some personality traits increase the individuals' vulnerability to symptoms of social anxiety, while others protect them.

Methods

The aim of this paper is to analyse the role of HEXACO personality traits in mediating the relationship between fear of negative evaluation and social anxiety, in a sample of 352 cadets from the Land Forces Academy of Sibiu. The relationships between these concepts were analysed using structural equation modeling (SEM) in several hypothetical models, two of which were ultimately validated.

Results

In the first model, the fear of negative evaluation has an indirect effect on social interaction anxiety through the mediation of extraversion, conscientiousness, and altruism, separately. Furthermore, extraversion, conscientiousness, and altruism play a serial mediating role in the association between the fear of negative evaluation and social interaction anxiety. In the second model, the fear of negative evaluation has an indirect effect on social interaction anxiety through the mediation of social boldness, liveliness, and organization, separately, but not through altruism. Social boldness, liveliness, and organization played a serial mediating role in the relationship between the two constructs, while altruism moderated the relationship between liveliness, organization, and social interaction anxiety.

Discussion

Analysing the relationship between the individuals' personality traits, social anxiety, and fear of negative evaluation facilitated the identification of ways to cultivate desirable behaviours in social environments typified by compliance, discipline, uniformity, and rigor.

Forehead Flap Reconstruction in Different Nasal Defect: 58 Patients' Psychological Outcomes

Forehead flap nasal reconstruction is a lengthy process; the final outcome requires multiple stages and several months to achieve. After flap transfer, the pedicle flap has to be kept attached to the face for weeks, which may lead to a variety of psychosocial distress and challenges for patients. From April 2011 to December 2016, 58 patients who underwent forehead flap reconstruction for nasal reconstruction were included. The general satisfaction questionnaire, Derriford Appearance Scale 19, and Brief Fear of Negative Evaluation Scale, were utilized to assess the change in psychosocial functioning over 4 time points: preoperative (time 1), 1 week after forehead flap transfer (time 2), 1 week after forehead flap division (time 3), and final outcome after refinement procedures (time 4). The patients were also divided into 3 groups based on the severity of nasal defects: defects involving only a single subunit (n=19), subtotal nasal defects (n=25), and total nasal defects (n=13). Between- and within-group comparisons were conducted. The vast majority of patients had the highest levels of postoperative distress and social avoidance immediately after flap transfer; these levels decreased after flap division and refinement procedures. The psychosocial functioning was more strongly affected by the stage time point than by the severity of the original nasal defects. The forehead flap nasal reconstruction can not only help patients gain a relatively normal nose but also restore their self-esteem and social confidence. The lengthy process is beneficial and worthwhile, even though it involves short-term psychosocial distress.

Prosocial learning: Model-based or model-free?

Prosocial learning involves the acquisition of knowledge and skills necessary for making decisions that benefit others. We asked if, in the context of value-based decision-making, there is any difference between learning strategies for oneself vs. for others. We implemented a 2-step reinforcement learning paradigm in which participants learned, in separate blocks, to make decisions for themselves or for a present other confederate who evaluated their performance. We replicated the canonical features of the model-based and model-free reinforcement learning in our results. The behaviour of the majority of participants was best explained by a mixture of the model-based and model-free control, while most participants relied more heavily on MB control, and this strategy enhanced their learning success. Regarding our key self-other hypothesis, we did not find any significant difference between the behavioural performances nor in the model-based parameters of learning when comparing self and other conditions.

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

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

Putative risk and resiliency factors among Royal Canadian Mounted Police cadets

Objective

Mental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons.

Methods

Cadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations.

Results

Cadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex.

Conclusion

Cadets’ significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers’ comparatively higher prevalence of mental health disorders over time.

Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.

Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients

Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.

Examination of bidirectional relationships between fear of negative evaluation and weight/shape concerns over 3 years: A longitudinal cohort study of Australian adolescents

OBJECTIVE

Adolescents commonly experience both fear of negative evaluation and weight/shape concerns. However, evidence concerning the prospective associations between these constructs during adolescence is limited. The current study examined the bidirectional relationships between fear of negative evaluation and weight/shape concerns over a 3-year period in adolescents.

