Exploring the relationship between fear of positive evaluation and social anxiety

Fear of Positive Evaluation and Loneliness: Mediating Role of Social Anxiety and Suppression

Loneliness is a commonly observed problem that is associated with several mental and physical health outcomes. Although research shows that fear of negative evaluation is related to loneliness, no study has examined the role of fear of positive evaluation (FPE) on loneliness. This study investigated the mediator role of social anxiety and suppression in the relationship between FPE and loneliness using an undergraduate sample (N = 467). The results show that FPE is positively associated with loneliness and that this relationship is mediated by social anxiety and suppression. This study highlights the importance of the FPE in understanding loneliness and can guide intervention programs for loneliness.

Bidirectional Associations Between Early Adolescent Internalizing Symptoms and Positive Affect Regulation Strategy Use in Daily-Life: An Experience Sampling Method Study

Disruptions in positive affect (PA) have been found to characterize several internalizing disorders, including depression, social anxiety, and generalized anxiety. One factor that may contribute to disruptions in PA are individual differences in PA regulation, or the tendency to upregulate ("enhance") or downregulate ("dampen") positive emotions in response to pleasant events. Yet, prospective associations between PA regulation and varying forms of internalizing are not well-understood, particularly during adolescence, a period during which risk for the onset these disorders rises. Thus, the present study evaluated bidirectional associations between daily-life PA regulation strategy use and symptoms of depression, social anxiety, and generalized anxiety in a sample of 151 early adolescents (52.0% girls; 48.0% boys; Mage[SD] = 12.72[.86]). Youth symptoms were assessed using self-report questionnaires at baseline and one year later. Daily-life enhancing and dampening were assessed 3-4 times per day for 9 days using experience sampling methods at baseline and 1-year (31 total assessments per time point). Results of multilevel correlation models demonstrated concurrent associations between dampening and symptoms of depression, social anxiety, and generalized anxiety. Multilevel structural equation models indicated that greater baseline dampening predicted increases in depressive symptoms across one year. Results also suggested that greater baseline depressive symptoms may predict prospective increases in dampening. Together, findings indicate that dampening is a common feature of varying internalizing symptoms during adolescence, and dampening and depressive symptoms may demonstrate relatively unique patterns of interrelation over time.

The relationship between childhood trauma and social anxiety in college students: the mediating role of evaluation fear

BACKGROUND

Social anxiety has become a common psychological problem that seriously affects the mental health of contemporary youth. Although numerous studies have shown that childhood trauma is closely related to social anxiety in adulthood, the mediating role of evaluation of fear in this relationship remains unclear. This study aims to explore the relationships among childhood trauma, evaluation fear, and social anxiety among college students and their internal pathways.

METHODS

In September 2023, a sample of 559 Chinese university students aged 18-22 years (mean age = 20.20, SD = 1.211; 229 males and 330 females) completed the Childhood Trauma Questionnaire, Liebowitz Social Anxiety Scale, Fear of Positive Evaluation Scale, and Brief Fear of Negative Evaluation Scale. Correlation analyses were conducted to explore the initial relationships among the main variables. Structural equation modeling was performed to examine the parallel mediating effects of fear of positive and negative evaluation on the relationship between childhood trauma and social anxiety.

RESULTS

Significant correlations were found among childhood trauma, social anxiety, fear of negative evaluation, and fear of positive evaluation. Childhood trauma significantly and positively predicted both fear of positive evaluation (β = 0.40, p < 0.001) and fear of negative evaluation (β = 0.31, p < 0.001). Fear of positive and negative evaluation also positively predicted social anxiety (β = 0.45, p < 0.001; β = 0.43, p < 0.001, respectively). The parallel mediation effects of fear of positive and negative evaluation on the relationship between childhood trauma and social anxiety were significant (effect size: 0.309, 95% CI = [0.240, 0.380]), with the mediation effects accounting for 60.78% of the total effect.

CONCLUSION

Fear of positive and negative evaluation plays a mediating role in the impact of childhood trauma on social anxiety. This finding provides a new perspective for understanding the formation mechanism of social anxiety and offers a scientific basis for developing effective intervention strategies.

Relationships among COVID-19 causal factors perceived by children, basic psychological needs and social anxiety

Background

The pandemic caused by COVID-19 had a great impact on our society as the lives of children have been affected, as well as their psychological health and social anxiety.

Objective

To examine whether COVID-19 causal factors perceived by children predicted basic psychological needs and social anxiety, and if basic psychological needs predicted social anxiety.

Methods

A sample of 58 schoolchildren (Mage = 10.18; SD = 0.77; 36 boys, 22 girls) participated in the study and completed a series of self-report measures. The relationship between the study variables was examined using partial least square path modelling (PLS-PM).

Results

Social distancing and protection were found to significantly reduce competence satisfaction. Perceived psychological impact significantly negatively predicted relatedness satisfaction and significantly positively autonomy frustration and competence frustration. Perceived psychological impact significantly negatively predicted anxiety in the interaction with the opposite sex. Autonomy satisfaction significantly positively predicted anxiety in the interaction with the opposite sex. Autonomy frustration significantly positively predicted anxiety in public speaking interaction with teachers, significantly positively anxiety in the interaction with the opposite sex, significantly positively anxiety of being embarrassed or ridiculed and significantly positively anxiety in the interaction with strangers.

