Internet-Based Versus Face-to-Face Cognitive-Behavioral Therapy for Social Anxiety Disorder: A Randomized Control Trial

During the COVID-19 epidemic, face-to-face mental health services faced obstacles. Using Internet-based interventions was a good solution and had the potential to overcome these treatment barriers. However, there is no strong research evidence about the effectiveness of these methods for social anxiety disorder in different cultures and developing countries. Therefore, the present study aimed to investigate the effectiveness and application of Internet-based cognitive-behavioral therapy for social anxiety disorder in Iran. The current study was a pretest-posttest follow-up experimental design. Fifty-four adolescents with social anxiety disorder were selected from Lorestan province (Iran) by cluster sampling method and randomly assigned to three groups: face-to-face, internet-based, and wait-list control. At the beginning and end of the study and 3-month follow-up, three groups were interviewed and answered questionnaires related to the primary and secondary symptoms of social anxiety disorder. Two experimental groups were treated with the same therapeutic intervention during 10 weekly sessions. ANCOVA analysis showed that both forms of intervention effectively reduced social phobia, fear of negative evaluation and social interaction anxiety and increased emotion regulation. Also, a significant decrease in secondary outcomes, including physical symptoms, insomnia, social dysfunction, and depression symptoms, was observed in both groups. The treatment effects were stable during a 3-month follow-up. Our findings showed that although Internet-based cognitive-behavioral therapy for adolescents with social anxiety disorder can be effective, several clinical, cultural, and implementation weaknesses should be considered.

Social Anxiety and Drunkorexia Behaviors among Adolescents and Young Adults: The Moderating Role of Resilience

Background: Existing evidence showed that social anxiety represents a significant factor in eating disorders. However, to our knowledge, no prior study has examined the association between social anxiety and drunkorexia behaviors. Objectives: The present study aimed at exploring the relationship between social anxiety and drunkorexia behaviors, and investigating resilience as a moderator of this relationship. Participants were 333 adolescents and young adults aged 15-24 years (Mage=18.26, SDage= 1.55; 66% females) who completed an online survey. Results: The results indicated that drunkorexia behaviors were positively correlated to three dimensions of social anxiety; however, only fear of negative evaluation had a significant predictive effect. In addition, resilience only moderated the relationship between fear of negative evaluation and drunkorexia behaviors, such that youths reporting high fear of negative evaluation and low resilience showed greater drunkorexia behaviors, whereas youths reporting high resilience showed no correlation between fear of negative evaluation and drunkorexia behaviors. Conclusions: The findings highlight the importance of drunkorexia interventions and preventive measures aimed at strengthening youths' resilience and ability to effectively manage stress and social anxiety (i.e., fear of negative evaluation).

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.

A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial

BACKGROUND

Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student's sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors.

OBJECTIVE

This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way.

METHODS

To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus.

RESULTS

In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of -2 to +2) and had a high completion rate (>97%).

CONCLUSIONS

This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class.

TRIAL REGISTRATION

OSF Registries osf.io/4ca68 http://osf.io/4ca68.

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.

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.

Modification of the therapist's facial expressions using virtual reality technology during the treatment of social anxiety disorder: a case series

Exposure therapy is a mainstream of treatment for social anxiety disorder (SAD). However, effort and time are required to recreate interpersonal situations that produce moderate anxiety. On the other hand, virtual reality exposure therapy can easily control anxiety-inducing conditions and allow for graduated exposure. However, artificial intelligence and animations that speak as naturally as actual humans are not yet practical, adding to the limitations of these treatments. The authors propose the use of a virtual reality technology that can transform facial expressions into smiling or sad faces in real time and display them on a monitor, potentially solving the above-mentioned problems associated with virtual reality animations. This feasibility study was conducted to determine whether this system can be safely applied to the treatment of SAD patients. A total of four SAD patients received 16 exposure therapy sessions led by an experienced therapist over a monitor; throughout the sessions, the facial expressions of the therapist were modified using software to display expressions ranging from smiling to sad on the monitor that was being viewed by the patient. Client satisfaction, treatment alliance, and symptom assessments were then conducted. Although one patient dropped out of the study, treatment satisfaction and treatment alliance were scored high in all the cases. In two of the four cases, the improvement in symptoms was sustained over time. Exposure therapy in which the interviewer's facial expressions are modified to induce appropriate levels of anxiety in the patient can be safely used for the treatment of SAD patients and may be effective for some patients.

The role of negative evaluation fears on associations between societal appearance pressures and disordered eating in university students

Objective: Previous research demonstrates that sociocultural appearance pressures and internalization of appearance ideals lead to disordered eating (DE); however, only a subset of individuals exposed to these influences develop clinically significant DE. Identifying moderators of these associations may increase efficacy of targeted preventions for eating disorders. This study investigated whether the fear of negative evaluation (FNE) moderates these associations. Participants: 567 university students participated between November 2019 and 2020. Methods: Participants completed self-report questionnaires assessing appearance pressures, internalization of appearance ideals, FNE, and DE. Results: There was a significant interaction between appearance pressures and FNE in relation to DE. Individuals with high appearance pressures and high FNE had the highest levels of DE. The interaction between internalization of appearance ideals and FNE did not significantly contribute to DE. Conclusions: Eating disorder prevention programs that address FNE and appearance pressures may have beneficial effects, particularly for university students with heightened FNE.

