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

The Brief Fear of Negative Evaluation Scale [BFNE; Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375] is a self-report measure designed to assess fear of negative evaluation, a characteristic feature of social anxiety disorders [Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756]. Recent psychometric assessments have suggested that a 2-factor model is most appropriate, with the first factor comprising the straightforwardly worded items and the second factor comprising the reverse-worded items [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]. Some researchers recommend the reverse-worded items be removed from scoring [e.g., Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]; however [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the fear of negative evaluation scale. Journal of Anxiety Disorders, 19, 345-359] recommend that these items be reworded to maintain scale sensitivity. The present study examined the reliability and validity of the BFNE-II, a version of the BFNE evaluating revisions of the reverse-worded items in a community sample. A unitary model of the BFNE-II resulted in excellent confirmatory factor analysis fit indices. Moderate convergent and discriminant validity were found when BFNE-II items were correlated with additional independent measures of social anxiety [i.e., Social Interaction Anxiety & Social Phobia Scales; Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], and fear [i.e., Anxiety Sensitivity Index; Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss, R. R. Bootzin (Eds.), Theoretical issues in behaviour therapy (pp. 107--121). New York: Academic Press. and the Illness/Injury Sensitivity Index; Carleton, R. N., Park, I., & Asmundson, G. J. G. (in press-b). The Illness/Injury Sensitivity Index: an examination of construct validity. Depression & Anxiety). These findings support the utility of the revised items and the validity of the BFNE-II as a measure of the fear of negative evaluation. Implications and future research directions are discussed.     

Brief fear of negative evaluation scale-revised

Rodebaugh et al. [2004: Psychol Assess 2:169-181] recently performed a confirmatory factor analysis (CFA) on the Brief Fear of Negative Evaluation scale (BFNE; Leary, 1983: Psychol Bull 9:371-375]. Their study resulted in the emergence of a two-factor solution comprising straightforwardly worded items and reverse-worded items. They concluded by recommending use of only the straightforwardly worded items in the BFNE. Our intent in this study was to evaluate this recommendation through replication and extension. Participants included 385 undergraduates from the Universities of Regina and Houston, who provided responses to a questionnaire battery including either the BFNE or a revision utilizing straightforwardly worded versions of the reverse-worded items (BFNE-II). A CFA of the BFNE, using the two-factor model proposed by Rodebaugh et al., supported their conclusion that the reverse-worded items comprise a separate, methodologically based factor. However, CFA of the BFNE-II resulted in an acceptable unitary model that conforms to the theoretical basis for the BFNE, without risking loss of sensitivity from item removal. Additional analyses suggest use of the BFNE-II rather than a shortened form.     

Stereotype confirmation concern and fear of negative evaluation among African Americans and Caucasians with Social Anxiety Disorder

Fear of negative evaluation is a central component of social anxiety. The current study examines the relation between fear of negative evaluation and fears of confirming stereotypes about social groups to which one belongs among people diagnosed with social anxiety disorder. Participants (N = 94) with a primary diagnosis of social anxiety disorder who self-identified as either African American (n = 41) or Caucasian (n = 53) completed standardized self-report measures of stereotype confirmation concerns and fear of negative evaluation. Results from hierarchical logistical regression showed that stereotype confirmation concerns predicted fear of negative evaluation for both racial groups, with greater concern predicting greater fear. This association was moderated by race, B = −.24, t = −2.67, p < .01, such that stereotype confirmation concerns had a stronger association with fear of negative evaluation for Caucasians (b = .38, p < .01) than for African Americans (b = .14, p < .05). This study is the first to directly examine the relation between stereotypes and fear of negative evaluation within a socially anxious sample. Although we cannot identify the specific social group to which each participant's stereotype confirmation concerns apply, this study provides quantitative evidence that the social context within which socially anxious individuals view themselves impacts their fear of negative evaluation and highlights the need for further research in this area.     

Treatment sensitivity of implicit threat evaluation, avoidance tendency and visual working memory bias in specific phobia

Cognitive theories of anxiety postulate that negative processing biases play a causal role in the pathogenesis of a disorder, while a normalisation of bias drives recovery. To test these assumptions it is essential to investigate whether biases seen in anxiety are treatment-sensitive, or whether they instead represent enduring vulnerability factors. Twenty-nine spider fearfuls were tested before and after brief cognitive-behaviour therapy (CBT), with half of them additionally being tested before a waiting period to control for retest effects. Using three cognitive bias tasks, we measured implicit threat evaluation (Extrinsic Affective Simon Task), avoidance tendency (Approach-Avoidance Task), and working memory for threat. CBT significantly enhanced negative implicit evaluation and avoidance. This indicates that these cognitive biases are no stable risk factors and provides further evidence for their potential key role in the development and remission of anxiety.     