Conclusion

Perceived psychological impact was the causal factor that revealed a higher impact on basic psychological needs. As such, it is important to take measures with children in pandemic situations to minimize this variable. On the other hand, Autonomy frustration revealed a higher impact on social anxiety. Thus, it is necessary to emphasize autonomy in children respecting the restrictions imposed to minimize the impact of social anxiety.

Subgroups based on fears of evaluation exhibited different social anxiety levels

The bivalent fear of evaluation model proposes that fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are distinct but related constructs, and that social anxiety arises when they are elevated. This represents a variable-centered perspective. However, a recent review suggested that individuals may be affected by unique combinations of FNE and FPE because they have different functions, mechanisms, and outcomes. Such patterns can be revealed by taking a person-centered approach. To explore this, the current study employed latent profile and k-means clustering analyses in four independent samples (total n = 2,913) to identify subgroups based on FNE and FPE levels. Between-group levels of social anxiety were further examined. Results demonstrated that participants could be classified into four groups: (1) high bivalent fears of evaluation group, (2) high FNE group, (3) high FPE group, and (4) low fears of evaluation group. Importantly, significant differences in social anxiety levels were found among these groups. Our findings extend the bivalent fear of evaluation model to a person-centered perspective and enable clinicians to tailor interventions that specifically address distinct underlying fears of evaluation. This may facilitate more effective treatment for individuals with social anxiety.

Late positive potentials elicited by negative self-referential processing predict increases in social anxiety, but not depressive, symptoms from age 11 to age 12

Social anxiety and depression exacerbate in early adolescence. Maladaptive self-referential processing confers risk for both conditions and can be assessed by the Self-Referent Encoding Task (SRET). Our cross-sectional findings indicated that the SRET-elicited anterior late positive potential (LPP) was uniquely associated with social anxiety symptoms, whereas behavioral SRET scores were uniquely associated with depressive symptoms. Expanding this work, this study investigated whether the SRET-generated behavioral and LPP indices differentially predicted changes of social anxiety or depressive symptoms over time. At baseline, 115 community-dwelling youths (66 girls; Mean age/SD = 11.00/1.16 years) completed an SRET with EEG. Youths reported social anxiety and depressive symptoms at baseline and ∼six and ∼ 12 months later, based on which the intercept and slope of symptoms were estimated as a function of time. A larger anterior LPP in the negative SRET condition uniquely predicted a larger slope (faster increase) of social anxiety (but not depressive) symptoms. Greater positive behavioral SRET scores marginally predicted a smaller slope (slower increase) of depressive (but not social anxiety) symptoms. We provided novel evidence concerning the differential, prospective associations between self-referential processing and changes of social anxiety and depressive symptoms in early adolescence.

Visual search attentional bias modification reduced the attentional bias in socially anxious individuals

Recent years have raised questions about the effectiveness of attentional bias modification (ABM) in individuals with social anxiety. In the current study, we employed a novel training method-ABM-positive-search training-to modify attentional bias in socially anxious individuals. The attentional bias was measured using the dot-probe task, and brain electrical activity was recorded. The ABM-positive-search group was instructed to search for a happy face in a 3 × 3 visual array. The placebo control group was asked to find out whether the only male from the female or the only female from the male. In terms of behavioral indicators, the results showed a significant reduction in the variability of trial level-bias score (TL-BS) in the ABM-positive-search group post-training. However, there was no significant change observed in the placebo control group. The electrophysiological results were consistent with the behavioral findings. To be specific, both groups displayed the N2pc effect in response to threatening faces before the training. After training, the N2pc effect disappeared in the ABM-positive search group, while it remained in the placebo control group. In conclusion, ABM-positive-search training can effectively modify the attentional bias of socially anxious individuals, and cognitive control plays an important role in this process.

Differences in attentional bias between self-related information and external cues from others in individuals with social anxiety: An event-related potential study

Individuals with high social anxiety show a more considerable attentional bias toward self-relevant information and outwardly threatening stimuli than do those with low social anxiety. Some studies have investigated the attentional bias between self-relevant information and external social cues in people with high social anxiety but have not reached consistent conclusions. This study used a modified dot-probe task and collected temporal and electroencephalogram responses to three self-other face pairs among 15 people with high social anxiety and 20 people with low social anxiety. Both groups responded quicker to self-relevant information than external social cues. Others' emotional potencies moderated the attentional bias. Individuals with high social anxiety exhibited larger P1 amplitudes and smaller N170 amplitudes (mainly in the right hemisphere) for all face pairs and larger P2 amplitudes for the self-neutral and other-angry face pairs than those with low social anxiety. These findings suggest that people with social anxiety prioritize allocating attentional resources to self-relevant information, with others' angry faces having the greatest influence on the allocation. Individuals with high social anxiety initially exhibit more attentional vigilance and less structural coding for face pairs, followed by heightened engagement with threatening cues compared to those with low social anxiety.