METHOD

Australian high school students (n = 2073; 55% girls) completed self-report measures at three timepoints, each 1 year apart.

RESULTS

Findings showed a bidirectional relationship, whereby increases in fear of negative evaluation predicted exacerbated weight/shape concerns, and vice versa. Results point towards a vicious maintenance cycle between fear of negative evaluation and weight/shape concerns.

DISCUSSION

Findings from the current study highlight the importance of considering both fear of negative evaluation and weight/shape concerns in the development of health promotion and prevention programs designed to reduce the occurrence and adverse effects of body dissatisfaction or improve general mental health.

PUBLIC SIGNIFICANCE

Many adolescents experience some level of fear of negative evaluation (i.e., worry about being judged by others) and worry about their weight and/or shape. This study examined the prospective relationship between both constructs. Findings showed a bidirectional relationship, whereby higher fear of negative evaluation predicted increased weight/shape concerns, and vice versa. Programs designed to reduce body dissatisfaction might be improved by targeting both fear of negative evaluation and weight/shape concerns.

A transdiagnostic evaluation of contrast avoidance across generalized anxiety disorder, major depressive disorder, and social anxiety disorder

BACKGROUND

The contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD).

METHODS

In a large college sample (N = 1409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD.

RESULTS

Participants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen's d = 1.32, 1.62 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD.

CONCLUSION

A measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these disorders.

Clarifying the association of social anxiety with cognitive variables: The role of self-esteem, self-perception, fears of positive and negative evaluation, and post-event processing

Theoretical models of social anxiety disorder (SAD) have identified several cognitive factors (fear of negative evaluation [FNE], self-perception, self-esteem, and post-event processing [PEP]) that play a role in the maintenance of the disorder. The current study aimed at testing both the cognitive factors addressed in these different models and the fear of positive evaluation (FPE) in the same construct. A non-clinical emerging adulthood sample (N = 325) were subjected to structural equation modeling (SEM). The results of the SEM showed that FPE, FNE, and self-concepts (self-esteem and self-perception) were significantly associated with social anxiety. Effect sizes indicated that the variables that most affected social anxiety were FPE, self-perception, FNE, and self-esteem, respectively. However, although it was significant in the conceptual model, the direct effect of social anxiety on PEP was not significant in the full model. On the other hand, the present findings add further support to the roles of negative self-perception and low self-esteem in social anxiety. Moreover, FPE may not be just delayed/postponed FNE. Considering the effect size of FPE on social anxiety, targeting it when appropriate in treatment may reduce the severity of social anxiety.

Interpersonally-Based Fears and Problematic Social Networking Site Use: The Moderating Role of Online Social Support

Within the Compensatory Internet Use Theory (CIUT) framework, online activities may compensate for psychosocial problems. However, those who attempt to satisfy their needs or mitigate their fears via Social Networking Sites (SNSs) may be at heightened risk for problematic use of SNSs (PSNSU), especially in cases when these fears have an interpersonal basis, and the individual effectively finds online social support. The current study hypothesizes that interpersonally-based fears (i.e., fear of no mattering, fear of intimacy, and fear of negative evaluation) predict PSNSU, and online social support moderates these associations. Four hundred and fifty Italian participants (Mage = 27.42 ± 7.54; F = 73.5%) take part in the study. As examined by path analysis, the three interpersonal fears were positively associated with PSNSU, and online social support significantly moderates the relationship between fear of negative evaluation and PSNSU. The model accounted for 19% of the variance of PSNSU and showed good fit indices. The associations' strengths decrease as age increases. Overall, the current study finds further support for the theory that motivations need to be taken into account when it comes to internet uses (i.e., CIUT) and extends our understanding by highlighting that online social support might reinforce the link between the fear of being negatively evaluated and PSNSU.