Context and domain matter: the error-related negativity in peer presence predicts fear of negative evaluation, not global social anxiety, in adolescents

BACKGROUND

Social anxiety symptoms are most likely to emerge during adolescence, a developmental window marked by heightened concern over peer evaluation. However, the neurocognitive mechanism(s) underlying adolescent social anxiety remain unclear. Emerging work points to the error-related negativity (ERN) as a potential neural marker of exaggerated self/error-monitoring in social anxiety, particularly for errors committed in front of peers. However, social anxiety symptoms are marked by heterogeneity and it remains unclear exactly what domain(s) of social anxiety symptoms are associated with ERN variation in peer presence, particularly within the adolescent period.

METHODS

To advance and deepen the mechanistic understanding of the ERN's putative role as a neural marker for social anxiety in adolescence, we leveraged a social manipulation procedure and assessed a developmentally salient domain of social anxiety during adolescence - fear of negative evaluation (FNE). Adolescents residing in Hanzhong, a small city in the southwestern region of mainland China, had EEG recorded while performing a flanker task, twice (peer presence/absence); FNE, as well as global social anxiety symptoms, was assessed.

RESULTS

Overall ERN increases in peer presence. FNE specifically, but not global levels of social anxiety symptoms, predicted ERN in peer presence.

CONCLUSIONS

These data are the first demonstration that the ERN relates to a specific domain of social anxiety in adolescents, as well as the first evidence of such relations within a non-WEIRD (Western, Educated, Industrialized, Rich and Democratic) sample. Results have important implications for theory and research into adolescent social anxiety.

Perceived stigmatization and fear of negative evaluation: Two distinct pathways to body image dissatisfaction and self-esteem in burn survivors

OBJECTIVE

Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation.

DESIGN & MAIN OUTCOME MEASURES

Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships.

RESULTS

Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly.

CONCLUSIONS

Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

"I still have issues with pronunciation of words": A mixed methods investigation of the psychosocial and speech effects of Childhood Apraxia of Speech in adults

PURPOSE

Adolescents with Childhood Apraxia of Speech (CAS) are likely to have persistent speech errors compared to non-CAS peers (Lewis et al., 2018) and may have ongoing psychosocial issues (e.g. Carrigg, Parry, Baker, Shriberg, & Ballard, 2016). Beyond this, little is known about the long-term consequences of CAS in adulthood. This study explored whether adults who were reported to have had CAS as children have ongoing psychosocial or speech impacts.

METHOD

A cross-sectional descriptive design, with mixed-method analyses of demographic, psychosocial, and speech data was used. Data were collected via a four-part online survey. Part one consisted of questions about demographic information and participants' self-reported performance in speech, language and literacy. Parts two and three investigated the psychosocial impacts of CAS using the Brief Fear of Negative Evaluation Scale - Revised (BFNE- R) and The State-Trait Anxiety Inventory (STAI). Part four collected single word and connected speech data via an online audio recording, which was then transcribed following the Connected Speech Transcription Protocol (CoST-P). Analyses of speech characteristics reported in CAS was completed using Phon software.

RESULT

There were 17 participants in part one, 16 in parts two and three, and six in part four. Participants reported elevated levels of state (p = 0.01) and trait (p = 0.0001) anxiety compared to normative data. Ongoing segmental and suprasegmental speech errors were observed, with a significant difference between percent phonemes correct in single words versus connected speech (p = 0.03). Participants who provided a speech sample had difficulty with correct stress, use of juncture, and had increased intra- and inter-word segregation. Participants with better speech reported less anxiety.

CONCLUSION

Psychosocial effects and speech characteristics associated with CAS in childhood appear to persist into adulthood. Confirmation of these results and research to determine treatment and psychosocial support needs past early childhood is warranted.

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.

Fear of negative evaluation and suicidal ideation among college students: the moderating role of impulsivity-like traits

Objective: Fear of negative evaluation (FNE) is a key trait of social anxiety and has been linked to isolation and low self-esteem. Impulsivity has been shown to amplify the risk of socially anxious individuals engaging in risky behaviors such as suicidal behaviors; yet little research has examined associations between FNE and suicidality or the relationship between FNE and impulsivity. Participants/Methods: This study tested whether FNE was associated with suicidal ideation in a sample of 1,816 college students from 10 universities. Analyses also examined whether impulsivity-like traits moderated the relationship between FNE and suicidal ideation. Results: Results showed that FNE was significantly associated with suicidal ideation and the positive association between FNE and suicidal ideation was strongest among individuals with higher negative urgency and lower perseverance. Conclusions: These findings highlight FNE as an important risk factor of suicidal ideation in college students and illuminates potential influence of impulsivity on this relationship.