Negative Affect Following Dating Application Use is Predicted by Social Anxiety Symptoms and Match Rate

Social rejection is a common and unavoidable experience for users of dating apps. Research suggests that socially anxious individuals may be particularly likely to use dating apps to establish intimate relationships, given their preference for online (vs. face-to-face) communication. However, social anxiety (SA) symptoms are associated with heightened negative affect and decreased prosocial behavior following social rejection, suggesting that exposure to dating app rejection has deleterious consequences in this population. This study examined whether SA symptoms and social rejection (vs. acceptance) feedback interact to predict participants' negative and positive affect and social engagement with dating app matches. Participants (N = 128) evaluated for SA symptoms were randomly assigned to receive high or low match rate feedback on a simulated dating application task. SA symptoms were negatively associated with positive affect following high match rate feedback and positively associated with negative affect following low match rate feedback. SA symptoms were negatively associated with self-reported likelihood of contact initiation with matches. Results suggest that high socially anxious individuals are more susceptible to negative repercussions of social rejection on dating applications.

Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis

Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals' vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.

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

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

Daily stress and emotions in relation to fear of negative and positive evaluation

Fear of negative (FNE) and positive (FPE) evaluation constitute distinct components of social anxiety and relate to altered affectivity. It is unclear whether individuals with strong FNE/FPE overreact to social stressors only or to more unspecific ones as well. The present set of three studies (n = 109 and n = 97 healthy individuals in study 1/2, n = 49 patients with social anxiety disorder in study 3) assessed whether reactivity to various daily stressors and non-specific momentary stress/emotions assessed through ecological momentary assessment depend on individuals' level of FPE/FNE. Almost all relationships with FPE/FNE were explained by depressive symptoms, except for a unique association of FNE with reactivity to stressors from the distant social network. Relationships of FNE with momentary global stress and emotions were mixed, but again explained by depressive symptoms. More depressive symptoms were associated with higher stress, negative affect, and most stressor types as well as lower positive affect in all studies. These results show that for social stressors from the distant social network, FNE has explanatory power. They further document the role of depressive affect for reactivity to a wide range of everyday stressors and question the need for specific instruments assessing FPE/FNE unless stressors are explicitly social-evaluative in nature.

Lack of optimistic bias during social evaluation learning reflects reduced positive self-beliefs in depression and social anxiety, but via distinct mechanisms

Processing social feedback optimistically may maintain positive self-beliefs and stable social relationships. Conversely, a lack of this optimistic bias in depression and social anxiety may perpetuate negative self-beliefs and maintain symptoms. Research investigating this mechanism is scarce, however, and the mechanisms by which depressed and socially anxious individuals respond to social evaluation may also differ. Using a range of computational approaches in two large datasets (mega-analysis of previous studies, n = 450; pre-registered replication study, n = 807), we investigated how depression (PHQ-9) and social anxiety (BFNE) symptoms related to social evaluation learning in a computerized task. Optimistic bias (better learning of positive relative to negative evaluations) was found to be negatively associated with depression and social anxiety. Structural equation models suggested this reflected a heightened sensitivity to negative social feedback in social anxiety, whereas in depression it co-existed with a blunted response to positive social feedback. Computational belief-based learning models further suggested that reduced optimism was driven by less positive trait-like self-beliefs in both depression and social anxiety, with some evidence for a general blunting in belief updating in depression. Recognizing such transdiagnostic similarities and differences in social evaluation learning across disorders may inform approaches to personalizing treatment.

Reward positivity moderates the association between pubertal status and social anxiety symptoms in nine-to-12-year-old youths

The transition to adolescence is characterized by rapid development of puberty, reward processing, and internalizing psychopathology (i.e., depression and anxiety). More advanced pubertal status and altered reward processing are both known to be associated with elevated internalizing symptoms. However, it was unclear to what extent pubertal status and reward processing interacted with each other in predicting internalizing psychopathology. We examined how the puberty-psychopathology association was moderated by the reward processing indexed by ERPs, including the reward positivity (RewP) and the late positive potential (LPP). A-hundred-and-fifteen nine-to-12-year-old typically developing youths (66 girls; Mean age/SD =10.98/1.18 years) reported their pubertal status and symptoms of depression and social anxiety and completed an EEG Doors task that assessed monetary reward feedback processing. A principal component analysis of the ERP data identified a RewP, an anterior LPP, and a posterior LPP, elicited by the win and loss feedback of the task. The puberty-social anxiety relationship was moderated by the RewP, an identified neural marker of reward sensitivity. Specifically, more advanced puberty was associated with heightened social anxiety symptoms in the presence of a larger, but not smaller, RewP. We did not observe any moderating effect of the LPPs. Our study provided novel evidence that a hypersensitivity toward the reward stimuli (indexed by an enlarged RewP) further exacerbated the risks associated with more advanced pubertal status for social anxiety.

Re-assessing the assessment of fears of positive and negative evaluation: Scale development and psychometric evaluation of the Bivalent Fear of Evaluation Scale (BFOES)

The bivalent fear of evaluation (BFOE) model of social anxiety divides fear of evaluation into two distinct valences: fear of positive evaluation (FPE) and fear of negative evaluation (FNE). However, there is evidence that the two most widely utilized and psychometrically supported measures of FNE and FPE contain items which are ambiguous with regard to valence of evaluative fear. To formally address this, the BFOE Scale (BFOES) was developed, by merging items from measures of FNE and FPE into a single scale with an integrated response format. The present studies examined the psychometric profile of the BFOES across a large pooled archival dataset (N = 2216), which included approximately 10 % (n = 224) patients with social anxiety disorder (SAD). The factorial validity, internal consistency, and construct validity of the BFOES were examined. Additionally, item response theory analyses were employed for the purpose of merging items from self-report scales which utilized different Likert-type response formats. Results from both studies provided support for the psychometric profile of the BFOES. The implications of the BFOES for the assessment of social anxiety, and theoretical models of fear of evaluation and SAD, are discussed.