Blend in or stand out: social anxiety levels shape information-sharing strategies

Although living in social groups provides many benefits for group members, such groups also serve as a setting for social competition over rank and influence. Evolutionary accounts suggest that social anxiety plays a role in regulating in-group conflict, as individuals who are concerned about social threat may choose to defer to others to maintain the hierarchical status quo. Here, we examine how social anxiety levels are related to the advice-giving style an individual adopts: a competitive influence-seeking strategy or a defensive blend-in strategy. We begin by demonstrating that similarity to others drives activity in the brain's valuation system, even during a competitive advice-taking task. Then, in three behavioural experiments, we show that social anxiety levels are related to the tendency to give advice resembling the advice given by rival advisers and to refrain from status-seeking behaviour. Social anxiety was also associated with negative social comparisons with rival advisers. Our findings highlight the role of competing social goals in shaping information sharing.

Minority Stress and Loneliness in a Global Sample of Sexual Minority Adults: The Roles of Social Anxiety, Social Inhibition, and Community Involvement

Research suggests that loneliness among sexual minority adults is associated with marginalization, but it is unclear which processes may underlie this relationship. This cross-sectional study examined five possibilities: stigma preoccupation, internalized homonegativity, sexual orientation concealment, social anxiety, and social inhibition. The study also examined the possible protective role of LGBTQ community involvement. Respondents were 7856 sexual minority adults aged 18-88 years from 85 countries who completed an online survey. Results of structural equation modeling indicated that marginalization was positively associated with both social and emotional loneliness, and that part of this relationship was indirect via proximal minority stress factors (especially stigma preoccupation) and, in turn, social anxiety and social inhibition. Moreover, while LGBTQ community involvement was associated with greater marginalization, it was also associated with lower levels of proximal stress and both forms of loneliness. Among those who were more involved in the LGBTQ community, the associations between marginalization and proximal stress were somewhat weaker, as were those between stigma preoccupation and social anxiety, and between social inhibition and social loneliness. In contrast, the associations between concealment and social anxiety were somewhat stronger. Model fit and patterns of association were similar after controlling for the possible confounding effect of dispositional negative affectivity, but several coefficients were lower. Findings underscore the continuing need to counter marginalization of sexual minorities, both outside and within the LGBTQ community, and suggest possible avenues for alleviating loneliness at the individual level, such as cognitive-behavioral interventions targeting stigma preoccupation and social anxiety.

Am I really seeing what's around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback

Cognitive models of social anxiety propose that socially anxious individuals engage in excessive self-focusing attention when entering a social situation. In the present study, speech anxiety was induced to socially anxious and control participants. Event-related potentials were recorded while participants performed a perceptual judgment task using distinct or ambiguous stimuli, before and after social feedback. Disputed feedback led to more revisions and decreased levels of confidence, especially among socially anxious individuals. Prior feedback, greater occipital P1 amplitudes in both groups for ambiguous probes indicated heightened sensory facilitation to ambiguous information, and greater anterior N1 amplitudes for ambiguous stimuli in highly anxious participants suggested anticipation of negative feedback in this group. Post-feedback, P1, N1 and LPP amplitudes were reduced overall among socially anxious individuals indicating a reduction in sensory facilitation of visual information. These results suggest excessive self-focusing among socially anxious individuals, possibly linked to anticipation of an anxiety-provoking social situation.

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.

Patient reported psychosocial functioning following successful ptosis surgery

Background

Ptosis may result in increased anxiety, appearance-related distress and social avoidance, and impacts visual function. Previous work demonstrates the benefits of ptosis surgery for health-related quality of life, but there is a paucity of research comparing such outcomes before and after surgery. The aim of this study was to determine potential patient benefits in health-related quality of life, social dysfunction and anxiety following successful ptosis surgery using validated measures.

Methods

Adult ptosis correction surgery patients completed validated measures of appearance-related social anxiety and avoidance, anxiety and depression, and fear of negative evaluation pre-surgery. Following successful surgery, these measures were repeated post-discharge in addition to another health-related quality of life measure.