Relationships among inferiority feelings, fear of negative evaluation, and social anxiety in Chinese junior high school students

Introduction

This study aimed to explore the relationship between feelings of inferiority and social anxiety in Chinese junior high school students. In addition, it examined the potential mediating effect of fear of negative evaluation in this relationship.

Methods

A survey was administered to a sample of 734 Chinese junior high school students. The Feelings of Inadequacy Scale, Brief Fear of Negative Evaluation Scale, and Social Avoidance Distress Scale were used.

Results

First, there were significant positive correlations between all subscales for the inferiority feelings, social anxiety, and fear of negative evaluation. Furthermore, fear of negative evaluation mediated the predictive effects of four inferiority subscales (i.e., self-esteem, academic ability, appearance, and physical ability) for social anxiety. However, the total score for the sense of inferiority and social confidence subscale lacked this mediating effect.

Conclusion

The inferiority feelings of self-esteem, academic ability, appearance, and physical ability may directly and indirectly predict social anxiety through fear of negative evaluation.

[Mental disorders in blepharospasm]

OBJECTIVE

To analyze mental disorders in blepharospasm (BS) before and after botulinum therapy (BT).

MATERIAL AND METHODS

We examined 25 patients with BS (9 men and 16 women), aged 50 to 85 years (mean 64.1±18.5), with BS (main study group). The control group consisted of 20 healthy individuals (7 men and 13 women, mean age 63.5±8.5). Patients were examined before and after BT (after 3 weeks) using a diagnostic structured interview Mini International Neuropsychiatric Interview, GAD-7, PHQ-9, fear of negative assessment (short version) and The Liebowitz Social Anxiety Scale (LSAS).

RESULTS

Fifty-six percent of patients with BS, as assessed by the GAD-7, showed a high level of anxiety, while depression, measured by the PHQ-9 and found in 52% of patients, was mainly manifested by mild disorders. In the group of patients with BS, the mean scores were higher on the GAD-7, PHQ-9, fear of negative assessment (p<0.001) and LSAS (p<0.05) than in the control group. After treatment with BT, the levels of anxiety and depression in patients with BS decreased slightly and remained higher compared with the control group. Psychiatric examination in the majority (64%) of patients revealed mental disorders that could not be explained by the occurrence of BS. The remaining 36% of patients had adaptation disorders (nosogenic reactions) caused by BS. Affective mental pathology (recurrent depressive disorder and dysthymia) and anxiety disorders (social phobia and adjustment disorders) were more often observed in the main study group compared with the control group (24% versus 5% and 68% versus 10%, respectively).

CONCLUSION

A significant proportion of patients with BS have anxiety and depressive disorders, the severity of which does not depend only on the severity of motor symptoms and does not significantly decrease after successful BT, but is caused by mental disorders that preceded the manifestation of BS. Identification of mental disorders to varying degrees associated with BS, not only on the basis of psychometric scales, but also consultation with a psychiatrist, will allow, in addition to the correction of motor symptoms of BS, to differentiate the therapeutic approach through psychotherapy and psychopharmacotherapy.

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.

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.

The Influence of the Fear of Negative Evaluation on Activity Avoidance in Fibromyalgia: Exploring Pain Acceptance and Positive Affect as Resilience Variables

To examine the mediating role of pain acceptance (PAcc) between fear of negative evaluation (FNE) and activity avoidance (AV) at different levels of positive affect (PA) (moderator) among women diagnosed with fibromyalgia (FM) (moderate mediation model). This study was cross-sectional in design. A convenience sample of women with FM (n = 231) completed measures of pain severity, FNE, PAcc, AV, and PA. A simple mediation model and a moderate mediation model was constructed and analyzed using the SPSS macro-PROCESS. First, PAcc mediated the effect of FNE on AV (β = .02, SE = 0.008; [95% CI [0.0075, 0.0394]). Second, a mediated effect of PAcc between FNE and AV moderated by PA at medium and high levels of PA were found (m: 0.23; β = -.22, p = .0006; h: 9.59; β = -.34, p = .0002. Future work should seek to validate study findings in diverse samples of FM patients. Additionally, future work should explore how FM self-management interventions that include PAcc can promote increased activity among women suffering from FM with medium to high levels of PA.

Fear of negative evaluation modulates the processing of social evaluative feedback with different valence and contexts

Fear of negative evaluation (FNE) is a susceptible and maintaining factor of social anxiety disorders. However, the question, how people process negative evaluation is influenced by individual differences in FNE, is poorly understood. To clarify the habitual processing characteristics of individuals with different levels of FNE, electroencephalography was recorded when two groups of participants with high FNE (hFNE) and low FNE (lFNE) performed a social evaluation perception task in which the feedback context/source (human vs. a computer) and valence (thumb-up/like vs. thumb-down/dislike) were manipulated. We found effects of feedback source and valence on N1, P2, and P3, which reflect early attention, integrated perception, and elaborative processing, respectively, as well as general reward effects on reward positivity (RewP) across contexts. Importantly, compared to the lFNE group, the hFNE group showed larger midfrontal N1 and theta oscillation in response to negative feedback indicating dislike (vs. like), and also showed larger P3. These findings suggest that individuals with hFNE are more attentional vigilance to negative (vs. positive) social feedback, implying that individuals with different levels of FNE assign different implicit threat values to social-evaluation threat stimuli.

Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial

BACKGROUND

Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.

METHODS

A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.

RESULTS

Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).

CONCLUSIONS

Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.

Fear of Evaluation and Online Self-Disclosure on WeChat: Moderating Effects of Protective Face Orientation

Fear of evaluation is a key factor that affects how social media users present themselves to others, but little is known about the effects and mechanisms involved, especially on the relationship between fear of positive evaluation and online self-disclosure. This study explores how fear of evaluation affects online self-disclosure and examines how this relationship is moderated by protective face orientation in the Chinese context. A total of 750 Chinese WeChat users constituted the sample for a questionnaire-based analysis and regression analysis. The results showed that both fear of positive evaluation and fear of negative evaluation had a significant negative effect on the amount of online self-disclosure and a significant positive effect on the depth of online self-disclosure. Protective face orientation had a moderating effect on the relationship between fear of evaluation and online self-disclosure for both the amount and depth of online self-disclosure. Our findings suggest that social network site (SNS) users' fear of evaluation can be attributed to their cognitive attitude toward the external environment, and the loss of face in the Chinese context can be included in the social context.

Increased Conformity to Social Hierarchy Under Public Eyes

Why would people conform more to others with higher social positions? People may place higher confidence in the opinions of those who rank higher in the social hierarchy, or they may wish to make better impressions on people of higher social status. We investigated how individual preferences for novel stimuli are influenced by the preferences of others in the social hierarchy and whether anonymity affects such preference changes. After manipulation of their social rank, participants were asked to indicate how much they liked or disliked a series of images. Then, they were shown the rating given to each image by a partner (either inferior or superior in social rank) and were given a chance to adjust their ratings. The participants were more likely to change their preferences to match those of a superior partner in the public vs. private condition. The tendency to conform to the views of the superior partner was stronger among those with higher social dominance orientation (SDO) and those with greater fear of negative evaluation (FNE) by others. Altogether, the findings suggest that the motivation to make better impressions on people of higher social status can be the major driver of conformity to others with higher social positions.

Physical Activity as a Treatment for Social Anxiety in Clinical and Non-clinical Populations: A Systematic Review and Three Meta-Analyses for Different Study Designs

The fear of being in the focus of attention in social situations can develop into a social anxiety disorder (SAD). The classical treatment for SAD is cognitive behavioral therapy, which is in many cases accompanied by drug treatments. A promising alternative treatment is physical activity (PA) interventions, because regular PA has been shown to be suitable for reducing anxiety in general. We conducted a pre-registered systematic review and meta-analysis (PROSPERO registration no. CRD42020191181) as well as two additional searches. Our aim was to investigate whether PA interventions are a suitable treatment for SAD and whether PA is suitable for reducing social anxiety (SA) in general. For studies with randomized controlled trial designs, a not statistically significant effect of medium size toward lower general SA symptomatology was found in the PA group in comparison with the control group (d = -0.24, p = 0.377). For studies with longitudinal designs, significantly lower SA symptoms were found after PA treatments (d = -0.22, p = 0.001). The effect of PA on SA was stronger for adults than for children and adolescents (p = 0.003). For cross-sectional studies, a small negative association between SA symptoms and the amount of PA was found, i.e., lower SA was found for people who were more physically active (r = -0.12, p = 0.003). We conclude that PA is a promising means for the (additional) treatment of SAD or to reduce SA in general in non-clinical samples, but more research in which high-quality studies with randomized controlled trial designs are used is needed. Furthermore, open questions with respect to moderating variables (e.g., age, sex, BMI, type of intervention, stress, amount of regular PA before the intervention, and comorbidities) remain still open.

Spanish Women Making Risky Decisions in the Social Domain: The Mediating Role of Femininity and Fear of Negative Evaluation

Authors have empirically evidenced that cultural stereotypes influence gender-typed behavior. With the present work, we have added to this literature by demonstrating that gender roles can explain sex differences in risk-taking, a stereotypically masculine domain. Our aim was to replicate previous findings and to analyze what variables affect women making risky decisions in the social domain. A sample composed of 417 Spanish participants (281 women and 136 men), between 17 and 30 years old (M = 22.34, SD = 3.01), answered a set of self-report measures referring to femininity, fear of negative evaluation, and social risk-taking. According to the main results, sex indirectly linked to risk-taking in the social domain, through femininity and fear of negative evaluation. Specifically, women (vs. men) self-reported higher feminine traits, which were associated with increased fear of negative evaluation, which in turn was associated with less risky decisions in the social domain. Thus, we have showed the relationship between gender roles and women's behaviors in a stereotypically masculine domain (risk-taking). Our findings highlight the necessity of considering a gender-based perspective in the field of risk-taking, showing that not all women make more risky decisions in the social domain.