CyberStatus: Responses to status manipulation and fears of positive and negative evaluations

Fear of positive evaluation (FPE) and fear of negative evaluation (FNE), which play distinct and central roles in social anxiety (SA), are postulated to reflect conflicting forces in hierarchal group contexts. Yet, experimental studies testing these assumptions are scarce. We examined the impact of status positions on FPE, FNE, and SA using a novel manipulation, CyberStatus. Participants (N = 557) provided self-descriptive statements before being randomly assigned to high, intermediate, or low-status conditions. Next, they reported their emotions, status, and belongingness-related cognitions and adjusted their self-presentation. FPE was more strongly linked to self-presentation modifications in the high- compared to intermediate-status conditions and positively associated with perceived status in the low vs. intermediate conditions. Furthermore, FPE and SA were more linked to belongingness in low vs. intermediate status conditions while FNE demonstrated the reversed pattern. These findings support and expand the evolutionary perspective on evaluation fears and emphasize the importance of assessing the linkage between status and belongingness systems in SA.

A Brief Measure of Positive and Negative Interpretation Biases: Development and Validation of the Ambiguous Social Scenarios Questionnaire

Positive and negative interpretation biases have been conceptualized as distinct constructs related to anxiety and social anxiety, but the field lacks psychometrically sound self-report measures to assess positive and negative interpretations of social ambiguity. This study examined the psychometric properties of the Ambiguous Social Scenarios Questionnaire (ASSQ) in two samples of 2,188 and 454 undergraduates with varying levels of anxiety. Results supported a bifactor model with a general interpretation bias factor and specific factors assessing positive and negative interpretation biases. The ASSQ demonstrated measurement invariance across genders and levels of social anxiety, as well as convergent and incremental validity with two existing measures of interpretation bias. It also demonstrated concurrent validity with attentional control, intolerance of uncertainty, total anxiety, and social anxiety and discriminant validity with emotional awareness. Findings support the ASSQ as a brief, valid, and reliable measure of positive and negative interpretation biases toward ambiguous social situations.

Bivalent fears of evaluation: A developmentally-informed, multi-informant, and multi-modal examination of associations with safety behaviors

Fears of negative (FNE) and positive (FPE) evaluation and safety behaviors feature prominently in cognitive-behavioral models of social anxiety. However, we have a poor understanding of their associations, particularly given evidence that they both vary in form and function. This study aimed to identify the factor structure of safety behaviors and explore their differential associations with FNE and FPE. We addressed these aims across samples that varied in developmental stage, informant, and assessment modality. We collected self-reported data from college students (n = 349; Mage = 19.42) and adolescent-parent dyads (n = 134; Mage_adolescents = 14.49, Mage_parents = 45.01); parents also completed an ecologically-valid evaluation task. We confirmed a two-factor structure of safety behaviors (i.e., avoidance and impression management) that fit the data well for college students, adolescents, and parents' self-report, but not for parents' report about adolescents. Associations between avoidance and impression management and FNE/FPE were significant within-informants but not between-informants. For parents, in-the-moment arousal following receipt of negative, but not positive, feedback was associated with avoidance and impression management. Findings have implications for integrated measurement of FNE, FPE, and safety behaviors, as well as treatments that target social anxiety through each of these domains.

Performance of Working Memory Updating in Socially Anxious Individuals

Working memory updating plays a critical role in executive function. Few studies explored the working memory updating in socially anxious individuals. In this study, we wanted to explore the working memory updating in socially anxious individuals. We studied this issue by instructing participants to perform an emotional 2-back task, and recording their response time and accuracy. We found that high socially anxious individuals showed significant longer response time in positive word condition than that of negative and neutral words. But there was no significant difference in word type in low socially anxious group. In accuracy, we did not observe any significant difference in group, word type, and their interaction. These results indicate that socially anxious individuals have deficits in positive content updating, which have an important implication for developing method to reduce social anxiety.

Longitudinal Examination of the Relationship Between Virtual Companionship and Social Anxiety: Emotional Expression as a Mediator and Mindfulness as a Moderator

Purpose

As the interweaving of human interaction and Artificial Intelligence (AI) intensifies, understanding the psychological impact, especially regarding social anxiety, of engaging with AI-driven virtual companionship becomes crucial. While a substantial body of research on social anxiety has concentrated on interactions between individuals, both online and offline, there is a noticeable deficit in explorations concerning how human-computer interactions influence social anxiety. This study offers a comprehensive, longitudinal examination of this underinvestigated relationship, intricately dissecting the roles of emotional expression and mindfulness within the context of AI-based interactions.

Methods

We use social support theory and emotion regulation theory as our theoretical foundation. Data were collected from 618 undergraduate students in Eastern China over two intervals (May 15, 2023 and September 15, 2023). We utilized SPSS 26.0 to conduct descriptive statistics, while AMOS 25.0 facilitated multi-group confirmatory factor analysis (CFA) and the cross-lagged panel modeling.

Results

Our findings indicate that as the frequency of virtual companionship use increases, there's a decline in online social anxiety but a rise in offline social anxiety. Emotional expression emerges as a significant mediator, with heightened emotional expression leading to reduced social anxiety in both contexts. Mindfulness serves as a potent moderator, suggesting its protective role against the potential pitfalls of frequent virtual interactions.