Results

Of 61 patients recruited, follow-up measures were sent to 33 and completed by 23. Paired samples t-tests demonstrated positive significant changes in appearance-related social distress pre-op m = 30.94, post-op m = 23.67 (t(17) = 3.46, 95% CI 2.84–11.72, p = 0.003), anxiety pre-op m = 7.6, post-op m = 4.9 (t(19) = 4.27, 95% CI 1.38–4.02, p < 0.001) and fear of negative evaluation pre-op m = 34.79, post-op m = 31.26 (t(18) = 2.47, 95% CI 0.52–6.53, p = 0.024). There was no significant difference in depression scores pre-op m = 3.6; post-op m = 3.2 (t(19) = 0.672, 65% CL −0.85 to 1.65, p = 0.510). In total, 85% of patients reported positive benefit to well-being following surgery.

Conclusion

Increasingly, evidence suggests ptosis surgery may benefit patient’s well-being, appearance-related social anxiety and avoidance, as well as improving visual function. These psychosocial benefits should be considered alongside functional benefits in the provision of ptosis surgery.

Cortical processing of speaker politeness: Tracking the dynamic effects of voice tone and politeness markers

Information in the tone of voice alters social impressions and underlying brain activity as listeners evaluate the interpersonal relevance of utterances. Here, we presented requests that expressed politeness distinctions through the voice (polite/rude) and explicit linguistic markers (half of the requests began with Please). Thirty participants performed a social perception task (rating friendliness) while their electroencephalogram was recorded. Behaviorally, vocal politeness strategies had a much stronger influence on the perceived friendliness than the linguistic marker. Event-related potentials revealed rapid effects of (im)polite voices on cortical activity prior to ~300 ms; P200 amplitudes increased for polite versus rude voices, suggesting that the speaker's polite stance was registered as more salient in our task. At later stages, politeness distinctions encoded by the speaker's voice and their use of Please interacted, modulating activity in the N400 (300-500 ms) and late positivity (600-800 ms) time windows. Patterns of results suggest that initial attention deployment to politeness cues is rapidly influenced by the motivational significance of a speaker's voice. At later stages, processes for integrating vocal and lexical information resulted in increased cognitive effort to reevaluate utterances with ambiguous/contradictory cues. The potential influence of social anxiety on the P200 effect is also discussed.

Intolerance of uncertainty, and not social anxiety, is associated with compromised extinction of social threat

Extinction-resistant threat is regarded as a central hallmark of pathological anxiety. However, it remains relatively under-studied in social anxiety. Here we sought to determine whether self-reported trait social anxiety is associated with compromised threat extinction learning and retention. We tested this hypothesis within two separate, socially relevant conditioning studies. In the first experiment, a Selective Extinction Through Cognitive Evaluation (SECE) paradigm was used, which included a cognitive component during the extinction phase, while experiment 2 used a traditional threat extinction paradigm. Skin conductance responses and subjective ratings of anxiety (experiment 1 and 2) and expectancy (experiment 2) were collected across both experiments. The findings of both studies demonstrated no effect of social anxiety on extinction learning or retention. Instead, results from experiment 1 indicated that individual differences in Intolerance of Uncertainty (IU) were associated with the ability to use contextual cues to decrease a conditioned response during SECE. However, during extinction retention, high IU predicted greater generalisation across context cues. Findings of experiment 2 revealed that higher IU was associated with impaired extinction learning and retention. The results from both studies suggest that compromised threat extinction is likely to be a characteristic of high levels of IU and not social anxiety.

A systematic review of metacognitions in Internet Gaming Disorder and problematic Internet, smartphone and social networking sites use

Background

The use of new technologies is growing, and some authors have suggested that frequent use might hide a non‐chemical addiction (i.e., technological addiction). Over the last 5 years, several studies investigating the role of metacognitions in technological addictions have been published. We aim to provide the first systematic review focused on this topic, by updating the initial evidence highlighted by a previous systematic review on metacognitions across addictive behaviours (Hamonniere & Varescon, 2018).

Methods

Electronic literature databases (Pubmed, PsychINFO, SCOPUS and Web of Science) were searched to identify studies that examined the relationship between metacognitions and four different technological addictions (Internet Gaming Disorder, IGD; problematic Internet use, PIU; problematic smartphone use, PSU; and problematic social networking sites use, PSNSU).

Results

We found 13 empirical studies published between 2018 and 2021. Positive low to moderate cross‐sectional associations between the four technological addictions and both generic and specific metacognitions were found, in accordance with the metacognitive model of addictive behaviours. Positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, beliefs about the need to control thoughts and a lack of cognitive confidence were associated with IGD, PIU, PSU and PSNSU.