Social phobia and clonazepam

Five patients meeting the DSM-III-R criteria for social phobia, without any other psychiatric diagnosis, were treated with clonazepam, a high potency benzodiazepine. All patients improved markedly within four weeks. By the end of the eighth week of treatment, a marked improvement of their symptoms was reported. The adverse effects were minimal at an average dose of 3 mg per day. The authors suggest that clonazepam is a safe and effective medication in the treatment of social phobia. Moreover, clonazepam is easier to use as compared to other drugs which are used (atenolol, phenelzine, alprazolam).     

Social fear and social phobia types among community youth: Differential clinical features and vulnerability factors

Objective

To compare different social fears and social phobia subtypes with regard to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability factors (behavioural inhibition (BI), parental psychopathology and parental rearing) among community youth.

Methods

Fears of 6 social situations and Social Phobia (SP), along with their clinical features, were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N = 3021 14-24 year olds that were followed up for 10 years. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings’ family history reports.

Results

In the total sample, 20.0%, 11.6%, 11.7% reported fear of 1, 2, 3 or more social situations, respectively; rates were 24.2%, 18.7%, and 57.1% in SP-cases (6.6% of the total sample). Exploring the factorial structure indicated rather unidimensionality of social fears than mutual distinction of social fears by interaction vs. performance situations. Except for fear of taking tests and public speaking, social fears rarely occurred in isolation. Social fears of both interaction and performance situations were associated with severe avoidance (vs. fear of either situation; Odds Ratios, OR = 1.5, 95%CI: 1.1-1.9) and impairment (OR = 3.6, 95%CI: 2.6-4.9), and more comorbid anxiety and depressive disorders (OR range 3.2-5.8, p > .001). Fear of interaction situations was associated with higher BI (vs. performance-related fears, OR range 1.2-2.1, p < .05). Associations with parental psychopathology and unfavourable parental rearing were less consistent, albeit stronger for fear of interaction situations (vs. performance-related fears). Interactions with time indicated an earlier onset of SP for higher BI, but not for parental psychopathology or unfavourable parental rearing.

Conclusions

Interaction-related social fears differ in their clinical and vulnerability factors from performance-related social fears. The current DSM-IV specifier of “generalized” SP may fall short of adequately denoting these differences. Fear of taking tests appears to be conceptually and, possibly, etiologically distinct from other social fears, and may be better placed in another category (e.g., as a type of specific phobia).     

Social phobia: biological aspects and pharmacotherapy.

1. Social phobia is one of the anxiety disorders that until recently, had not been thoroughly investigated. 2. Social phobia is a relatively common anxiety disorder that appears to have a genetic basis. 3. There are certain physiological aspects of social phobia that separate it from the other anxiety disorders. 4. Support for a dopaminergic abnormality related to social phobia is supported by investigation studies and pharmacotherapy. 5. There are a number of studies reporting success in the treatment of social phobia with medications.     

Perfectionism and perceived stress: The role of fear of negative evaluation

Perfectionism is a multidimensional construct, with adaptive and maladaptive dimensions. Various studies have been conducted to explore the phenomenon of perfectionism. Perfectionism has been allied to achieve impossibly high standards, illogical significance on the achievement of these standards and overgeneralize failures. Researchers focused on how perfectionism leads to various psychological maladjustments. Building upon past research about perfectionism and perceived stress among students, this study tested a model of the association between each aspect of perfectionism (i.e., adaptive and maladaptive) and perceived stress mediating by fear of negative evaluation. From data obtained from a sample of undergraduate and postgraduate students from Rawalpindi and Islamabad institutions (N?=?300), it has been found that maladaptive perfectionism is significantly related to perceived stress and fear of negative evaluation. Mediation tests revealed that fear of negative evaluation accounts for mediating the direct relationship between maladaptive perfectionism and perceived stress. No complementary associations are shown by adaptive perfectionism with fear of negative evaluation and perceived stress. This study indicated that maladaptive perfectionists are exposed to more stress by taking the fear of negative evaluation. The current study will highlight directions for future research and implications for reducing the fear of negative evaluation of perfectionists, which is one of the main causes of psychological distress.     

Social phobia: etiology, neurobiology, and treatment

Social phobia is a common and often disabling condition, with an etiology that is not established. There is evidence at several levels for an interplay of biological and psychological processes in social phobia. Genetic studies show that both genetic and environmental factors are important, with evidence pointing to associations with 2 genetic conditions, autism and fragile X syndrome. Behavioral inhibition has emerged as an important precursor to social phobia and possibly to other anxiety disorders. Epidemiologic and clinical studies have suggested that factors within the family environment, such as overprotection, overcontrol, modeling of anxiety, criticism, and in some cases abuse, can play a role in the development of social phobia. During childhood, complex interactions between brain system disturbances that mediate responses to negative social cues and factors in the social setting may lead to the development of a distorted set of internal "blueprints" for social behavior. The impact of severe social anxiety on brain systems that mediate behavioral change may prevent patients from learning better "blueprints." These can be taught through cognitive-behavioral therapies. The effective control of social anxiety with medications enables patients to recover; whether recovery can last after discontinuation of medications may depend on whether a new "blueprint" has been developed and whether stable changes in affected brain systems have occurred. Neuroimaging techniques are at the early stage of identifying abnormalities at the neurotransmitter and systems levels.     