Conclusion

This research not only deepens our theoretical understanding of the dynamics between virtual interactions and social anxiety but also serves as a cornerstone for future endeavors aimed at optimizing AI and devising therapeutic interventions tailored for the digital generation.

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.

Long-Term Outcomes and Cost-Effectiveness of an Internet-Based Self-Help Intervention for Social Anxiety Disorder in University Students: Results of a Randomized Controlled Trial

Social anxiety disorder (SAD) is widespread among university students and is associated with high costs for the society. While unguided internet- and mobile-based interventions (IMIs) may have short-term effects in reducing SAD symptoms, evidence for their long-term efficacy and cost-effectiveness is still limited. The aim of this study is to examine the 6-month outcomes of an IMI for university students with SAD. Participants were recruited via mass mails sent to enrolled students and included if they were at least 18 years old, met the diagnostic criteria of SAD in a structured clinical interview for DSM-IV axis I disorders (SCID-I), and provided written informed consent. In a prospective study designed as a two-armed randomized-controlled trial, 200 students (mean age 26.7 years) diagnosed with SAD were randomly assigned to an IMI or a waitlist control (WLC) condition. The IMI consisted of nine weekly sessions based on the cognitive-behavioral treatment model for social phobia by Clark and Wells. The primary outcome was SAD symptom severity assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). A health economic evaluation from a societal and healthcare perspective examined the costs related to the symptom-free status and quality-adjusted life years (QALYs) gained. Statistically significant differences in SAD symptom severity previously found at posttreatment favoring the IMI were maintained at a 6-month follow-up [SIAS (Cohen's d = 0.59; 95% CI, 0.30, 0.87) and SPS (Cohen's d = 0.83; 95% CI, 0.54, 1.1)]. From a societal perspective, at a willingness to pay (WTP) of €0, the intervention was found to have a 92% and 93% probability of cost-effectiveness compared with the WLC per symptom-free status and QALY gained, respectively. From a healthcare perspective, the likelihood of cost-effectiveness of the intervention was 97% per symptom-free status at a WTP of €1000 (US$1326) and 96% per QALY gained at a WTP of €6000 (US$7956). This IMI is effective in treating university students with SAD and has an acceptable likelihood of cost-effectiveness compared with WLC from a societal perspective. This intervention can be integrated into university healthcare to reach students with SAD as it is scalable, shows a high probability of cost-effectiveness, and overcomes known treatment barriers. This trial is registered with DRKS00011424.

Social skills deficits and self-appraisal biases in children with social anxiety disorder

Social Anxiety Disorder is highly prevalent among children and leads to poor long-term outcomes if left untreated. Theoretical models of anxiety differ in whether children with Social Anxiety Disorder experience objective social skills deficits, negative self-interpretation biases, or some combination of the two. This pilot study evaluated evidence in support of the "deficit" and "bias" models. Approval was obtained from the ethics committee of a large private university in Cambridge, MA, USA, and data collection was completed in 2015. We recruited 68 parent-child dyads for a study in which anxious children (with Social Anxiety Disorder) and non-anxious children underwent a child-adapted version of the Trier Social Stress Test. Children were aged 8-14, 67.6% male, and self-identified as 54.4% White, 7.4% Black, 4.4% Latinx, 13.2% Asian, 14.7% multiethnic, and 5.9% "other" or no response. Performance ratings were obtained from children, their parents, and external observers. We found evidence of both specific social skills deficits and self-appraisal biases in anxious children. Anxious children struggled with signs of physical discomfort but not with actual speech content. Although children were generally able to accurately evaluate their social performance, older anxious children were most self-critical. Parents were similarly accurate in appraisals of their children's social performance. Anxious children responded favorably to positive feedback with improved self-evaluations of performance and decreased anxiety. Findings suggest that a comprehensive "integrated" theoretical model of Social Anxiety Disorder should include both skills deficits and self-appraisal biases.

The effect of positive and negative evaluation on state anxiety and repetitive negative thinking in social evaluative situations: An experimental study

The Bivalent Fear of Evaluation (BFOE) Model suggests that fears of negative and positive evaluation are core cognitive vulnerability and maintenance factors for social anxiety disorder The aim of this study was to experimentally assess cognitive and emotional effects of positive and negative feedback in social anxiety. False positive or negative feedback (vs no feedback) was provided following a speech task to high and low socially anxious individuals to investigate impacts on state anxiety and repetitive negative thinking (N = 152, Mage = 22.13, 69 % female). Measures were completed prior to the speech and after the false feedback but prior to an anticipated discussion with the group about participants' feedback and performance. High socially anxious participants reporting higher state anxiety and repetitive negative thinking than low socially anxious participants. There were no feedback type by group interactions, indicating that high socially anxious individuals experienced heightened social anxiety and repetitive negative thinking regardless of feedback type (or the absence of feedback). Exploratory analyses revealed that state fear of negative evaluation but not state fear of positive evaluation uniquely predicted both outcomes. Implications for theory and clinical practice are discussed.

Fear of positive evaluation mediates the relationship between self-efficacy and fear of negative evaluation in nursing students: A cross-sectional study

BACKGROUND

Fear of evaluation (including the negative and positive ones) has been the focus of scholarly attention as one of the core components of social anxiety. However, most existing research has focused on participants with social anxiety. Previous research has suggested that self-efficacy and fear of positive evaluation are associated with fear of negative evaluation. Still, it remains unknown whether there is an association between the three. For undergraduate nursing students in complex social environments, understanding the association between self-efficacy and fear of positive and negative evaluation is essential to facilitate the high-quality development of nursing talent.