Conclusions

The absence of longitudinal studies prevents us from providing definitive answers about the role of metacognitions in technological addictions. Despite this limitation, interventions that target metacognitions could be beneficial for people presenting with technological addictions.

Frogs in boiling water: a moderated-mediation model of exploitative leadership, fear of negative evaluation and knowledge hiding behaviors

Purpose

This study aims to utilize the cognitive appraisal theory of stress and coping by conducting a joint investigation of the mediating role of knowledge hiding behaviors in the relationship of exploitative leadership on employee’s work related attitudes (i.e. turnover intentions) and behaviors (e.g. job performance, creativity) and fear of negative evaluation in influencing this mediation.

Design/methodology/approach

Using the Preacher and Hayes’ (2004) moderated-mediation approach, the authors tested the model by collecting multi-wave and two-source data from employees and fellow peers (n = 281) working in the service sector of Pakistan.

Findings

Results of the study demonstrate that exploitative leadership adversely influences one’s performance and turnover intentions through knowledge hiding behaviors. The fear of negative evaluation moderates the indirect effects of exploitative leadership on employee’s outcomes through knowledge hiding behaviors such that these indirect effects are stronger for individuals possessing low levels of fear of negative evaluation.

Originality/value

The current study contributes to knowledge management and dark leadership literature by suggesting knowledge hiding behaviors as a process through which exploitative leaders unveil their negative effects on employee’s outcomes. This study is also unique in the sense, as it posits that employees might vary because of their dispositional traits (i.e. low fear of negative evaluation) in responding to exploitative leadership with greater knowledge hiding behaviors.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Psychometric properties of the Ryerson Social Anxiety Scales in individuals with social anxiety disorder

BACKGROUND

Although numerous self-report measures of social anxiety exist, most instruments assess symptom severity by examining the range of social situations that provoke anxiety, rather than the distress and impairment associated with social anxiety. The Ryerson Social Anxiety Scales (RSAS; Lenton-Brym, A. P., Rogojanski, J., Hood, H. K., Vorstenbosch, V., McCabe, R. E., & Antony, M. M. (2020). Development and validation of the Ryerson Social Anxiety Scales (RSAS). Anxiety, Stress, & Coping, 33(6), 642-660), a measure assessing breadth of social anxiety inducing situations and severity of associated distress and impairment, was recently developed to fill this gap. The present study is the first to investigate the psychometric properties of the RSAS in a clinical sample.

METHOD/DESIGN

Participants included 110 individuals with a principal diagnosis of social anxiety disorder (SAD). A subsample of participants (n = 23) completed cognitive-behavioural group treatment (CBGT) for SAD.

RESULTS

The RSAS demonstrated excellent internal consistency. Examination of the correlations between the RSAS and other conceptually related and distinct measures supported the convergent and discriminant validity of the RSAS. The RSAS was also sensitive to changes in severity of social anxiety following CBGT.

CONCLUSION

The RSAS is a reliable and valid instrument for assessing the severity of SAD.

Disrupted joint action accounts for reduced likability of socially anxious individuals

BACKGROUND AND OBJECTIVES

Motivated by their fear of disapproval, individuals with social anxiety continually monitor their own behaviour during social interactions hoping to prevent dreaded negative outcomes. Ironically, they do evoke less positive reactions from others. This study investigated whether lower engagement in the interpersonal process of joint action by socially anxious individuals leads them to attract less positive ratings by their conversation partners.

METHOD

High socially anxious (HSA; N = 36) and low socially anxious individuals (LSA; N = 36) had separate conversations with a naïve conversation partner (N = 36). Conversations were filmed and analysed for joint action using the conventional manual way and a more exploratory automated way. Conversation partners rated the quality of the interaction and the person they talked to.

RESULTS

Conversation partners rated HSA participants less positively than LSA participants. The conventional manual method showed less joint action in conversations with LSA participants and crucially, joint action served as mediator between social anxiety status and general impression, quality of interaction and desire to meet again. These results were not replicated with the automated method.