A longitudinal assessment of the bivalent fear of evaluation model with social interaction anxiety in social anxiety disorder

BACKGROUND

The Bivalent Fear of Evaluation Model proposes that the fears of positive and negative evaluation each uniquely contribute to social anxiety severity. However, the debate continues as to whether these are distinct constructs, and, if so, the degree of influence each has on social anxiety severity. This study used a longitudinal evaluation of these relationships in a clinical sample to identify whether the two fears differentially change over time and differentially relate to social anxiety severity.

METHODS

Individuals with a social anxiety disorder (N = 105) completed measures of fears of negative and positive evaluation weekly, and social interaction anxiety monthly, for 12 weeks. Temporal relationships were assessed using residual dynamic structural equation modeling.

RESULTS

Fears of positive and negative evaluation both predicted the future status of the other (ϕ = 0.18, 95% credibility interval [0.10-0.28] and ϕ = 0.22 [0.12-0.35], respectively). Fear of negative evaluation (ϕ = 0.16 [0.05-0.28]) but not positive evaluation (ϕ < 0.01 [-0.09 to 0.10]) directly predicted future social anxiety severity. Fear of positive evaluation only indirectly predicted anxiety severity via fear of negative evaluation.

CONCLUSIONS

Previous fears of negative evaluation could not fully explain future fears of positive evaluation (or vice-versa), which is consistent with the two constructs being likely distinct in social anxiety disorder. Given its more direct relationship with social anxiety severity, fear of negative evaluation should be targeted in treatment, as this could both directly reduce social anxiety severity and minimize the indirect impact of fear of positive evaluation.

The Fears of Evaluation About Performance (FEAP) Task: Inducing Anxiety-Related Responses to Direct Exposure to Negative and Positive Evaluations

Fears of negative and positive evaluation (i.e., evaluative fears) manifest within performance-based situations (e.g., public speaking, group presentations), particularly among those experiencing social anxiety. Within these performance-based situations, individuals experiencing such evaluative fears frequently display a variety of impairments (e.g., avoidance, nervousness) that might manifest within and across various settings (e.g., employment, school). How do those who experience these fears react to in-the-moment feedback about their performance? We constructed the Fear of Evaluation About Performance (FEAP) task to examine ecologically valid experiences with anxiety when reacting to positive and negative feedback. During the task, participants gave a speech, and subsequent to this and in counterbalanced order, received positive and negative feedback about their speech, with continued assessment of anxiety-related arousal throughout the task. We tested the FEAP task among 127 adults, who provided self-reports of fears of positive and negative evaluation before completing the task. Fears of positive evaluation uniquely predicted arousal following receipt of positive feedback, whereas fears of negative evaluation uniquely predicted arousal following receipt of negative feedback. Relative to participants receiving positive feedback first, those receiving negative feedback first experienced elevated post-feedback arousal, followed by a steep decline in arousal post-positive feedback. Conversely, participants receiving positive feedback first experienced a buffer effect whereby arousal post-negative feedback remained low, relative to the arousal experienced post-negative feedback among those who received negative feedback first. We expect the FEAP task to inform basic science on fears of negative and positive evaluation, as well as treatment planning in applied clinical settings.

Fear of negative evaluation among eating disorders: Examining the association with weight/shape concerns in adolescence

OBJECTIVE

Fear of negative evaluation has been proposed as a transdiagnostic factor associated with the development of eating disorders and has been shown to relate to disorders of body image, especially those with weight/shape concerns such as eating disorders and muscle dysmorphia. The current study aimed to investigate whether fear of negative evaluation was a transdiagnostic factor of disorders diagnostically characterized by weight/shape concerns. The study examined whether fear of negative evaluation was associated with higher odds for meeting criteria for an eating disorder and/or muscle dysmorphia, especially those disorders diagnostically characterized by weight/shape concerns.

METHOD

Data were used from a subgroup of the first wave of the EveryBODY study, a longitudinal investigation of eating disorders and body image concerns among Australian adolescents (N = 4,030). Participants completed measures on demographics, weight/shape concerns, disordered eating, psychological distress, muscularity concerns, and fear of negative evaluation.

RESULTS

Findings revealed that fear of negative evaluation was associated with higher odds of meeting criteria for any eating disorder but significantly more so for those characterized by weight/shape concerns diagnostically, as well as binge-eating disorder. Similar results were found for muscle dysmorphia.

DISCUSSION

The findings suggest that fear of negative evaluation constitutes a transdiagnostic feature for developing and/or maintaining an eating disorder.