OBJECTIVE

We aimed to explore the mediating role of fear of positive evaluation in the relationship between self-efficacy and fear of negative evaluation.

METHODS

A cross-sectional survey was conducted on 824 undergraduate nursing students using the Brief Fear of Negative Evaluation Scale-Straightforward Items, the Fear of Positive Evaluation Scale, and the General Self-Efficacy Scale. Pearson correlation analysis was used to explore the correlation of the variables. t-test or ANOVA was used as a univariate analysis. A bootstrap test was conducted to verify the mediating effect through the SPSS macro plugin PROCESS v3.3, with P < 0.05 indicating a statistically significant difference.

FINDINGS

Self-efficacy, fear of positive evaluation, and fear of negative evaluation were significantly associated. Self-efficacy directly and negatively predicted fear of negative evaluation (B = -3.14, p < 0.001). Fear of positive evaluation partially mediated between self-efficacy and fear of negative evaluation, with a mediating effect size of 38.22 %.

DISCUSSION

Self-efficacy can directly and negatively influence fear of negative evaluation. Meanwhile, it can also indirectly reduce the fear of negative evaluation by reducing the fear of positive evaluation. Nursing educators can improve the fear of negative evaluation by increasing students' self-efficacy and encouraging them to view positive assessments correctly.

Behavioral and ERP indices of self-schematic processing show differential associations with emerging symptoms of depression and social anxiety in late childhood: Evidence from a community-dwelling sample

Symptoms of depression and social anxiety elevate in late childhood. An identified cognitive risk to both depression and social anxiety is maladaptive self-schemas (or self-schematic processing). Beyond the behavioral indices of this construct, event-related potentials (ERPs) during self-schematic processing have also been observed to be associated with depression or depressive symptoms. However, no study has examined the ERPs underlying self-schematic processing in relation to social anxiety. More importantly, it was unclear to what extent behavioral and ERP indices of self-schematic processing were differentially associated with depression and social anxiety, especially in typical-risk youth with emerging symptoms. A hundred and fifteen community-dwelling children (66 girls; Mean age=10.91 years, SD=1.45) completed a self-referent encoding task (SRET) with EEG recorded. A Principal Component Analysis identified a late positive potential (LPP) component elicited in both the positive and negative SRET conditions. Multivariate multiple regression showed that in both conditions, behavioral SRET scores were associated with depressive symptoms while partialling out social anxiety symptoms, but not with social anxiety symptoms with depressive symptoms partialled out. The LPP amplitude elicited in both conditions showed marginally positive associations with social anxiety symptoms while partialling out depressive symptoms, but not with depressive symptoms while accounting for social anxiety. This study provides novel evidence concerning the ERP correlates of self-schematic processing in relation to social anxiety symptoms. More importantly, our findings for the first time speak to the differential associations between the behavioral SRET scores and SRET-elicited LPP and emerging symptoms of depression and social anxiety in late childhood.

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.

Mechanisms Linking Perfectionism and Social Anxiety: The Role of Hostility and Disqualification of Positive Social Outcomes

While considerable research has focused on maladaptive perfectionism as a risk factor for social anxiety, little attention has been given to the mechanisms that mediate the effects. We integrated perfectionism with the bivalent fear of evaluation model of social anxiety to investigate 2 hypothesized mechanisms: hostile attribution bias and disqualification of positive social outcomes (DPSO). Specifically, we hypothesized that individuals with maladaptive perfectionism develop hostile attribution biases which then lead to DPSO, which in turn predisposes them to social anxiety. Participants were 242 individuals from the general population who completed measures of perfectionism, hostile attribution bias, DPSO, and social anxiety. A test of multiple mediators using bootstrapping supported the hypothesized multiple mediator models. The results suggested that maladaptive perfectionism predisposes an individual to social anxiety through hostile attribution bias and DPSO. The results further suggested that DPSO but not hostile attribution bias operates as an individual mediator in the perfectionism-social anxiety relationship. The findings from this study provide support for the bivalent fear of evaluation model of social anxiety; however, the use of a cross-sectional design limited our ability to find true cause-and-effect relationships.

Fear of negative evaluation: A cross-sectional study among undergraduate nursing students

OBJECTIVE

To understand the current fear of negative evaluation among undergraduate nursing students and analyse the factors influencing it.

METHODS

A general information questionnaire, the scale of fear of negative evaluation, and the fear of positive evaluation scale were used to survey 546 undergraduate nursing students at Guizhou Medical University, China.

RESULTS

Undergraduate nursing students scored a total of (15.90 ± 7.18) negative evaluation fears, which is at an intermediate level. Gender, left-behind experience, whether in a romantic relationship, personality, and fear of positive evaluation entered the multiple regression equation and explained 29.1 % of the total variance.

