Alcohol and caffeine use by social phobics: an initial inquiry into drinking patterns and behavior

Psychometric Properties of Behavioral Checklist for Coping with Stress in Patients with Mood Disorders

OBJECTIVE

Even though the importance of stress-coping, there is no reliable and valid scale to measure the stress-coping behavior yet. The purpose of this study is to explore the psychometric properties of Behavioral Checklist for Coping with Stress (BCCS).

METHODS

A total of 458 subjects including healthy subjects and patients with bipolar or depressive disorders were analyzed. The reliability and validity of BCCS were examined by Chronbach's alpha and exploratory factor analysis using Principal Component Analysis. In order to evaluate criterion-related validity, the Pearson's correlation analyses between factors of BCCS and relevant scales were performed.

RESULTS

BCCS showed good Chronobach's alpha (0.695-0.833) and had acceptable validity. Factor 1 and factor 4 of BCCS were negatively correlated with depression, anxiety and positivity correlated with task and problem-solving, avoidance, tension-releasing copings in common. Factor 2 and 3 were positively correlated with impulsivity, emotionality, avoidance, behavioral and verbal aggression and tension-releasing copings in common. Different from factor 2, factor 3 was positively correlated with depression, anxiety and anger-suppression.

CONCLUSION

The results of this study suggest that this BCCS might be a reliable and valid scale for measuring stress-coping behaviors. This scale could facilitate research to investigate clinical implications related to behavioral stress-coping.

Social anxiety and alcohol problems: the roles of perceived descriptive and injunctive peer norms

Although people with higher social anxiety (HSA) appear particularly vulnerable to alcohol-related problems it remains unclear why people with HSA experience such problems. One possibility is that HSA people's drinking behavior is influenced by their beliefs about others' drinking (i.e., descriptive norms) and/or others' approval of drinking (i.e., injunctive norms). The current study investigated the relationship between social anxiety, alcohol-related problems, drinking frequency and quantity, and descriptive and injunctive norms. The sample consisted of current drinkers with clinically elevated social anxiety (HSA; n=86) or lower social anxiety (LSA; n=86). Injunctive norms moderated the relationship between social anxiety group status and alcohol-related problems such that HSA participants with higher injunctive norms reported the most alcohol-related problems. Descriptive norms moderated the relationship between social anxiety and drinking quantity such that among participants with higher descriptive norms, LSA participants drank more than HSA participants.

Effects of alcohol on the processing of social threat-related stimuli in socially phobic women

BACKGROUND

Social phobics are at a higher risk of developing alcohol problems. The mechanism promoting this association is not clear. According to Sayette (1993b), alcohol attenuates anxiety responses by disrupting initial appraisal of threatening stimuli. We used the emotional Stroop test and an implicit memory test to investigate whether alcohol hinders appraisal of social threat words in patients diagnosed with social phobia.

PROCEDURE

Thirty-two women with social phobia (DSM-IV) and 32 female controls performed an emotional Stroop test either after drinking alcohol resulting in a blood alcohol levels (BAL) of 0.6%. or after drinking a non-alcoholic beverage. The emotional Stroop test contained social anxiety-related and neutral stimuli. Implicit memory for the words presented was tested with a word-stem completion test.

RESULTS

Without alcohol, both controls and socially-phobic participants took longer to name the colour of socially-threatening stimuli than of neutral stimuli. Alcohol levelled response latencies to the two stimulus categories only in controls. Socially-phobic participants responded more slowly to social anxiety-related stimuli than to neutral stimuli, irrespective of their BAL. In contrast to controls, social phobics showed an implicit memory bias for social threat words. This bias was attenuated by alcohol.

DISCUSSION

Alcohol disrupts appraisal of social anxiety-related stimuli in controls but not in social phobics; in these it hinders the consolidation of memory. This also suggests that social phobics experience similar anxiety with and without alcohol, but remember this experienced anxiety less precisely. This effect might act as a reinforcer for the use of alcohol for the purpose of self-medication in future situations.

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

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

Ein Überblick über experimentelle Befunde zur Wirkung von Alkohol auf klinisch relevante Angst

Zusammenfassung. Hintergrund: Ein überzufälliger Zusammenhang zwischen Angststörungen und Alkoholproblemen ist belegt. Trotz zahlreicher Studien mit subklinischen Populationen ist die Befundlage zur anxiolytischen Wirkung von Alkohol jedoch uneindeutig. Fragestellung: Wirkt Alkohol bei klinisch relevanten Ängsten anxiolytisch? Welche Einflussfaktoren existieren und welche Mechanismen sind beteiligt? Methode: Ein Review empirischer Studien zur anxiolytischen Wirkung von Alkohol bei pathologischer Angst. Ergebnisse: Die Ergebnisse der 11 publizierten Studien werden dargestellt. Der Fokus liegt auf der Wirkung von Alkohol bei Sozialphobie (N = 7), Panikstörung (N = 3) und spezifischer Phobie (N = 1). Zusammenfassend ist eine anxiolytische Wirkung an eine Mindestmenge Alkohol (BAK: > 0.05%), positive Wirkungserwartungen sowie andere psychologische Faktoren gebunden. Diskussion: Die Selbstmedikationshypothese hat nur unter Berücksichtigung verschiedener biologischer und psychologischer Faktoren Bestand. Mögliche Implikationen für die Behandlung werden diskutiert.

Social anxiety and problematic alcohol consumption: the mediating role of drinking motives and situations

Social anxiety is inconsistently associated with alcohol use variables. To elucidate factors that contribute to the relationship between social anxiety and problematic alcohol use, the present study investigated drinking motives and drinking situations in an undergraduate sample (N=293). Social anxiety was significantly correlated with endorsement of enhancement drinking motives (i.e., drinking to enhance positive experiences or emotions) but not social or coping motives. Social anxiety was also correlated with endorsement of drinking in the following high-risk situations: unpleasant emotions, conflict with others, social pressure, and testing personal control. Importantly, enhancement motives and each of these drinking situations mediated the relationship between social anxiety and alcohol-related problems. Findings suggest that alcohol use to enhance positive affect or in response to these specific situations may account for the risk for alcohol-related problems among those with social anxiety.

The relationship between social anxiety disorder and alcohol use disorders: A critical review

Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.

Alcohol and anxiety: subtle and obvious attributes of abuse in adults with social anxiety disorder and panic disorder

Previous research has found a relation between social anxiety disorder and alcoholism but recent work found no differences in drinking levels among socially anxious individuals, dysthymics, and normal controls. Using a more sophisticated measure of substance abuse may further explicate the relation between social anxiety and drinking. We examined aspects of substance abuse in treatment-seeking individuals with social anxiety disorder or panic disorder (psychiatric control group) as well as nondisordered individuals (normal control group). We used the Substance Abuse Subtle Screening Inventory-3 because it includes both face valid and subtle items to control for social desirability. Contrary to the hypotheses, there were few obvious or subtle aspects of substance abuse significantly greater for individuals with social anxiety disorder than those with panic disorder or normal controls. Implications for understanding the social anxiety-alcohol relationship, assessment of substance abuse in socially anxious populations, and the construct of social anxiety-are discussed.

Self-medication in social phobia: a review of the alcohol literature

It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH). Support for one aspect of the SMH was found; individuals with social phobia use alcohol to reduce anxiety. Support for the second premise, that alcohol actually reduces social anxiety, was less conclusive.