Malaise with praise: A narrative review of 10 years of research on the concept of Fear of Positive Evaluation in social anxiety

Social anxiety is characterized by a fear of being negatively evaluated by others (i.e., Fear of Negative Evaluation [FNE]). In 2008, Weeks, Heimberg, and Rodebaugh proposed Fear of Positive Evaluation (FPE) as a second cognitive component in social anxiety. The article presents an overview of FPE, its psycho-evolutionary theoretical foundation and assessment by the Fear of Positive Evaluation Scale as well as relevant psychometric research on demographic characteristics. The relationship of FPE with a wide range of established dimensions from clinical, personality, and social psychology (i.e., self-esteem, perfectionism, or quality of life) will be reviewed. The role of FPE for psychological comorbidities such as other anxiety disorders, depression, eating, and substance use disorders as well as for treatment of social anxiety will be discussed. Future research might address questions of causality of FPE relative to related constructs, further data on psychometric properties, as well as on its independence from FNE in longitudinal studies. In sum, FPE seems to be a valid and reliable construct that explains cognitions, emotions, and behavior related to social anxiety at subclinical and clinical levels and therefore enriches the psychometric repertoire in the fields of social psychology, personality, and clinical psychology.

Intolerance of uncertainty moderates the relations among religiosity and motives for religion, depression, and social evaluation fears

OBJECTIVES

Intolerance of uncertainty (IU) underlies several psychological disorders, and religion may help some individuals cope with IU and/or protect against psychological symptoms. It was hypothesized that IU would moderate the relations between coping motives for being religious, as well as religiosity, and common psychological disorder symptoms: Depression and social evaluation fears.

METHODS

Study 1 included 473 self-reporting community members (M _age  = 48, 48% female, 80% Protestant/Catholic). Study 2 included 412 self-reporting undergraduates ( M _age  = 19, 71% female, 76% Protestant/Catholic).

RESULTS

For Study 1, coping-based motives related to greater depression for young adults with above-average IU and to lower depression for young adults with below-average IU. For Study 2, religiosity related to lower depression and fear of negative evaluation for individuals with above-average IU and to greater fear of positive evaluation for individuals with below-average IU.

CONCLUSION

IU may be an important mechanism between aspects of religion and psychological disorder symptoms.

Relationship between body mass index, body image, and fear of negative evaluation: Moderating role of self-esteem

This study examined the correlation between body mass index as independent variable, and body image and fear of negative evaluation as dependent variables, as well as the moderating role of self-esteem in these correlations. A total of 318 Malaysian young adults were conveniently recruited to do the self-administered survey on the demographic characteristics body image, fear of negative evaluation, and self-esteem. Partial least squares structural equation modeling was used to test the research hypotheses. The results revealed that body mass index was negatively associated with body image, while no such correlation was found with fear of negative evaluation. Meanwhile, the negative correlation of body mass index with body image was stronger among those with lower self-esteem, while a positive association of body mass index with fear of negative evaluation was significant only among individuals with low self-esteem.

Social Difficulties As Risk and Maintaining Factors in Anorexia Nervosa: A Mixed-Method Investigation

Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients' perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.

[A psychological content of social phobia syndrome]

AIM

To perform a psychological analysis of social phobia syndrome. The subject area of research is the structure of mental activity and behavior in social activity.

MATERIAL AND METHODS

The study included 32 patients with symptoms of social phobia (ICD-10 F40.1) and 29 healthy people (controls). A complex of psychological methods (questionnaires; pathopsychological experiment) was used.

RESULTS AND CONCLUSION

Early maladaptive schemes and a tendency to mental rigidity can be a premorbid basis of the syndrome. Primary violation is in organizational target component by type of distortion of goal-setting regulation. The mechanism is a reduction in the mediation of emotions and behavior (an influence of emotions on the process of activity, excess metacognitive anxiety control leading to multi-task and exhaustion of resources of voluntary activity). Fear of negative evaluation leads to the fact that a wide class of situations is interpreted as threatening. Secondary are changes in the system of goals and motives of activity (technically performing components of social behavior act as a focus of attention, along with the target, the target replaces the suprasituational meaning). Along with a strong motivation to succeed, the motive of avoiding failure is formed, which leads to a decrease in social activity. Tertiary symptoms of syndrome dynamics (ways to cope with maladaptation) are destructive forms of decompensation (substance abuse, learned helplessness and hopelessness, suicidal behavior, etc.), repeatedly reinforcing the primary and secondary disturbances.

The Role of Self-esteem and Fear of Negative Evaluation in Compulsive Buying

Compulsive buying is a relatively new addictive disorder that interferes with everyday functioning and may result in serious psychological and financial problems (1). A very few data are currently available regarding this behavioral addiction. This study investigated gender differences in the relationships between contingent self-esteem (CSE), fear of negative evaluation (FNE), and compulsive buying. Participants included 240 Italian adults (170 females, M age = 33.80) who responded to self-report questionnaires. The results showed that women scored higher on CSE and FNE scales than men. No gender differences were found in compulsive buying tendencies. CSE and FNE were positively related to CB. Furthermore, structural equation modeling confirmed the evidence on CSE as a strong predictor of CB for both genders. Interestingly, FNE seems to play a mediating role between CSE and compulsive buying behaviors only for women. These findings highlight the importance of studying self-esteem in compulsive buying tendencies to inquire more deeply into the underlying mechanisms of some compulsive behaviors.