CONCLUSIONS

The fear of negative evaluation among undergraduate nursing students was moderate. Nursing students' gender, left-behind experience, whether in a romantic relationship, personality, and fear of positive evaluation were important factors influencing their level of fear of negative evaluation. Nursing educators and administrators should be aware of nursing students' evaluation fears and select targeted evaluation strategies to promote the development of high-quality nursing talent.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Positive attention bias in high socially anxious individuals: Evidence from an ERP study

The Bivalent Fear of Evaluation (BFEO) model posits that the fear of positive evaluation (FPE) is a core feature of social anxiety. As such, high socially anxious individuals may show attention bias when faced with positive stimuli. However, most of the previous studies focused on the negative attention bias of social anxiety, and less on the attention bias of positive stimuli. Meanwhile, the effect of stimulus presentation time on the attention bias pattern was unclear. In order to investigate this question, we used a dot-probe paradigm with facial expressions (happy, fearful, angry, neutral) presented for 100 ms and 500 ms. The ERP results showed: (1) For high socially anxious group, happy faces elicited a larger N1 for valid than for invalid cued probes, whereas for healthy control group, angry faces elicited a larger N1 for valid than for invalid cued probes. (2) When valid cues following happy faces presented for 500 ms, the N1 amplitude was larger than that of invalid cues. However, when valid cues following angry and fear faces presented for 100 ms, the N1 amplitude was larger than that of invalid cues. The results showed difficulty in attention disengagement of high socially anxious individuals from positive stimuli, as reflected by N1, illustrating the positive attention bias in social anxiety. These results prove that FPE may contribute to maintaining social anxiety.

A mixed methods investigation of reasons underlying fear of positive evaluation

Fear of negative evaluation (FNE) is a hallmark feature of social anxiety disorder (SAD). There is also evidence that people with SAD fear receiving positive evaluation and that fear of positive evaluation (FPE) is distinct from FNE. However, researchers have speculated that concerns related to negative evaluation may actually underlie FPE. This study sought to advance our understanding of FPE by employing both quantitative and qualitative methods to assess the reasons underlying participants' endorsement of FPE on the Fear of Positive Evaluation Scale and the extent to which these reasons reflect FNE versus FPE in a sample of individuals with SAD (n = 47) and a nonclinical comparison group (n = 49). Results indicated that responses to the FPES items primarily reflected an underlying FNE. Consistent with contemporary cognitive-behavioural theories of SAD, fear of proximal or eventual negative judgement emerged as the most common reason for participants' responses on the FPES. However, participants reported other reasons that did not reflect FNE, such as fear of hurting people's feelings and uncertainty associated with positive evaluation. All of the reasons underlying participants' ratings on the FPES were reported by both the SAD group and the nonclinical comparison group; however, individuals with SAD endorsed each of the reasons to a greater extent. These findings suggest that the FPES does not exclusively assess FPE as intended; however, the emergence and endorsement of reasons other than FNE suggest that FPE exists as a distinct construct.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

Relationship Between Hardiness and Social Anxiety in Chinese Impoverished College Students During the COVID-19 Pandemic: Moderation by Perceived Social Support and Gender

During the COVID-19 epidemic, quarantine and financial disadvantages might exacerbate social anxiety among impoverished college students. Based on the hardiness model and the social support buffering model, the present study proposed and verified a dual moderation model to investigate the effects of hardiness on social anxiety and the moderating roles of gender and perceived social support. The hardiness scale, the perceived social support scale, and the social anxiety subscale of the self-consciousness scale were administered to 673 Chinese college students aged 18 to 23 years who were recognized as impoverished by the Chinese authorities and provided with funding. The results revealed that (1) hardiness had a significant negative effect on social anxiety, (2) perceived social support moderated the effect of hardiness on social anxiety, and (3) gender moderated the effect of hardiness on social anxiety. The dual moderated model proposed in the study provides practical implications for helping impoverished college students cope with social anxiety during the COVID-19 pandemic.

As they wait: Anticipatory neural response to evaluative peer feedback varies by pubertal status and social anxiety

Adolescence is a developmental period characterized by substantial biological, neural, behavioral, and social changes. Learning to navigate the complex social world requires adaptive skills. Although anticipation of social situations can serve an adaptive function, providing opportunity to adjust behavior, socially anxious individuals may engage in maladaptive anticipatory processing. Importantly, elevated social anxiety often coincides with adolescence. This study investigated cortical electroencephalogram (EEG) responses during anticipation of evaluative feedback in 106 healthy adolescents aged 12–17 years. We examined differences in anticipatory event-related potentials (i.e., stimulus preceding negativity [SPN]) in relation to social anxiety levels and pubertal maturation. As expected, the right frontal SPN was more negative during feedback anticipation, particularly for adolescents with higher social anxiety and adolescents who were at a more advanced pubertal stage. Effects for the left posterior SPN were the opposite of those for the right frontal SPN consistent with a dipole. Anticipatory reactivity in adolescence was related to social anxiety symptom severity, especially in females, and pubertal maturation in a social evaluative situation. This study provides evidence for the development of social anticipatory processes in adolescence and potential mechanisms underlying maladaptive anticipation in social anxiety.