LIMITATIONS

The study used an analogue sample and future research should investigate whether these findings also apply to a clinical sample. Future studies should further explore the utility of automated techniques to measure joint action.

CONCLUSION

Reduced joint action may explain why socially anxious individuals tend to be perceived less positively by others. The findings emphasise the importance of taking an interpersonal and holistic approach to understanding aspects of social anxiety disorder.

Reassurance seeking and spoiled answers on academic tests

Background: The current study examined whether test-related reassurance seeking is associated with lower scores on a high stakes, standardized test (i.e., the ACT) after controlling for academic performance in high school, and with spoiled answers (i.e., changing correct answers to incorrect) on a subsequent academic exam. Method: Students (N = 59) completed measures of test-related reassurance seeking behavior, other test anxiety-related constructs, and social anxiety-related constructs prior to taking the last in-class exam in their introductory psychology courses. Erasure marks on the bubble answer sheets were inspected to identify the number of spoiled answers. Results: Replicating results from a prior study, reassurance seeking predicted underperformance on the ACT. In addition, reassurance seeking predicted the number of spoiled answers on the in-class exam. Reassurance seeking did not predict irrelevant changes or corrections. Conclusions: Overall, these results provide additional evidence that test-related reassurance seeking is associated with performance on academic tests, and novel evidence that test-related reassurance seeking is associated with spoiling answers.

Psychometric evaluation of the Iranian version of brief fear of negative evaluation scale-straightforward item (BFNE-S): A validation study

Background: The Brief Fear of Negative Evaluation Scale-Straightforward Item (BFNE-S) is an internationally recognized tool for measuring fear of negative evaluation. The current investigation was designed to assess the reliability and validity of the Persian version of BFNE-S in a non-clinical sample in Iran.

Methods: A cross-sectional study was conducted on a sample of university students. They completed the Iranian version of the BFNE-S and the Social Phobia Inventory (SPIN). Internal consistency was assessed using the Cronbach's alpha coefficient. Validity was examined using known groups comparison to test how well the questionnaire differentiates between subgroups of the study sample that differed in gender. In addition convergent validity was performed to examine the correlation between the BFNE-S and scores derived from the SPIN. Furthermore, the structural validity of the questionnaire was examined by performing confirmatory factor analysis using the LISREL 8.8 software.

Results: A total of 150 university students participated in the study. The results obtained from reliability analysis indicated that the Iranian version of the BFNE-S had desirable internal consistency. The Cronbach's alpha coefficient was 0.89. Satisfactory discriminant and convergent validity of the questionnaire also were established. The BFNE-S score was significantly higher in female respondents compared to male respondents as hypothesized (P = 0.008). The BFNE-S was correlated to the Iranian version of the Social Phobia Inventory (SPIN) in the expected direction (r = 0.58, P <0.001). The confirmatory factor analysis indicated a good fit to data lending support to its original one-dimensional structure.

Conclusion: The findings indicated that the Iranian version of the BFNE-S was a valid measure of fear of negative evaluation. Since the scale showed a unitary factor structure, the theoretical basis for the BFNE-S is confirmed.

The ACCEPT-study: design of an RCT with an active treatment control condition to study the effectiveness of the Dutch version of PEERS® for adolescents with autism spectrum disorder

BACKGROUND

Social skills interventions are commonly deployed for adolescents with autism spectrum disorder (ASD). Because effective and appropriate social skills are determined by cultural factors that differ throughout the world, the effectiveness of these interventions relies on a good cultural fit. Therefore, the ACCEPT study examines the effectiveness of the Dutch Program for the Education and Enrichment of Relational Skills (PEERS®) social skills intervention.