Implications of fear of negative evaluation, state anxiety, and implied level of target-dominance on perceptions of personality traits

Fear of negative evaluation (FNE), state anxiety (SA), and dominance have consequences for social functioning. The present study assessed how FNE, SA, and a target's dominance-relevant label are related to perceptions of personality. One hundred seventy-eight participants who scored high or low on FNE underwent a laboratory manipulation of SA, viewed a photograph of a target with a high or low dominance-relevant label, and rated the target on the Big Five personality traits and dominance. FNE and SA were unrelated to perceptions, but the high-dominance label was associated with perceptions of higher dominance, conscientiousness, and openness. In conclusion, judges did use information about others when making initial judgments of personality, but these judgments were not impacted by trait or state psychological distress.

Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults

AIMS

The social causation hypothesis suggests that the stress in connection with a depressing social position results in the development of mental disorders. This study examines the psychological mechanisms underlying the link between family socioeconomic status (SES) and social anxiety in Chinese emerging adults.

METHODS

A self-administered questionnaire was given to a representative sample (N = 717) of undergraduate students (17-23 years old) at three universities in China. Correlational and structural equation modeling analyses were employed to test the hypothesized three-path effect of self-esteem and fear of negative evaluation (FNE) as mediators between family SES and social anxiety.

RESULTS

Findings suggest the following: (1) the emerging adults belonging to families with low SES are at an increased risk of social anxiety, and (2) lower family SES caused lower self-esteem, which, in turn, serves to enhance the levels of FNE, thereby increasing social anxiety.

CONCLUSION

In addressing the prevention and treatment of social anxiety, we conclude that preventive efforts toward improving self-esteem may help reduce social anxiety in individuals with low family SES.

Social anxiety in orthognathic patients

There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population.

Thwarted Belongingness Mediates the Relationship between Fear of Negative Evaluation and Suicidal Ideation

Fear of negative evaluation has been documented as a mechanism that explains variations in feelings of belongingness. According to the interpersonal theory of suicide (Joiner, 2005), feelings of thwarted belongingness, that one does not belong, can significantly increase desire and risk for suicide. We proposed that differences in thwarted belongingness may explain variations in suicidal ideation and behavior as a function of levels of fear of negative evaluation. This hypothesis was tested by examining self-reported fears of negative evaluation, thwarted belongingness, and suicidal ideation in 107 young adults, many who were explicitly targeted for recruitment due to a history of suicidal ideation and behavior (13.1% had thoughts about suicide without a previous attempt; 15.9% reported at least one previous attempt [max = 5 attempts]). Mediation analyses were conducted with suicidal ideation entered as the outcome variable. Results indicated that greater fears of negative evaluation were significantly and positively associated with levels of suicidal ideation. Differences in thwarted belongingness fully accounted for the relationship between fears of negative evaluation and suicidal ideation. We conclude with clinical implications and future directions.

Fear of positive evaluation and alcohol use problems among college students: the unique impact of drinking motives

BACKGROUND AND OBJECTIVES

There is strong empirical support that individuals with elevated social anxiety are at risk for alcohol-related impairment. Because social anxiety is a multifaceted construct, it is important to consider which specific facets contribute to alcohol problem vulnerability. For example, although social anxiety has traditionally been conceptualized as a fear of negative evaluation (FNE), emerging data suggest that fear of positive evaluation (FPE) is also an important factor in pathological social anxiety. The current manuscript reports novel findings regarding FPE, alcohol use motives, and reported alcohol use problems.

DESIGN AND METHODS

Participants included undergraduates from two American universities (n = 351) who completed a battery of measures assessing fears of evaluation, drinking motives, and alcohol usage related problems.

RESULTS

FPE significantly predicted alcohol use problems, above and beyond FNE. Also, coping and conformity motives for drinking, but not social or enhancement motives, each uniquely mediated the relationship between FPE and alcohol use problems.

CONCLUSIONS

FPE may be an important cognitive-affective vulnerability factor. With additional clinical research, FPE could serve as a meaningful therapeutic target in interventions designed to decrease problem drinking among highly socially anxious patients.

Replication and extension of a hierarchical model of social anxiety and depression: fear of positive evaluation as a key unique factor in social anxiety

Wang, Hsu, Chiu, and Liang (2012, Journal of Anxiety Disorders, 26, 215-224) recently proposed a hierarchical model of social interaction anxiety and depression to account for both the commonalities and distinctions between these conditions. In the present paper, this model was extended to more broadly encompass the symptoms of social anxiety disorder, and replicated in a large unselected, undergraduate sample (n = 585). Structural equation modeling (SEM) and hierarchical regression analyses were employed. Negative affect and positive affect were conceptualized as general factors shared by social anxiety and depression; fear of negative evaluation (FNE) and disqualification of positive social outcomes were operationalized as specific factors, and fear of positive evaluation (FPE) was operationalized as a factor unique to social anxiety. This extended hierarchical model explicates structural relationships among these factors, in which the higher-level, general factors (i.e., high negative affect and low positive affect) represent vulnerability markers of both social anxiety and depression, and the lower-level factors (i.e., FNE, disqualification of positive social outcomes, and FPE) are the dimensions of specific cognitive features. Results from SEM and hierarchical regression analyses converged in support of the extended model. FPE is further supported as a key symptom that differentiates social anxiety from depression.