The role of psychopathic traits, social anxiety and cortisol in social approach avoidance tendencies

Social anxiety and psychopathy have conceptually been linked to nearly opposite emotional, behavioral and endocrinological endophenotypes, representing social fearfulness and fearlessness, respectively. Although such a dimensional view has theoretical and practical implications, no study has directly compared social anxiety and psychopathy in terms of emotional experiences, relevant hormones (i.e. cortisol, testosterone) and behavioral tendencies (i.e. social approach-avoidance). Therefore, the present study examined 1) whether self-reported social anxiety and psychopathic traits are indeed anticorrelated, and 2) whether social anxiety, psychopathic traits, cortisol, testosterone and their interplay are differentially linked to social approach-avoidance tendencies. In a well-powered study, a sample of 196 healthy female participants, we assessed self-reported emotional and behavioral tendencies of social fear (i.e. social anxiety and social avoidance) and psychopathic traits (i.e. Factor I [interpersonal-affective deficit] and Factor II [impulsive behavior]). Furthermore, hormone levels were assessed, and approach-avoidance tendencies towards emotional (angry, happy) facial expressions were measured by means of a joystick reaction time task. Results confirmed that self-reported emotional tendencies of social anxiety and psychopathy Factor I (interpersonal-affective deficit) correlated negatively, but self-reported behavioral tendencies (social avoidance and psychopathy Factor II [impulsive behavior]) correlated positively. Furthermore, Structural Equation Modelling demonstrated that participants with higher social anxiety and higher cortisol levels showed an avoidance tendency towards happy faces, while participants with higher psychopathic traits showed an approach tendency towards angry faces. In sum, the notion that social anxiety and psychopathic traits are opposing ends of one dimension was supported only in terms of self-reported emotional experiences, but a comparable relationship with regard to behavioral and endocrinological aspects is debatable. The current findings stress the necessity to study emotional, endocrinological and behavioral factors in unison in order to better understand the shared and distinctive mechanisms of social anxiety and psychopathic traits.

Anxiety- and Depression-Related Individual Differences in Affective and Cognitive Judgments of Self-Referential Praise and Criticism

Introduction: While praise is generally pleasant and criticism unpleasant, individual differences in response to social evaluations arise from distinct personal traits and states. Here, we investigate how processing of self-referential praise and criticism varies with personal attributes related to anxiety and depression, two highly prevalent and often chronic affective conditions. Methods: Ninety-three healthy participants first completed questionnaires for anxiety- and depression-related traits and states, and then they were scheduled to perform an evaluation task to rate praise and criticism for pleasantness and truthfulness. Results: Fear of negative evaluation positively correlated with unpleasantness of criticism. Trait- and state-anxiety and depression were positively associated with the truthfulness of criticism but negatively associated with that of praise. We further divided participants into high- and low-scoring groups based on the medians of their scores of each scale that displayed significant correlations with comment ratings and found group differences in their responses to praise and criticism. Discussion: The findings suggest that more highly anxious and depressed individuals may be subject to negatively-distorted self-representations in response to self-referential evaluations, thus exhibiting attenuated rejection for criticism or reduced acceptance for praise, which may have important implications not only for facilitating daily social interactions but also for subclinical and clinical diagnosis and treatment given that affective and cognitive processing of self-referential evaluations serves as a critical process exhibiting the sense of the self.

An effort-based social feedback paradigm reveals aversion to popularity in socially anxious participants and increased motivation in adolescents

We created a novel social feedback paradigm to study how motivation for potential social links is influenced in adolescents and adults. 88 participants (42F/46M) created online posts and then expended physical effort to show their posts to other users, who varied in number of followers and probability of positive feedback. We focused on two populations of particular interest from a social feedback perspective: adolescents relative to young adults (13-17 vs 18-24 years of age), and participants with social anxiety symptoms. Individuals with higher self-reported symptoms of social anxiety did not follow the typical pattern of increased effort to obtain social feedback from high status peers. Adolescents were more willing to exert physical effort on the task than young adults. Overall, participants were more likely to exert physical effort for high social status users and for users likely to yield positive feedback, and men were more likely to exert effort than women, findings that parallel prior results in effort-based tasks with financial rather than social rewards. Together the findings suggest social motivation is malleable, driven by factors of social status and the likelihood of a positive social outcome, and that age, sex, and social anxiety significantly impact patterns of socially motivated decision-making.

Behavior when socially anxious individuals expect to be (dis)liked: The role of self-disclosure and mimicry in actual likeability

BACKGROUND AND OBJECTIVES

This study aimed to unravel the relationship between socially anxious individuals' expectation of being (dis)liked and actual likeability by looking at the mediating role of both strategic and automatic social behavior: Self-disclosure as well as mimicry were examined.

METHOD

Female participants (N = 91) with various levels of social anxiety participated in a social task with a confederate. Before the task, participants indicated their expectation of being liked by the confederate. Afterwards, objective video-observers rated the likeability of the participants before and after the social task as well as their level of self-disclosure and mimicry.

RESULTS

Social anxiety correlated negatively with the expectation to be liked but was not related to observer ratings of likeability, self-disclosure or mimicry. However, degree of social anxiety moderated the relation between expectations and self-disclosure. As expected, participants with low levels of social anxiety disclosed more if they expected to be liked. A reversed pattern was found for the high socially anxious participants: Here, higher expectations of being liked were related to less self-disclosure.

LIMITATIONS

The study used an analogue female sample. Our social interaction task was highly structured and does not reflect informal day-to-day conversations.

CONCLUSION

Socially anxious individuals function rather well in highly structured social tasks. No support was found for declined likeability or disrupted mimicry. Nevertheless, high socially anxious individuals did have a cognitive bias and show a self-protective strategy: when expecting a neutral judgment they reduce their level of self-disclosure. This pattern probably adds to their feelings of social disconnectedness.