METHODS/DESIGN

This study is a two-arm parallel group randomized controlled trial (RCT) in which adolescents are randomly assigned (after baseline assessment) to one of two group interventions (PEERS® vs. active control condition). In total, 150 adolescents are to be included, with multi-informant involvement of their parents and teachers. The ACCEPT study uses an active control condition (puberty psychoeducation group training, focussing on social-emotional development) and explores possible moderators and mediators in improving social skills. The primary outcome measure is the Contextual Assessment of Social Skills (CASS). The CASS assesses social skills performance in a face to face social interaction with an unfamiliar, typically developing peer, making this a valuable instrument to assess the social conversational skills targeted in PEERS®. In addition, to obtain a complete picture of social skills, self-, parent- and teacher-reported social skills are assessed using the Social Skills improvement System (SSiS-RS) and Social Responsiveness Scale (SRS-2). Secondary outcome measures (i.e. explorative mediators) include social knowledge, social cognition, social anxiety, social contacts and feelings of parenting competency of caregivers. Moreover, demographic and diagnostic measures are assessed as potential moderators of treatment effectiveness. Assessments of adolescents, parents, and teachers take place at baseline (week 0), intermediate (week 7), post intervention (week 14), and at follow-up (week 28).

CONCLUSION

This is the first RCT on the effectiveness of the PEERS® parent-assisted curriculum which includes an active control condition. The outcome of social skills is assessed using observational assessments and multi-informant questionnaires. Additionally, factors related to social learning are assessed at several time points, which will enable us to explore potential mediators and moderators of treatment effect.

TRAIL REGISTRATION

Dutch trail register NTR6255 (NL6117). Registered February 8th, 2017 - retrospectively registered.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Factor structure and psychometric properties of the Italian version of the fear of missing out scale in emerging adults and adolescents

Fear of missing out (FoMO) has been linked to problematic social media use and negative health outcomes among adolescents and emerging adults. The 10-item Fear of Missing Out Scale (FoMO) is the most used instrument to measure FoMO levels and, for this reason, it seems relevant to evaluate its psychometric properties across various cultures. In Study 1, exploratory factor analysis was conducted on the scale items using a sample of 436 college students [F = 51.1%; M (SD) = 22.13 (2.78) years old]. In Study 2, confirmatory factor analysis was conducted in order to determine whether the results of Study 1 could be confirmed with another sample of college students [n = 239; F = 61.1%; M (SD) = 23.02(2.64) years old] and adolescents [n = 178; M = 57.3%; M (SD) = 16.2 (1.48) years old]. The model was also tested for measurement invariance by sex and age (collegiate versus high school students). Full scalar invariance of the FoMO across sex and age was supported and adequate internal consistency was found. Convergent validity was also demonstrated. As a result, we concluded that the FoMO might be used in clinical settings as a means of screening people who show potentially high behavioral engagement with social media. The FoMO can also help identify specific maladaptive cognitions and ruminative thoughts that maintain FoMO.

Not intended, still embarrassed: Social anxiety is related to increased levels of embarrassment in response to unintentional social norm violations

Background:

Social anxiety disorder (SAD) is associated with altered social norm (SN) processing: SAD-patients rate stories on SN violations as more inappropriate and more embarrassing than healthy participants, with the most prominent effect for stories on unintentional SN violations (i.e. committing a blunder). Until now it’s unknown how levels of social anxiety (SA) are related to ratings of SN violations in the general population, in which SA-symptoms are present at a continuum. More insight in this relationship could improve our understanding of the symptom profile of SAD. Therefore, we investigated the relation between ratings of SN violations and SA-levels in the general population.

Methods:

Adults and adolescents (n = 87) performed the revised Social Norm Processing Task (SNPT-R) and completed self-report questionnaires on social anxiety. Repeated-measures ANCOVAs were used to investigate the effect of SA on the ratings of inappropriateness and embarrassment.

Results:

As hypothesized, participants with higher SA-levels rated SN violations as more inappropriate and more embarrassing. Whereas participants with low-to-intermediate SA-levels rated unintentional SN violations as less embarrassing than intentional SN violations, participants with high SA-levels (z-score SA ≥ 1.6) rated unintentional SN violations as equally embarrassing as intentional SN violations.

Conclusion:

These findings indicate that increased embarrassment for unintentional SN violations is an important characteristic of social anxiety. These high levels of embarrassment are likely related to the debilitating concern of socially-anxious people that their skills and behavior do not meet expectations of others, and to their fear of blundering. This concern might be an important target for future therapeutic interventions.