Negative Social Evaluative Fears Produce Social Anxiety, Food Intake, and Body Dissatisfaction: Evidence of Similar Mechanisms through Different Pathways

Social anxiety and eating disorders are highly comorbid, suggesting there are shared vulnerabilities that underlie the development of these disorders. Two proposed vulnerabilities are fear of negative evaluation and social appearance anxiety (i.e., fear of negative evaluation regarding one's appearance). In the current experimental study (N=160 women) we measured these fears: (a) through a manipulation comparing fear conditions, (b) with trait fears, and (c) state fears. Results indicated that participants in the fear of negative evaluation condition increased food consumption, whereas participants in the social appearance anxiety condition and high in trait social appearance anxiety experienced the highest amounts of body dissatisfaction. Participants in the fear of evaluation and social appearance anxiety conditions experienced elevated social anxiety. These results support the idea that negative evaluation fears are shared vulnerabilities for eating and social anxiety disorders, but that the way these variables exert their effects may lead to disorder specific behaviors.

Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents

OBJECTIVE

To examine longitudinal bidirectional associations between changes in adolescents' weight status and psychosocial constructs.

METHOD

118 obese adolescents aged 13-16 years participated in a behavioral weight control intervention. Percent overweight (OW), fear of negative evaluation (FNE), and frequency of weight-related teasing (WRT) were collected at baseline, end of intervention, and 12 and 24 months post-randomization. 3 multivariate latent change score models were estimated to examine longitudinal cross-lagged associations between: (1) OW and FNE; (2) OW and WRT; and (3) FNE and WRT.

RESULTS

Decreases in OW were prospectively associated with subsequent decreases in both FNE and WRT; however, changes in FNE and WRT were not prospectively associated with subsequent change in OW. Decreases in FNE were prospectively associated with subsequent decreases in WRT.

CONCLUSION

Moderate weight loss in the context of a behavioral weight control intervention has positive long-term implications for obese adolescents' peer relations.

Fear of negative evaluation modulates electrocortical and behavioral responses when anticipating social evaluative feedback

Cognitive models posit that the fear of negative evaluation (FNE) is a hallmark feature of social anxiety. As such, individuals with high FNE may show biased information processing when faced with social evaluation. The aim of the current study was to examine the neural underpinnings of anticipating and processing social-evaluative feedback, and its correlates with FNE. We used a social judgment paradigm in which female participants (N = 31) were asked to indicate whether they believed to be socially accepted or rejected by their peers. Anticipatory attention was indexed by the stimulus preceding negativity (SPN), while the feedback-related negativity and P3 were used to index the processing of social-evaluative feedback. Results provided evidence of an optimism bias in social peer evaluation, as participants more often predicted to be socially accepted than rejected. Participants with high levels of FNE needed more time to provide their judgments about the social-evaluative outcome. While anticipating social-evaluative feedback, SPN amplitudes were larger for anticipated social acceptance than for social rejection feedback. Interestingly, the SPN during anticipated social acceptance was larger in participants with high levels of FNE. None of the feedback-related brain potentials correlated with the FNE. Together, the results provided evidence of biased information processing in individuals with high levels of FNE when anticipating (rather than processing) social-evaluative feedback. The delayed response times in high FNE individuals were interpreted to reflect augmented vigilance imposed by the upcoming social-evaluative threat. Possibly, the SPN constitutes a neural marker of this vigilance in females with higher FNE levels, particularly when anticipating social acceptance feedback.

Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears

Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with disordered eating. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation, and social appearance anxiety. Results indicated that social appearance anxiety predicted body dissatisfaction, bulimic symptoms, shape concern, weight concern, and eating concern over and above fear of scrutiny, social interaction anxiety, and fear of positive evaluation. Fear of negative evaluation uniquely predicted drive for thinness and restraint. Structural equation modeling supported a model in which social appearance anxiety and fear of negative evaluation are vulnerabilities for both social anxiety and eating disorder symptoms. Interventions that target these negative social evaluation fears may help prevent development of eating disorders.

Deductive Reasoning and Social Anxiety: Evidence for a Fear-confirming Belief Bias

This study investigated the relationship between belief bias and fear of negative evaluation. Belief bias refers to a bias in deductive reasoning that acts to confirm rather than falsify prior beliefs. Participants (N = 52) with varying levels of fear of negative evaluation completed a belief bias task by means of linear syllogisms, with stimuli covering both social anxiety convictions and factual neutral statements. A linear relationship was found between fear of negative evaluation and belief bias for the social anxiety conviction category. No differences in reasoning were found for the neutral syllogisms. These results support the view that highly socially anxious individuals do not have a reasoning abnormality, but do have difficulty judging anxiogenic information as false and reassuring convictions-contradicting information as true. Such belief bias logically prevents dysfunctional cognitions from being corrected, thereby sustaining phobic fear.