Approach and avoidance in fear of spiders

We examined attitudes towards spiders by employing an Approach-Avoidance Task, in which participants respond to pictures by pulling a joystick towards themselves or by pushing it away from themselves. For spider fearfuls, this stimulus-response assignment is either compatible (push spiders away) or incompatible (pull spiders closer). Specific compatibility effects were found: compared to non-anxious controls and control pictures, highly spider fearful participants responded to spider pictures more quickly by pushing than by pulling, even when picture contents was task-irrelevant. Moreover, compatibility effects predicted fear-related behavior independently of questionnaires. Potential applications, extensions, and limitations of the findings are discussed.     

Social phobia symptoms: prevalence, sociodemographic correlates, and overlap with specific phobia symptoms

BACKGROUND: Social phobia (SP) is a highly prevalent disorder in Western countries, but is rather rare in Eastern societies. Prevalence rates range from 0.5% in Eastern samples up to 16% in Western studies. Its prevalence in Israel, an Asian state characterized by Western culture, has not yet been studied. The present study aimed to assess the prevalence of SP symptoms in a nonclinical sample of Israeli adolescents, to characterize sociodemographic correlates of SP symptoms and to evaluate comorbidity with specific phobia symptoms. METHODS: Participants included 850 young soldiers from the Israel Defense Forces. Measures included the Liebowitz Social Anxiety Scale (LSAS; self-report version), a questionnaire on specific fears and phobias, and a sociodemographic questionnaire. Clinical and demographic correlates of SP were also examined. RESULTS: Probable SP (LSAS >or=80) was present in 4.5% of the sample. Overall, SP symptoms were reported by a great percentage of the subjects, as displayed by the rather high mean LSAS scores (29; SD = 23.79) in this nonclinical sample. The following variables were accompanied by higher LSAS scores according to our regression model: inability to perform command activities, receiving psychotropic medication before army service, having less than two friends, shy family members, and treatment during military service. Subjects with probable SP had a rate of comorbidity with specific phobia symptoms of 44%. CONCLUSIONS: Our findings corroborate those from other studies in Western countries, both regarding the high prevalence of SP symptoms and its demographic and clinical correlates, as well as regarding the high overlap rate with specific phobia symptoms.     

Social phobia and selective mutism

Social phobia (SOP) and selective mutism (SM) are related anxiety disorders characterized by distress and dysfunction in social situations. SOP typically onsets in adolescence and affects about 8% of the general population, whereas SM onsets before age 5 and is prevalent in up to 2% of youth. Prognosis includes a chronic course that confers risk for other disorders or ongoing social disability, but more favorable outcomes may be associated with young age and low symptom severity. SOP treatments are relatively more established, whereas dissemination of promising and innovative SM-treatment strategies is needed.     

Brain morphology,harm avoidance,and the severity of excessive internet use

As the previous studies have mainly focused on the reward system and the corresponding brain regions, the relationship between brain morphology and excessive internet use (EIU) were not clear; the purpose of the study was to investigate if the brain regions other than the reward system were associated with EIU. Data were acquired from 131 excessive internet users. Psychological measures included internet use, life quality, personality, mental illness symptoms, impulsivity, and thought suppression. The brain was scanned with 3T magnetic resonance imaging (MRI) and six types of brain morphological indexes were calculated. Lasso regression methods were used to select the predictors. Stepwise linear regression methods were used to build the models and verify the model. The variables remaining in the model were left precentral (curve), left superior temporal (surface area), right cuneus (folding index), right rostral anterior cingulate (folding index), and harm avoidance. The independent variable was the EIU score of the worst week in the past year. The study found that the brain morphological indexes other than the reward system, including the left precentral (curve), the left superior temporal (surface area), the right cuneus (folding index), and the right rostral anterior cingulate (folding index), can predict the severity of EIU, suggesting an extensive change in the brain. In this study, a whole‐brain data analysis was conducted and it was concluded that the changes in certain brain regions were more predictive than the reward system and psychological measures or more important for EIU.     

Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: a prospective longitudinal study

Background: This study is aimed to evaluate the role of two vulnerability factors, health anxiety and fear of fear, in the prediction of the onset of panic disorder/agoraphobia (PDA) relative to a comparison anxiety disorder. Methods: Young women, aged between 18 and 24 years, were investigated at baseline and, 17 months later, using the Anxiety Disorders Interview Schedule‐Lifetime and measures of health anxiety and fear of bodily sensations (subscale disease phobia of the Whiteley Index, and total score of the Body Sensations Questionnaire). First, 22 women with current PDA were compared to 81 women with current social phobia and 1,283 controls. Second, 24 women with an incidence of PDA were compared to 60 women with an incidence of social phobia and 1,036 controls. Results: Multiple logistic regression analyses adjusted for history of physical diseases, somatic symptoms, and other psychological disorders revealed that (a) fear of bodily sensations was elevated for women with PDA vs. controls as well as women with social phobia, and (b) health anxiety (and history of physical diseases) was elevated in women who developed PDA vs. controls and vs. women who developed social phobia. Conclusions: These results suggest that health anxiety, as well as history of physical diseases, may be specific vulnerability factors for the onset of PDA relative to social phobia. Whereas fear of bodily sensations was not found to be a risk factor for the onset of panic disorder/agoraphobia, it was a specific marker of existing PDA relative to social phobia. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

The fear behind the fear: A case study of apparent simple injection phobia

The interrelations of multiple phobias are illustrated in the case of a female student whose presenting complaint of injection phobia did not at first appear to be related to her other fears. The rapid amelioration of her presenting complaint (sustained at three-month and eight-month follow-up) followed the discovery of functional relationships between these fears. The implications of the case with respect to Lang's (Anxiety and the Anxiety Disorders, 1985) work on the cognitive psychophysiology of emotion, and the investigations of McNeil and Berryman (Behavior Research Therapy 27, 233–236, 1989) and Rachman and Lopatka (Behavior Research Therapy 24, 653–660, 1986; Behavior Research Therapy 24, 661–664, 1986) are discussed.     

Social phobia. Review of a neglected anxiety disorder

While other anxiety disorders have recently become the subjects of increasing investigation, social phobia remains, except among behavior therapists, relatively unstudied. As a result, major uncertainties exist concerning classification, prevalence, severity, etiology, assessment, and treatment of social phobia. Existing findings do suggest that in its own right and as a comparison for other anxiety disorders, social phobia should prove a fertile area for psychobiological and clinical investigation.     

Social phobia. Comorbidity and morbidity in an epidemiologic sample.

Selected sociodemographic and clinical features of social phobia were assessed in four US communities among more than 13,000 adults from the Epidemiologic Catchment Area study. Rates of social phobia were highest among women and persons who were younger (age, 18 to 29 years), less educated, single, and of lower socioeconomic class. Mean age at onset was 15.5 years, and first onsets after the age of 25 years were uncommon. Lifetime major comorbid disorders were present in 69% of subjects with social phobia and usually had onset after social phobia. When compared with persons with no psychiatric disorder, uncomplicated social phobia was associated with increased rates of suicidal ideation, financial dependency, and having sought medical treatment, but was not associated with higher rates of having made a suicide attempt or having sought treatment from a mental health professional. An increase in suicide attempts was found among subjects with social phobia overall, but this increase was mainly attributable to comorbid cases. Social phobia, in the absence of comorbidity, was associated with distress and impairment, yet was rarely treated by mental health professionals. The findings are compared and contrasted with prior reports from clinical samples.     

Social phobia and perceived friendship quality

Although it is clear that people with social phobia have interpersonal impairment, evidence that social phobia (as opposed to other mental disorders) affects friendship in particular is lacking. Two large epidemiological datasets were used to test whether diagnosis of social phobia is related to perceived friendship quality above and beyond perceived family relationship quality, diagnosis of other mental disorders, and a variety of demographic variables. After Bonferroni correction, social phobia was the only diagnosis related to perceived friendship quality above and beyond other factors, such that people with social phobia reported more impaired friendship quality. Social phobia's effect was similar in magnitude to demographic characteristics in both samples. The current study demonstrates that social phobia is specifically related to perceived friendship quality, suggesting that this aspect of social phobia's effects is worthy of further study.     

Social phobia in children and adolescents

Epidemiological data indicate that anxiety disorders are the most common childhood disorders. 1% of children and adolescents suffer from social phobia and it may influence further adult life. The aim of the article is to show differences of child and adolescent social phobia and its diagnostic criteria. Contrast and distinction of childhood social phobia symptoms are also shown, such as risk factors of appearance of childhood social phobia. The article presents main therapeutic methods--psychotherapy and pharmacotherapy applied to children with phobia and difficulties with estimating efficacy of the particular therapy in this group of patients. Phobic children perceive surroundings more negatively. They have reduced estimations of their own competency to cope with danger. They also show cognitive impairments of ambiguous situations. As much as 60% children with social phobia suffer from a second, concurrent disorder. Widening of information about symptoms and therapeutic methods may reduce the intensity of the disorder during adulthood.