Imagery Rescripting and Exposure in Social Anxiety: A Randomized Trial Comparing Treatment Techniques

This randomized trial compared the effects of imagery rescripting against in vivo exposure administered separately during a single session with 27 socially anxious individuals. Previous research shows that imagery rescripting is a promising treatment technique for various disorders including social anxiety, although imagery rescripting and exposure for social anxiety have not yet been compared. Social anxiety self-report measures (LSAS-SR and BFNE-II); the distress, vividness, and frequency of fear images (i.e., Imagery condition); and the levels of anxiety, avoidance, and the strength of convictions of a feared social situation (i.e., exposure condition) were rated at baseline, before treatment, and after a 2- and 4-week follow up period. Both treatment groups improved significantly on all measures pre- to post treatment and the effects largely remained at the 4-week follow-up. No significant differences between the treatment groups were found on the anxiety measures. The results suggest that either a single session of imagery rescripting or of exposure are effective in reducing social anxiety, and that both treatment techniques, even when administered in a single session, reduces social anxiety.

Niacin biological challenge: A paradigm to evaluate social concerns

BACKGROUND AND OBJECTIVES

Anxiety sensitivity (AS) social concerns, the fear of observable anxiety symptoms is posited as a risk factor for social anxiety by increasing fear reactivity in social situations when observable anxiety symptoms are present. Experimental evaluation of AS social concerns is limited. The current study utilized several manipulations designed to be relevant to AS social concerns or fear of negative evaluation (FNE), a distinct social anxiety risk factor. The effects of these manipulations on fear reactivity to a speech were examined.

METHODS

Participants (N = 124 students; M age = 19.44, SD = 2.45; 64.5% female) were randomized to one of four conditions in a 2 (100 mg niacin vs 100 mg sugar pill) X 2 (instructional set) design. For the instructional set manipulation, participants were told their speech performance would be evaluated by a judge based on their performance (i.e., FNE-relevant) or their observable anxiety symptoms (i.e., AS social concerns-relevant).

RESULTS

There was a main effect for vitamin condition with participants in the niacin condition reporting higher panic symptoms post-speech relative to those in the placebo condition. There was no main effect for speech instructions. As hypothesized, these effects were qualified by an interaction indicating that AS social concerns significantly predicted panic symptoms for those receiving niacin.

LIMITATIONS

Limitations include the reliance on self-reports of outcome variables and the use of an undergraduate student sample.

CONCLUSIONS

These findings highlight a distinct role of AS social concerns in fear responding to socially evaluative situations in the context of physically observable arousal.

Self-Esteem Relates to Expecting Others to See Us How We See Ourselves

We examined whether self-esteem relates to coherence between self-evaluations and anticipated evaluations by others. In two studies (total N = 279), participants twice completed a measure of their personal attributes, once from their own standpoints and once from the perspective of someone they anticipated meeting, separated by a 25-minute distractor task. Supporting our preregistered predictions, the within-person association between self- and other-ratings was stronger as a function of between-person increases in self-esteem. These effects remained after statistically controlling for self-concept clarity and for fear of negative evaluation, both of which related meaningfully to self-esteem. Together, these findings indicate that persons high in self-esteem anticipate that others will evaluate them consistently with how they evaluate themselves.

The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis

Intolerance of uncertainty is a dispositional trait associated with a range of psychological disorders, but the influence of methodological factors on theses associations remains unknown. The first aim of this meta-analysis was to quantify the strengths of the association between IU and symptoms of generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive compulsive disorder, depression, and eating disorders. The second aim was to assess the influence of methodological factors on these relationships, including clinical (vs. non-clinical) status, age group, sex, IU measure, and symptom measure. We extracted 181 studies (N participants = 52,402) reporting 335 independent effect sizes (Pearson's r). Overall, there was a moderate association between IU and symptoms (r = 0.51, 95% CI = 0.50-0.52), although heterogeneity was high (I² = 83.50, p < .001). Some small but significant moderator effects emerged between and within disorders. Effect sizes were not impacted by sample size. The results indicate that IU has robust, moderate associations with a range of disorder symptoms, providing definitive evidence for the transdiagnostic nature of IU.